title: Neonatal Type I diabetes associated with maternal echovirus 6 infection: a case report.
abstract: OBJECTIVE
  Neonatal diabetes mellitus is rare, and it has not been associated with beta-cell autoimmunity. Enteroviral infections during pregnancy have been implicated as a risk factor for the later development of Type I (insulin-dependent) diabetes mellitus. We now report of a baby girl who was born severely growth-retarded with neonatal insulin-deficient diabetes, and look for evidence of intrauterine enteroviral infections and beta-cell targeted autoimmunity.
  
  
  METHODS
  Diabetes-associated autoimmunity was studied by measurement of several types of islet cell reactive autoantibodies. The infant's T-cell responses to insulin and enterovirus antigens were recorded and enterovirus antibodies were measured both from the mother and the child.
  
  
  RESULTS
  Several types of diabetes-associated autoantibodies were detected postnatally, including insulin autoantibodies, conventional islet cell autoantibodies and glutamic acid decarboxylase antibodies, whereas no autoantibodies were observed in the mother. The infant's T-cells showed reactivity to insulin and purified enterovirus particles. Based on serological studies, the pathogenetic process could have been triggered by an echovirus 6 infection during pregnancy. The patient's diabetes has been permanent, although there were signs of endogenous insulin production for several months. Exocrine pancreatic insufficiency was diagnosed at the age of 1 year.
  
  
  CONCLUSIONS
  These observations suggests that enteroviral infections may induce beta-cell autoimmunity even in utero.
authors.affiliation: Hospital for Children and Adolescents and Haartman Institute, Transplantation Laboratory, University of Helsinki, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Otonkoski
authors.forename: M
authors.initials: M
authors.lastname: Roivainen
authors.forename: O
authors.initials: O
authors.lastname: Vaarala
authors.forename: B
authors.initials: B
authors.lastname: Dinesen
authors.forename: J A
authors.initials: JA
authors.lastname: Leipälä
authors.forename: T
authors.initials: T
authors.lastname: Hovi
authors.forename: M
authors.initials: M
authors.lastname: Knip
mesh_terms: D015551:Autoimmunity; D003922:Diabetes Mellitus, Type 1 / Q000276:immunology / Q000821:virology*; D004458:Echovirus 6, Human; D004457:Echovirus Infections / Q000276:immunology / Q000635:transmission; D005260:Female; D005759:Gastroenteritis / Q000150:complications / Q000821:virology; D005968:Glutamate Decarboxylase / Q000276:immunology; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007328:Insulin / Q000276:immunology; D007515:Islets of Langerhans / Q000276:immunology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology
chemical_list: D007328:Insulin; D005968:Glutamate Decarboxylase