Congenital Enterovirus Infection

An infectious embryofetopathy including coxsackie viruses and ECHO viruses that have been reported to cause spontaneous abortion, stillbirth, acute systemic illness in the newborn, and possibly fetal malformations.

Epidemiology

Congenital enterovirus infection (EV) prevalence is still unknown. EV infections are underdiagnosed in the mother (mainly because of frequent subclinical infections) and hence may be far more frequent than supposed.

Clinical description

Clinical manifestations of congenital EV infection ranges from asymptomatic to benign, febrile to severe illness consisting of variable combinations of sepsis, hepatitis, coagulopathy, myocarditis, pneumonitis and meningoencephalitis. Clinical features are observed in utero or occurring in the first 1-2 days of life, some with viremia detected within hours after delivery. Additional features of congenital EV infection include spontaneous abortion, hydrops fetalis and stillbirths in which multiorgan disease may include myocarditis or pancarditis. Fetal anomalies of the cardiovascular, gastrointestinal and genitourinary system, along with neurodevelopmental delay, bilateral pleural effusion, abdominal ascitis, severe respiratory failure, cortical necrosis (that may lead to severe long-term neurologic sequelae) have also been scarcely reported. Infants may also develop a ''sepsis-like syndrome'' characterized by hypotension, leucopenia or leukocytosis, neutropenia, thrombocytopenia, and disseminated intravascular coagulopathy.

Etiology

Coxsackie A, B, ECHO viruses, and numbered EVs are believed to cross the placenta and cause fetal disease. Severity and outcome of perinatally acquired enteroviral infection is influenced by several factors, including term at delivery (premature neonates are more susceptible to severe infections), symptoms in the mother, infection in the 10 first days of life, virus strain, route of transmission (in utero or during delivery), and presence of passively acquired serotype-specific maternal antibody.

Diagnostic methods

In case of ultrasound findings antenatal diagnosis of congenital EV infection is achieved by molecular detection of the virus' RNA in amniotic fluid. Postnatal diagnosis of EV infection (congenital or not) relies on molecular detection of the virus' RNA in plasma (including cord blood at birth), stool, nasopharyngeal swab, and cerebrospinal fluid.

Differential diagnosis

Differential diagnosis includes congenital infection with Toxoplasma gondii, Rubella, Cytomegalovirus, Herpes simplex virus, Parvovirus B19, Syphilis.

Management and treatment

There is no specific curative treatment for EV maternal or congenital infection.

Prognosis

Prognosis of mild congenital EV infections is quite good if reanimation procedures are available. Prognosis of severe congenital EV infections is poor and the disease has been reported to be fatal.