title: Frequency of enterovirus detection in blood samples of neonates admitted to hospital with sepsis-like illness in Kuwait.
abstract: This study investigated the role of enteroviruses in sepsis-like illness among neonates in Kuwait. Serum samples from 139 consecutive neonates presenting with sepsis-like illness during a three and a half-year-period whose blood cultures were negative for bacterial pathogens were tested. Enterovirus RNA was detected by single-step reverse-transcription PCR (RT-PCR). Specific genotypes were identified by direct DNA sequencing of enteroviral genome. Serotype-specific antibodies in serum samples from some selected patients were detected by virus neutralization test using coxsackievirus B types (CBVs). All 139 neonates presented with sepsis-like illness and blood samples were uniformly negative for aerobic/anaerobic bacterial cultures. Fifty-six (40%) neonates had further complications of sepsis including carditis (n = 34) and multi-organ involvement (n = 22). Enterovirus RNA was detected by RT-PCR in 34 of 139 (24%) serum samples which is among the highest frequency reported so far in non-epidemic settings. Genotyping identified CBVs as most common enteroviruses, causing 19 of 34 (56%) enteroviral sepsis episodes in neonates. Of 34 carditis cases, 18 were positive for CBVs by serotyping including all 10 enterovirus RNA-positive samples. Only one fatality was observed due to liver failure in a neonate with hepatitis. Our data showed that enteroviruses are responsible for 24% of neonatal sepsis cases due to non-bacterial causes in Kuwait. The data indicate that enteroviruses should be considered in the differential diagnosis of sepsis-like illness among neonates, particularly those with negative blood cultures for bacterial pathogens.
authors.affiliation: Faculty of Medicine, Department of Microbiology, Kuwait University, Safat, Kuwait.
authors.forename: Suhail
authors.initials: S
authors.lastname: Ahmad
authors.forename: Ajmal
authors.initials: A
authors.lastname: Dalwai
authors.forename: Widad
authors.initials: W
authors.lastname: Al-Nakib
mesh_terms: D057134:Antibodies, Neutralizing / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D004770:Enterovirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000821:virology; D005838:Genotype; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D007730:Kuwait / Q000453:epidemiology; D008969:Molecular Sequence Data; D009500:Neutralization Tests; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood / Q000235:genetics / Q000302:isolation & purification; D020133:Reverse Transcriptase Polymerase Chain Reaction; D018805:Sepsis / Q000453:epidemiology* / Q000209:etiology* / Q000821:virology; D017422:Sequence Analysis, DNA; D016019:Survival Analysis
chemical_list: D057134:Antibodies, Neutralizing; D000914:Antibodies, Viral; D012367:RNA, Viral
keywords: Kuwait; enteroviruses; etiologic agents; neonates; sepsis-like illness