title: Pitfalls in the diagnosis of enteroviral infection in young children.
abstract: BACKGROUND
  Three infants with enteroviral infections were admitted to a neonatal intensive care unit (NICU). Investigation into the possible nosocomial spread of enterovirus identified 31 other infected infants. Only 1 of the 31 was truly positive; 30 were false-positive results.
  
  
  METHODS
  This was a retrospective observational study. Investigational laboratory studies were conducted to identify problems in diagnostic procedures.
  
  
  RESULTS
  Stool cultures were used to identify asymptomatic infections. Investigation identified several problems in the procedures in identification of enterovirus: (1) stool specimens were not properly filtered, (2) insufficient number of tissue culture cell types were used, (3) nonspecific toxicity due to stool and the presence of Clostridia difficile toxin was responsible for cytopathic effects in tissue culture, (4) the failure to block nonspecific fluorescent staining led to misidentification of enteroviruses.
  
  
  CONCLUSIONS
  The use of stool cultures to identify asymptomatic enteroviral infections in infants in an NICU can be fraught with problems because of high frequency of C. difficile toxin and the nonspecific toxic effects of stool on tissue culture cells. These problems can be rectified when proper procedures are followed.
authors.affiliation: Department of Pediatrics, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, Division of Infectious Diseases, Women and Children's Hospital of Buffalo, Buffalo, NY 14222, USA. hfaden@upa.chob.edu
authors.forename: Howard
authors.initials: H
authors.lastname: Faden
authors.forename: Pravin H
authors.initials: PH
authors.lastname: Patel
authors.forename: Linda
authors.initials: L
authors.lastname: Campagna
mesh_terms: D016360:Clostridioides difficile / Q000302:isolation & purification; D003428:Cross Infection / Q000175:diagnosis; D003937:Diagnosis, Differential; D004768:Enterotoxins / Q000032:analysis; D004769:Enterovirus Infections / Q000175:diagnosis*; D005243:Feces / Q000821:virology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D012189:Retrospective Studies
chemical_list: D004768:Enterotoxins