Severe enterovirus disease in febrile neonates.
BACKGROUND
Fever in newborn infants may be due to an invasive infection with potential morbidity and mortality. Our aim was to describe the characteristics and outcome of group of febrile neonates with severe enterovirus infection compared to a group of neonates with severe bacterial infection.


METHODS
Prospective study including all neonates (<29 days old) admitted to a teaching hospital for fever (>38 degrees C), with positive bacterial cultures or enterovirus detection in sterile samples, from September 2003 to December 2004. Clinical information, analytical data at admission (complete leukocyte count and C-reactive protein concentrations), blood, urine, and cerebrospinal fluid culture results, molecular detection of enterovirus by polymerase chain reaction (PCR), and outcome were recorded.


RESULTS
Invasive bacterial infections were observed in 62 patients: urinary tract infection (n=57, including 8 cases of bacteremia), sepsis (n=3), and meningitis (n=2). Molecular tests for enterovirus were positive in 10 patients. C-reactive protein values were significantly higher in neonates with bacterial infection than in those with enterovirus infection (62,3 versus 9mg/L, P=0,008). Two patients with Streptococcus agalactiae meningitis, 1 with Staphylococcus aureus sepsis and 3 with enterovirus infection (manifested as myocarditis, hepatitis, and meningoencephalitis) required admission to the pediatric intensive care unit. Among these, 1 newborn with S. agalactiae and 2 of the 3 with enterovirus infection died.


CONCLUSIONS
In our series, enterovirus infection was an important cause of severe invasive disease. Specific viral diagnosis can contribute to the management of febrile neonates.
Jordán
Iolanda
I
University Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
Esteva
Cristina
C
Esteban
Elisabeth
E
Noguera
Antoni
A
García
Juan-José
JJ
Muñoz-Almagro
Carmen
C
D000328:Adult; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D001424:Bacterial Infections / Q000150:complications / Q000453:epidemiology; D002097:C-Reactive Protein / Q000032:analysis; D015897:Comorbidity; D004770:Enterovirus / Q000302:isolation & purification; D004769:Enterovirus Infections / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005334:Fever / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D007231:Infant, Newborn; D007958:Leukocyte Count; D008590:Meningoencephalitis / Q000134:cerebrospinal fluid / Q000453:epidemiology / Q000382:microbiology / Q000821:virology; D009205:Myocarditis / Q000209:etiology / Q000821:virology; D016133:Polymerase Chain Reaction / Q000379:methods; D011247:Pregnancy; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000382:microbiology; D013030:Spain / Q000453:epidemiology; D013292:Streptococcus agalactiae; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology / Q000652:urine
D002097:C-Reactive Protein