Utilidad de la sangre seca del talón (tarjeta de Guthrie) en el diagnóstico de infección congénita por enterovirus / Use of dried blood from the heel (Guthrie card) in the diagnosis of congenital enterovirus infection

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Neonatal nonpolio enterovirus and parechovirus infections.

Nonpolio enteroviruses and parechoviruses are frequent causes of neonatal infection. Clinical manifestations of infection range from asymptomatic infection to mild infection without sequelae to septic shock with muiltiorgan failure. Neonates with clinically apparent infection typically have mothers and/or other contacts with recent symptoms consistent with a viral illness. Severe neonatal infection with nonpolio enterovirus or parechovirus cannot be differentiated clinically from serious bacterial infection. The preferred method for diagnosing neonatal nonpolio enterovirus or parechovirus infection is PCR as it is rapid, sensitive, specific, and commercially available for the detection of virus from various clinical specimens. Investigational agents such as the capsid inhibitors pleconaril and pocapavir show promise for treatment of neonatal enterovirus infections, and other investigational agents are being developed. This review focuses on the epidemiology, diagnosis, and treatment of neonatal nonpolio enterovirus and parechovirus infections.

Congenital cytomegalovirus, parvovirus and enterovirus infection in Mozambican newborns at birth: A cross-sectional survey.

BACKGROUND: Congenital cytomegalovirus (cCMV) infection is the most prevalent congenital infection acquired worldwide, with higher incidence in developing countries and among HIV-exposed children. Less is known regarding vertical transmission of parvovirus B19 (B19V) and enterovirus (EV). We aimed to assess the prevalence of CMV, B19V and EV vertical transmission and compare results of screening of congenital CMV obtained from two different specimens in a semirural Mozambican maternity. METHODS: A cross sectional study was conducted among pregnant mothers attending Manhiça District Hospital upon delivery. Information on maternal risk factors was ascertained. Dried umbilical cord (DUC) samples were collected in filter paper for CMV, B19V and EV detection by real-time polymerase chain reaction (RT-PCR), and nasopharyngeal aspirates (NPA) to test for CMV by RT-PCR. Maternal blood samples and placental biopsy samples were also obtained to investigate CMV maternal serology, HIV status and immunopathology. RESULTS: From September 2014 to January 2015, 118 mothers/newborn pairs were recruited. Prevalence of maternal HIV infection was 31.4% (37/118). CMV RT-PCR was positive in 3/115 (2.6%) of DUC samples and in 3/96 (6.3%) of NPA samples obtained from neonates. The concordance of the RT-PCR assay through DUC with their correspondent NPA sample was moderate (Kappa = 0.42 and p<0.001. No differences on cCMV prevalence were found among HIV-exposed and unexposed. All (100%) mothers were seropositive for CMV IgG. RT-PCR of EV and B19V in DUC were both negative in all screened cases. No histological specific findings were found in placental tissues. No risk factors associated to vertical transmission of these viral infections were found. CONCLUSIONS: This study indicates the significant occurrence of vertical transmission of CMV in southern Mozambique. Larger studies are needed to evaluate the true burden, clinical relevance and consequences of congenital infections with such pathogens in resource-constrained settings.

Congenital coxsackievirus B5 infection: report of one case.

In infants and children, enterovirus (EV) infections are very common. In neonates, EV infections may lead to fatal myocarditis, encephalitis, or necrotizing hepatitis. Transplacental viremia before delivery is possible but has only been demonstrated occasionally. The presence or absence of passively acquired maternal antibody specific for the infecting EV serotype plays the most important role in neonatal EV infections. We report a fatal case of congenital coxsackievirus B5 infection, confirmed by culture of the virus from the patient's throat and rectal swab and from his mother's throat. The mother had suffered from fever for 1 week since 9 days before delivery. Fever subsided 2 days before the day of delivery, but absence of fetal movements was noted. The newborn's 4-year-old elder sister also had suffered from fever with upper respiratory symptoms during the same period. Fever occurred in this baby immediately after birth by cesarean section, suggesting the presence of transplacental virus transmission.

[Significance of congenital mixed viral infection in the pathogenesis of retinopathy of prematurity]. / Znachenie vrozhdennoi smeshannoi virusnoi infektsii v patogeneze retinopatii nedonoshennykh.

Forty-three infants aged 1-5 months with somatic and neurological diseases, including congenital, 18 of these with retrolental fibroplasia (RF) and 25 without RF were examined. Control group consisted of 36 age-matched infants. Based on identification of viral antigens in urine precipitate cells, mixed viral infection was diagnosed in 100% patients and 16.6% healthy babies. Ophthalmotropic ECHO 11 and 19 viruses were detected in 100% patients with RF, 28% patients without RF, and 10% healthy babies, while rubella virus was identified in 83.3, 60, and 8.3%, respectively. The viruses were detected only in association with other enteroviruses: Coxsakie A, B, and entero 69-71. These viruses detected in infants with RF were as a rule present in their mothers. Maternal anamnesis was in all cases aggravated by high risk indicators of vertical transfer of toxigenic enteroviruses to the fetus. The results indicate that congenital mixed viral infection (association of ophthalmotropic ECHO and rubella viruses with toxigenic Coxsakie and entero 69-71 viruses) is involved in the pathogenesis of RF.

Congenital enterovirus 71 infection: a case study with virology and immunohistochemistry.

Previously reported enterovirus 71 (EV71) infections associated with hand-foot-mouth disease, aseptic meningitis, encephalitis, polio-like myelitis, and paralysis all have involved young children. We report a 28-year-old woman who possibly contracted EV71 infection during pregnancy. Obstetric ultrasonograms at 25 weeks of gestation revealed an abnormal placenta, as well as hepatosplenomegaly, liver calcification, excessive ascites, and mild hydrocephalus of the fetus. Presence of EV71 was determined by immunodot blotting, virus culture, and partial sequencing of the amplified product of nested reverse transcription-polymerase chain reaction. Postmortem immunohistochemistry further identified EV71 in the fetal midbrain and liver. The findings indicate that intrauterine EV71 infection is possible during pregnancy.

[The importance of the vertical transmission of enteroviruses in the epidemiology of congenital viral infections]. / Znachenie vertikal'noi peredachi énterovirusov v épidemiologii vrozhdennykh virusnykh infektsii.

A total of 814 newborns were examined using a highly sensitive method of indication of viral antigens. A high incidence of congenital viral infection was revealed: 450 per 1000 live-born children. Enteroviral infections (mainly Coxsackie) ranked first in prevalence. These infections in the newborns are mainly caused by the vertical transmission of enteroviruses from mothers with persistent forms of infections. Virtually all the other viruses (influenza viruses, cytomegalovirus, herpes simplex virus, parainfluenza, measles, and rubella viruses) are detected in the newborns included in the group at a high risk of vertical transmissions of enteroviral infections. In the majority of cases the said viruses were detected in association with enteroviruses.

Enterovirus isolation from foetal and placental tissues.

Four spontaneous abortions and two stillbirth occurred during a prospective survey following the teratogenicity of echoviruses in 80 pregnant women selected at random from the Antenatal Care Service. Echovirus types 19, 27, and 33. Coxsackie B2 and B6 were isolated from placental and foetal tissues (brain, liver, kidney, heart, and spleen). The mothers also excreted the virus by faeces at least twenty days before abortion and responded serologically, indicating active virus infection. Almost all aborted children were anomalous with signs of viral infection.

The arginine-stimulated insulin response is impaired in congenital duck hepatitis B virus infection.

Duck hepatitis B virus (DHBV) infects both A (glucagon-containing) and B (insulin-containing) islet cells. To examine the effect of this infection on islet cell function, baseline and secretagogue-augmented plasma insulin and glucagon levels as well as the pancreatic content of insulin and glucagon were compared in congenitally DHBV- and noninfected ducks. No difference in baseline plasma levels or the pancreatic content of insulin or glucagon was detected. However, the magnitude of the second phase of the biphasic arginine-stimulated insulin response was markedly diminished in infected ducks.

Perinatal viral infections.

In comparison to older children and adults, neonates are immunologically incompetent. They are susceptible to infections caused by a variety of microorganisms, including bacteria, fungi and viruses. These infectious agents may be acquired by neonates either prenatally, during the intrapartum period or postnatally. The purpose of this review is to emphasize the potential impact of viral infections contracted by neonates at the time of delivery or within the neonatal period. The viruses reviewed include the herpes group of viruses (cytomegalovirus, herpes simplex viruses and varicella-zoster virus), type B hepatitis virus, human immunodeficiency virus, respiratory viruses, enteroviruses, rotavirus and human papilloma virus. For each virus the potential sources and incidence of the infection, the common manifestations of the illness, and possible means of prevention and therapy are discussed. Although infections caused by bacteria tend to be more clinically dramatic and more immediately life-threatening, it is emphasized that infections caused by viruses are common and associated with substantial long-term morbidity. Perinatal viral infections need to be recognized as early in life as possible so that their natural history can be more completely defined and any possible intervention made.

Epidemiology of neonatal enterovirus infection.

During a typical enterovirus season in Rochester, New York, none of 666 neonates or 629 mothers were found to be excreting nonpolio enteroviruses within 1 day of delivery. No enteroviruses were isolated from weekly cultures of the 23 infants who died or remained hospitalized during the first month of life. After discharge, culture specimens were obtained in 586 infants at one to four weekly home visits until 1 month of age. The incidence of acquisition of nonpolio enterovirus infection was 12.8%, and the overall prevalence of enterovirus excretion was 5.3%. Risk of virus infection was associated only with lower socioeconomic status (P less than 0.0001) and lack of breast-feeding (P less than 0.0001). Four percent of all infants and 21% of infants in whom cultures for enterovirus were positive were readmitted to the hospital in the first month of life; 79% of infants with positive enterovirus cultures were asymptomatic. We conclude that enterovirus infection during the first month of life is very common in the late summer and early fall. Most infants are asymptomatic, but the risk of hospitalization is high. Breast-feeding may be associated with protection from infection.