In general, positive cultures and PCR assays of mucosal sites such as throat or rectum may reflect asymptomatic infection or presence of virus that is causing symptoms. Positive culture and PCR tests of body fluids such as serum and cerebrospinal fluid more specifically suggest disease causation (35,91). Nevertheless, a positive culture or PCR from a mucosal site in the first month of life (even in the absence of positive testing of normally sterile body fluids) in the presence of an EV-compatible illness and in the absence of another viral (e.g., herpes simplex virus, cytomegalovirus, or adenovirus) or bacterial (e.g., group B Streptococcus or E. coli) pathogen or noninfectious condition (e.g., metabolic disorder or structural cardiac disease) that can produce the constellation of clinical findings likely signifies that an EV is the etiologic agent.
Herpes simplex virus infection of the newborn can closely mimic findings of neonatal EV infection; surface viral cultures and PCR testing of cerebrospinal fluid and serum for herpes simplex virus and EV usually should be done concomitantly when evaluating a sick newborn (33). Co-infection by EVs and bacteria may occur, so bacterial infection should be ruled out by appropriate cultures before ascribing an illness solely to EV infection (33,37,98). Likewise, for meningitis, evaluation may be indicated for other congenital infections such as syphilis, toxoplasmosis, or rubella. It should be remembered that, after the neonatal period, receipt of live attenuated (oral) poliovirus vaccine can result in a positive viral culture or PCR assay of throat or rectum and occasionally of serum or cerebrospinal fluid.
The primary causes of neonatal EV infections are the coxsackie B viruses and the echoviruses; coxsackie A viruses are implicated less often (37). An association has been observed between EV subgroup and disease pattern, with coxsackie B viruses associated with meningoencephalitis and myocarditis and echoviruses associated with hepatitis and coagulopathy, but significant overlap exists (34,36,38). Coxsackie B virus-associated hepatitis and coagulopathy have been increasingly reported (99). Coxsackieviruses B2-B5 and echoviruses 6, 11, and 19 are frequently the causes of severe neonatal disease (34,36-38). Many other EV serotypes have also been reported to cause severe neonatal disease, however. In the absence of an epidemic situation or the occurrence of a unique disease manifestation, identification of the EV subgroup and serotype is generally not necessary and does not have an impact on clinical management.
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