A case report of a premature infant with coxsackie B1 meningitis.
This case report describes a 36-week gestational age infant diagnosed with coxsackie B1 meningitis at 20 days of age. A head ultrasound 5 days after diagnosis was consistent with cystic periventricular leukomalacia. The scientific literature does not clearly elucidate differences between bacterial and viral infections in infants. When difficulties arise, it is pertinent to consider a viral etiology for the underlying illness and obtain a detailed maternal and infant history focusing on clinical symptoms, seasonality, geographic location, exposure, and incubation period. Polymerase chain reaction is a rapid and sensitive diagnostic test for the identification of enteroviruses in cerebrospinal fluid, blood, urine, and throat specimens and should be performed as part of the general workup in the evaluation of a febrile infant with sepsis. In retrospect, it may have established an earlier diagnosis of meningitis, consequently preventing the unnecessary use of antibiotics, potentially decreasing the length of hospitalization, and eliminating the need for more detailed investigations to rule out other etiological factors. In addition, treatment with pleconaril may have affected the severity of the encephalitis. This article reviews the pathogenesis, clinical manifestations, and differential diagnoses of enteroviral infections, specifically focusing on the prevention, treatment, and prognosis of the disease and the implications for clinical practice.
McMaster Children's Hospital, Hamilton, Ontario, Canada. callen@hhsc.ca
Jennifer
J
Callen
Bosco A
BA
Paes
D000328:Adult; D001062:Appendectomy; D002675:Child, Preschool; D003384:Coxsackievirus Infections / Q000175:diagnosis* / Q000503:physiopathology / Q000635:transmission; D002658:Developmental Disabilities / Q000821:virology*; D029822:Enterovirus B, Human / Q000472:pathogenicity; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007969:Leukomalacia, Periventricular / Q000503:physiopathology / Q000821:virology*; D008297:Male; D008587:Meningitis, Viral / Q000175:diagnosis* / Q000503:physiopathology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000601:surgery