November 1, 2007


EIN Reports Cases of Severe Neonatal Enteroviral Disease


In mid-October, a member of the Emerging Infections Network (EIN) reported a recent increase in severe enteroviral infections, identified as Coxsackie B viruses, in newborn infants in the Los Angeles metropolitan area.

The member wrote, “All presented in the first week of life. Meningitis, myocarditis, disseminated intravascular coagulation (DIC), and hepatitis were seen alone or in combination. There were two deaths from myocarditis. Three infants with myocarditis still have poor cardiac function.” The member asked if others were seeing similar cases.

Two EIN members in California, two in New Jersey, one in Alaska, and one in Illinois reported similar cases of neonatal enterovirus infection. Cases presented with meningitis, hepatitis, myocarditis, DIC, or a combination. Two cases were fatal; a few had persistent heart complications. Several cases were not severe and the infants made full recoveries. A member in Michigan reported a mild enterovirus season overall.

Enterovirus was identified from cultures of stool, urine, cerebrospinal fluid (CSF), or nasopharynx; or by PCR of CSF. In some patients virus was identified in one sample and not another. Two cases were classified as Coxsackie B1 virus; the others were not classified.

Some members mentioned the unavailability of pleconaril, a novel antiviral against enteroviruses and rhinoviruses that has had a rocky history in clinical trials. One asked about the status of this drug.

A member in Alabama responded, “The NIAID Collaborative Antiviral Study Group (CASG) has an ongoing controlled trial of pleconaril in babies with neonatal enteroviral sepsis syndrome. It is a Phase II study with virologic endpoints, and to our knowledge is the only way to gain access to systemic pleconaril. Due to the time required to establish all regulatory and contractual arrangements with new sites, it can be challenging to bring new sites online after an enterovirus baby is identified. Arrangements can sometimes be made to transport a patient to a study site, though, and in addition consideration can be given to adding new sites prior to the time an enterovirus patient is identified. Further information on the study can be found at http://www.casg.uab.edu/.”

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