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Abstract
During summer and fall months (from June to November), enteroviral infection is more common than group B streptococcal infection or herpes simplex viral infection in neonates. Enteroviruses are divided into polioviruses, coxsackieviruses A, coxsackieviruses B, and echoviruses. Enteroviruses can cause a wide spectrum of acute illnesses ranging from non-specific febrile illness, upper respiratory tract infection or gastroenteritis, to severe diseases such as myocarditis, and encephalitis. Coxsackieviruses B are important neonatal pathogens, which can cause meningoencephalitis, disseminated intravascular coagulopathy, and cardiomyopathy. Transplacental transmission of coxsackievirus or perinatal transmission by inhalation or swallowing of cervical secretion or feces during delivery causes more severe diseases than postnatal transmission by horizontal transmission in nursery or neonatal intensive care unit, due to larger load of viruses. Four preterm infants had severe coxsackieviral B infection with thrombocytopenia, meningitis, disseminated intravascular coagulopathy, and myocarditis within seven days of age during this June. Coxsackieviruses B were detected from their feces, cerebrospinal fluid, and blood. Viruses might be transmitted prenatally through placenta from mother to fetus, which caused severe disease. Coxsackieviruses B infections have to be considered in the neonates with sepsis-like illness during summer and fall months, or enteroviral seasons.
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Fig. 1
(A) Chest radiograph of case 2 at postnatal day 7 shows general pulmonary edema with cardiomegaly, cardiothoracic ratio is 0.65. (B) Chest radiograph of case 2 at postnatal day 15 shows improved pulmonary edema and cardiomegaly after treatment.
Fig. 2
(A) Axial T2-weighted magnetic resonance (MR) image and (A) Gradient echo (GRE) MR image show band-like structures of low signal intensity lining dependant portion of lateral ventricles (arrows). These findings are consistent with old intraventricular hemorrhage.
Fig. 3
(A) Chest radiograph of case 4 at postnatal day 12 shows general pulmonary edema with cardiomegaly, cardiothoracic ratio is 0.6. (B) Chest radiograph of case 4 at postnatal day 20 shows improved pulmonary edema and cardiomegaly after treatment.
Table 1.
Clinical Characteristics
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