Perinatal Enterovirus Infections

Mark J. Abzug

doi:10.1128/9781555818326.ch10

Chapter 10 : Perinatal Enterovirus Infections

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Affiliations: 1: Department of Pediatrics, Section of Infectious Diseases, University of Colorado School of Medicine, and The Children's Hospital, Denver, Colorado 80218

Content Type: Monograph

Publication Year: 1995

Category: Clinical Microbiology; Viruses and Viral Pathogenesis

Book DOI: 10.1128/9781555818326

Chapter DOI: 10.1128/9781555818326.ch10

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Abstract:

This chapter summarizes information about the effects of enteroviral infections during gestation and the neonatal period. Pathology of the human fetus infected in utero with enteroviruses has been described in several reports. The majority of enterovirus (poliovirus and nonpoliovirus)-infected newborns are presumed to be infected intrapartum or postnatally via exposure to maternal blood, vaginal secretions, or oropharyngeal secretions or feces of mothers or other infectious contacts. Maternal poliovirus infection during gestation is associated with an increased risk of fetal loss, stillbirth, intrauterine growth retardation, and prematurity, particularly when maternal infection occurs early in pregnancy. Fetal loss was greatest with maternal infection in the first trimester, occurring in almost half of clinically affected pregnancies in one series, and with severe maternal disease, although fetal loss with mild, nonparalytic maternal illness was also observed. Researchers have reported several cases of abortion between the third and fifth months of pregnancy and stillbirths during the ninth month associated with enteroviral infection; echovirus 27, echovirus 33, coxsackievirus B2, and coxsackievirus B6 were implicated by placental and/or fetal cultures (brain, liver, heart, kidney, adrenal glands, and/or spleen). Viral culture is the standard technique for diagnosis of neonatal enteroviral infections. The highest-yield specimens in the newborn are rectum or stool and cerebrospinal fluid. Symptomatic newborns most often require hospitalization both for diagnostic evaluation and for empiric treatment of possible bacterial and/or herpes simplex virus infection, because the symptoms of enteroviral infection are nonspecific.

Citation: Abzug M. 1995. Perinatal Enterovirus Infections, p 221-238. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch10

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Perinatal Enterovirus Infections

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Citation: Abzug M. 1995. Perinatal Enterovirus Infections, p 221-238. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch10

/content/10.1128/9781555818326.chap10.fig10-1

FIGURE 1

One-week-old infant with overwhelming sepsis due to echovirus 11. A typical maculopapular rash is seen on the trunk and extremities. This child recovered from virus-induced disseminated intravascular coagulation, meningoencephalitis, pneumonia, and renal impairment but died at age 3 months of hepatic failure. Infection was likely acquired in utero. This baby is profiled in the preface to this book.

10.1128/9781555818326/fig10-1_thmb.gif

10.1128/9781555818326/fig10-1.gif

FIGURE 1

Citation: Abzug M. 1995. Perinatal Enterovirus Infections, p 221-238. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch10

References

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1. Abzug, M. J. 1993. Identification of trophoblastic giant cells as the initial principal target of early gestational murine enterovirus infection. Placenta 14: 137– 148.

2. Abzug, M. J. Characterization of the placental barrier to murine enterovirus infection. Placenta, in press.

3. Abzug, M. J. Unpublished data.

4. Abzug, M. J.,, H. L. Keyserling,, M. L. Lee,, M. J. Levin,, and H. A. Rotbart. Clin. Infect. Dis., in press.

5. Abzug, M. J.,, M. J. Levin,, and H. A. Rotbart. 1993. Profile of enterovirus disease in the first two weeks of life. Pediatr. Infect. Dis. J. 12: 820– 824.

6. Abzug, M. J.,, M. LoefFelholz,, and H. A. Rotbart. Diagnosis of neonatal enterovirus infection by polymerase chain reaction. J. Pediatr., in press.

7. Abzug, M. J.,, H. A. Rotbart,, and M. J. Levin. 1989. Demonstration of a barrier to transplacental passage of murine enteroviruses in late gestation. J. Infect. Dis. 159: 761– 765.

8. Abzug, M. J.,, H. A. Rotbart,, S. A. Magliato,, and M. J. Levin. 1991. Evolution of the placental barrier to fetal infection by murine enteroviruses. J. Infect. Dis. 163: 1336– 1341.

9. Amstey, M. S.,, R. K. Miller,, M. A. Menegus, and R A. di Sant 'Agnese. 1988. Enterovirus in pregnant women and the perfused placenta. Am. J. Obstet. Gynecol. 158: 775– 782.

10. Aycock, W. L. 1941. The frequency of poliomyelitis in pregnancy . N. Engl. J. Med. 225: 405– 408.

11. Baetz-Greenwalt, B.,, N. B. Ratliff,, and D. S. Moodie. 1983. Hypoplastic right-sided heart complex: a cluster of cases with associated congenital birth defects. A new syndrome? J. Pediatr. 103: 399– 401.

12. Baker, D. A.,, and C. A. Phillips. 1980. Maternal and neonatal infection with coxsackievirus. Obstet. Gynecol. 55: 12S– 15S.

13. Baker, M. E.,, and I. G. Baker. 1947. Acute poliomyelitis in pregnancy. Report of thirty cases. Minn. Med. 30: 729– 758.

14. Baskin, J. L.,, E. H. Soule,, and S. D. Mills. 1950. Poliomyelitis of the newborn. Am. J. Dis. Child. 80: 10– 21.

15. Basso, N. G. S.,, M. E. F. Fonseca,, A. G. P. Garcia,, J. A. T. Zuardi,, M. R. Silva,, and H. Outani. 1990. Enterovirus isolation from foetal and placental tissues. Acta Virol. 34: 49– 57.

16. Batcup, G.,, P. Holt,, M. H. Hambling,, L. M. Gerlis,, and M. R. Glass. 1985. Placental and fetal pathology in coxsackie virus A9 infection: a case report. Histopathology 9: 1227– 1235.

17. Bates, H. R. 1970. Coxsackie virus B3 calcific pancarditis and hydrops fetalis. Am. J. Obstet. Gynecol. 106: 629– 630.

18. Bates, T. 1955. Poliomyelitis in pregnancy, fetus, and newborn. Am. J. Dis. Child. 90: 189– 195.

19. Bell, E. J.,, C. A. C. Ross,, and N. R. Grist. 1975. ECHO 9 infection in pregnant women with suspected rubella. J. Clin. Pathol. 28: 267– 269.

20. Bergman, I.,, M. J. Painter,, E. R. Wald,, D. Chiponis,, A. L. Holland,, and H. G. Taylor. 1987. Outcome in children with enteroviral meningitis during the first year of life. J. Pediatr. 110: 705– 709.

21. Berkovich, S.,, and E. M. Smithwick. 1968. Transplacental infection due to ECHO virus type 22. J. Pediatr. 72: 94– 96.

22. Black, S. 1983. Program Abstr. 23rd Intersci. Conf. Antimicrob. Agents Chemother., abstr. 314, p. 140.

23. Bowers, V. M.,, and D. N. Danforth. 1953. The significance of poliomyelitis during pregnancy. Am. J. Obstet. Gynecol. 65: 34– 39.

24. Boyd, M. T.,, S. W. Jordan,, and L. E. Davis. 1987. Fatal pneumonitis from congenital echo-virus type 6 infection. Pediatr. Infect. Dis. J. 6: 1138– 1139.

25. Boyd, P. A., 1987. Placenta and umbilical cord, p. 67– 73. In J. W. Keeling (ed.), Fetal and Neonatal Pathology. Springer-Verlag, New York.

26. Brady, W. K.,, and A. Purdon. 1986. Intrauterine fetal demise associated with enterovirus infection. South. Med. J. 79: 770– 772.

27. Brightman, V. J.,, T. F. McNair Scott,, M. Westphal,, and T. R. Boggs. 1966. An outbreak of coxsackie B-5 virus infection in a newborn nursery. J. Pediatr. 69: 179– 192.

28. Brown, G. C.,, and R. S. Karunas. 1971. Relationship of congenital anomalies and maternal infection with selected enteroviruses. Am. J. Epidemiol. 95: 207– 217.

29. Burch, G. E.,, S. C. Sun,, K. C. Chu,, R. S. Sohal,, and H. L. Colcolough. 1968. Interstitial and coxsackievirus B myocarditis in infants and children. JAMA 203: 1– 8.

30. Byrd, C. L. 1950. The influence of infection with Lansing strain poliomyelitis virus on pregnant mice. J. Neuropathol. Exp. Neurol. 9: 202– 203.

31. Carolane, D. J.,, A. M. Long,, P. A. McKeever,, S. J. Hobbs,, and A. P. Roome. 1985. Prevention of spread of echovirus 6 in a special care baby unit. Arch. Dis. Child. 60: 674– 676.

32. Carter, H. M. 1956. Congenital poliomyelitis. Report of a case. Obstet. Gynecol. 8: 373– 374.

33. Cheeseman, S. H.,, M. S. Hirsch,, E. W. Keller,, and D. E. Keim. 1977. Fatal neonatal pneumonia caused by echovirus type 9. Am. J. Dis. Child. 131: 1169.

34. Cherry, J. D.,, F. Soriano,, and C. L. Jahn. 1968. Search for perinatal viral infection. A prospective, clinical, virologic, and serologic study. Am. J. Dis. Child. 116: 245– 250.

35. Chuang, E.,, E. S. Mailer,, M. A. Hoffman,, R. L. Hodinka,, and S. M. Altschuler. 1993. Successful treatment of fulminant echovirus 11 infection in a neonate by orthotopic liver transplantation. J. Pediatr. Gastroenterol. Nutr. 17: 211– 214.

36. Dagan, R.,, C. B. Hall,, K. R. Powell,, and M. A. Menegus. 1989. Epidemiology and laboratory diagnosis of infection with viral and bacterial pathogens in infants hospitalized for suspected sepsis. J. Pediatr. 115: 351– 356.

37. Dagan, R.,, J. A. Jenista,, S. L. Prather,, K. R. Powell,, and M. A. Menegus. 1985. Viremia in hospitalized children with enterovirus infections. J. Pediatr. 106: 397– 401.

38. Dagan, R.,, S. Prather,, K. Powell,, and M. A. Menegus. 1983. Neutralizing antibodies to non-polio enteroviruses in human immune serum globulin. Pediatr. Infect. Dis. J. 2: 454– 456.

39. Dalldorf, G.,, and R. GifiFord. 1954. Susceptibility of gravid mice to coxsackie virus infection. J. Exp. Med. 99: 21– 27.

40. Dilovski, M.,, and D. Ognianov. 1975. Isolation and identification of a virus causing abortions and stillbirths in swine (preliminary report). Vet. Med. Nauki 12: 52– 53.

41. Eagles, J. M. 1992. Are polioviruses a cause of schizophrenia? Br. J. Psychiatry 160: 598– 600.

42. Farmer, K.,, B. A. Mac Arthur,, and M. M. Clay. 1975. A follow-up study of 15 cases of neonatal meningoencephalitis due to coxsackie virus B5. J. Pediatr. 87: 568– 571.

43. Feldman, R. G.,, J. Bryant,, K. N. Ives,, and N. C. W. Hill. 1987. A novel presentation of coxsackie B2 virus infection during pregnancy. J. Infect. 15: 73– 76.

44. Fox, M. J.,, and F. H. Belfus. 1950. Poliomyelitis in pregnancy. Am. J. Obstet. Gynecol. 59: 1134– 1139.

45. Freedman, P. S. 1979. Echovirus 11 infection and intrauterine death. Lancet i: 96– 97.

46. Garcia, A. G. P.,, N. G. D. S. Basso,, M. E. F. Fonseca,, and H. N. Outani. 1990. Congenital echo virus infection-morphological and virological study of fetal and placental tissue. J. Pathol. 160: 123– 127.

47. Garcia, A. G. P.,, N. G. D. S. Basso,, M. E. F. Fonseca,, J. A. T. Zuardi,, and H. N. Outanni. 1991. Enterovirus associated placental morphology: a light, virological, electron microscopic and immunohistologic study. Placenta 12: 533– 547.

48. Gaudin, O. G.,, B. Pozzetto,, M. Aouni,, and A. Ros. 1989. Detection of neutralizing IgM antibodies in the diagnosis of enterovirus infections. J. Med. Virol. 28: 200– 205.

49. Gauntt, C. J.,, R. J. Gudvangen,, Y. W. Brans,, and A. E. Marlin. 1985. Coxsackievirus group B antibodies in the ventricular fluid of infants with severe anatomic defects in the central nervous system. Pediatrics 76: 64– 68.

50. Gauntt, C. J.,, D. C. Jones,, H. W. Huntington,, H. M. Arizpe,, R. J. Gudvangen,, and R. M. DeShambo. 1984. Murine forebrain anomalies induced by coxsackievirus B3 variants. J. Med. Virol. 14: 341– 355.

51. Gicheva, T. A. 1988. Modelling coxsackievirus infection in pregnant mice in long-term experiment. J. Hyg. Epidemiol. Microbiol. Immunol. 32: 439– 445.

52. Gillam, G. L.,, K. B. Stokes,, J. McLellan,, and A. L. Smith. 1986. Fulminant hepatic failure with intractable ascites due to an echo-virus 11 infection successfully managed with a peritoneo-venous (LeVeen) shunt. J. Pediatr. Gastrenterol. Nutr. 5: 476– 480.

53. Gonzalez-del-Rey, J. A.,, R. C. Baker,, A. W. Kummer,, and J. R. Schultz. 1991. Neurodevelopmental outcome of infants with enteroviral meningitis in the first three months of life, abstr. 1018, p. 172A. Abstr. Soc. Pediatr. Res. 1991.

54. Goren, A.,, M. Kaplan,, J. Glaser,, and M. Isacsohn. 1989. Chronic neonatal coxsackie myocarditis. Arch. Dis. Child. 64: 404– 406.

55. Haddad, J.,, J. P. Gut,, M. J. Wendling,, D. Astruc,, M. Jernite,, G. Obert,, and J. Messer. 1993. Enterovirus infections in neonates. A retrospective study of 21 cases. Eur. J. Med. 2: 209– 214.

56. Haddad, J.,, F. Keller,, U. Simeoni,, J. P. Gut,, J. Messer,, and D. Willard. 1988. Meningomyocardite à virus coxsackie B4 en périnatologie. Arch. Fr. Pediatr. 45: 259– 261.

57. Haddad, J.,, J. Messer,, J. P. Gut,, D. Chaigne,, D. Christmann,, and D. Willard. 1990. Neonatal echovirus encephalitis with white matter necrosis. Neuropediatrics 21: 215– 217.

58. Hammond, G. W.,, H. Lukes,, B. Wells,, L. Thompson,, D. E. Low,, and M. Cheang. 1985. Maternal and neonatal neutralizing antibody titers to selected enteroviruses. Pediatr. Infect. Dis. J. 4: 32– 35.

59. Haynes, R. E.,, H. G. Cramblett,, M. D. Hilty,, P. H. Azimi,, and J. Crews. 1972. ECHO virus type 3 infections in children: clinical and laboratory studies. J. Pediatr. 80: 589– 595.

60. Helin, I.,, A. Widell,, S. Borulf,, M. Walder,, and U. Ulmsten. 1987. Outbreak of coxsackievirus A-14 meningitis among newborns in a maternity hospital ward. Acta Paediatr. Scand. 76: 234– 238.

61. Horn, P. 1955. Poliomyelitis in pregnancy. A twenty-year report from Los Angeles County, California. J. Am. Acad. Obstet. Gynecol. 6: 121– 137.

62. Huang, J.,, R. F. Gentry,, and A. Zarkower. 1980. Experimental infection of pregnant sows with porcine enterovirus. Am. J. Vet. Res. 41: 469– 473.

63. Hughes, J. R.,, C. M. Wilfert,, M. Moore,, K. Benirschke,, and E. de Hoyos-Guevara. 1972. Echovirus 14 infection associated with fatal neonatal hepatic necrosis. Am. J. Dis. Child. 123: 61– 67.

64. Hyypia, T.,, M. Kallajoki,, M. Maaronen,, G. Stanway,, R. Kandolf,, P. Auvinen,, and H. Kalimo. 1993. Pathogenetic differences between coxsackie A and B virus infections in newborn mice. Virus Res. 27: 71– 78.

65. Isaacs, D.,, A. R. Wilkinson,, R. Eglin,, S. R. M. Dobson,, P. L. Hope,, and E. R. Moxon. 1989. Conservative management of an echovirus 11 outbreak in a neonatal unit. Lancet i: 543– 545.

66. Jahn, C. L.,, and J. D. Cherry. 1966. Mild neonatal illness associated with heavy enterovirus infection. N. Engl. J. Med. 274: 394– 395.

67. Jenista, J. A.,, L. E. Dalzell,, P. W. Davidson,, and M. A. Menegus. 1984. Outcome studies of neonatal enterovirus infection, abstr. 808, p. 230A. Abstr. Soc. Pediatr. Res. 1984.

68. Jenista, J. A.,, K. R. Powell,, and M. A. Menegus. 1984. Epidemiology of neonatal enterovirus infection. J. Pediatr. 104: 685– 690.

69. Jenista, J. A.,, S. A. Prather,, and M. A. Menegus. 1983. Determinants of severity of neonatal enterovirus infection. Am. J. Dis. Child. 137: 532.

70. Johnston, J. M.,, and J. C. Overall. 1989. Intravenous immunoglobulin in disseminated neonatal echovirus 11 infection. Pediatr. Infect. Dis. J. 8: 254– 256.

71. Jones, M. J.,, M. Kolb,, H. J. Votava,, R. L. Johnson,, and T. F. Smith. 1980. Intrauterine echovirus type 11 infection. Mayo Clin. Proc. 55: 509– 512.

72. Kaplan, M. H.,, S. W. Klein,, J. McPhee,, and R. G. Harper. 1983. Group B coxsackievirus infections in infants younger than three months of age: a serious childhood illness. Rev. Infect. Dis. 5: 1019– 1032.

73. Kibrick, S.,, and K. Benirschke. 1956. Acute aseptic myocarditis and meningoencephalitis in the newborn child infected with coxsackie virus group B, type 3. N. Engl. J. Med. 255: 883– 889.

74. Kibrick, S.,, and K. Benirschke. 1958. Severe generalized disease (encephalohepato-myocarditis) occurring in the newborn period and due to infection with coxsackie virus, group B. Evidence of intrauterine infection with this agent. Pediatrics 22: 857– 874.

75. Kinney, J. S.,, E. McCray,, J. E. Kaplan,, D. E. Low,, G. W. Hammond,, G. Harding,, P. F. Pinsky,, M. J. Davi,, S. F. Kovnats,, P. Riben,, W. J. Martone,, L. B. Schonberger,, and L. J. Anderson. 1986. Risk factors associated with echovirus 11' infection in a hospital nursery. Pediatr. Infect. Dis. J. 5: 192– 197.

76. Kleinman, H.,, J. T. Prince,, W. E. Mathey,, A. B. Rosenfield,, J. E. Bearman,, and J. T. Syverton. 1962. ECHO 9 virus infection and congenital abnormalities: a negative report. Pediatrics 29: 261– 269.

77. Knox, A. W. 1950. Infection and immunity in offspring of mice inoculated during gestation with murine poliomyelitis virus. Proc. Soc. Exp. Biol. Med. 74: 792– 796.

78. Koskimies, O.,, K. Lapinleimu,, and L. Saxen. 1978. Infections and other maternal factors as risk indicators for congenital malformations: a case-control study with paired serum samples. Pediatrics 61: 832– 837.

79. Krous, H. F.,, D. Dietzman,, and C. G. Ray. 1973. Fatal infections with echovirus types 6 and 11 in early infancy. Am. J. Dis. Child. 126: 842– 846.

80. Kulhanjian, J. 1992. Fever, hepatitis and coagulopathy in a newborn infant. Pediatr. Infect. Dis. J. 11: 1069.

81. Lake, A. M.,, B. A. Lauer,, J. C. Clark,, R. L. Wesenberg,, and K. Mcintosh. 1976. Enterovirus infections in neonates. J. Pediatr. 89: 787– 791.

82. Landsman, J. B.,, N. R. Grist,, and C. A. C. Ross. 1964. Echo 9 virus infection and congenital malformations. Br. J. Prev. Soc. Med. 18: 152– 156.

83. McLean, D. M.,, W. L. Donohue,, C. E. Snelling,, and J. C. Wyllie. 1961. Coxsackie B5 virus as a cause of neonatal encephalitis and myocarditis. Can. Med. Assoc. J. 85: 1046– 1048.

84. Modlin, J. F. 1986. Perinatal echovirus infection: insights from a literature review of 61 cases of serious infection and 16 outbreaks in nurseries. Rev. Infect. Dis. 8: 918– 926.

85. Modlin, J. F. 1988. Echovirus infections of newborn infants. Pediatr. Infect. Dis. J. 7: 311– 312.

86. Modlin, J. F. 1988. Fatal echovirus 11 disease in premature neonates. Pediatrics 66: 775– 780.

87. Modlin, J. F.,, and M. Bowman. 1987. Perinatal transmission of coxsackievirus B3 in mice. J. Infect. Dis. 156: 21– 25.

88. Modlin, J. F.,, and C. S. Crumpacker. 1982. Coxsackievirus B infection in pregnant mice and transplacental infection of the fetus. Infect. Immun. 37: 222– 226.

89. Modlin, J. F.,, B. F. Polk,, P. Horton,, P. Etkind,, and E. Crane. 1981. Perinatal echo-virus infection: risk of transmission during a community outbreak. N. Engl. J. Med. 305: 368– 371.

90. Morens, D. M. 1978. Enteroviral disease in early infancy. J. Pediatr. 92: 374– 377.

91. Nagington, J. 1982. Echovirus 11 infection and prophylactic antiserum. Lancet ii: 446.

92. Nagington, J.,, J. Walker,, G. Gandy,, and J. J. Gray. 1983. Use of normal imunoglobulin in an echovirus 11 outbreak in a special-care baby unit. Lancet ii: 443– 446.

93. Nagington, J.,, T. G. Wreghitt,, G. Gandy,, N. R. C. Roberton,, and P. J. Berry. 1978. Fatal echovirus 11 infections in outbreak in special-care baby unit. Lancet ii: 725– 728.

94. Nielsen, J. L.,, G. K. Berryman,, and G. D. V. Hankins. 1988. Intrauterine fetal death and the isolation of echovirus 27 from amniotic fluid. J. Infect. Dis. 158: 501– 502.

95. Ogilvie, M. M.,, and C. F. Tearne. 1980. Spontaneous abortion after hand-foot-and-mouth disease caused by coxsackie virus A16. Br. Med. J. ii: 1527– 1528.

96. Overall, J. C. 1972. Intrauterine virus infections and congenital heart disease. Am. Heart J. 84: 823– 833.

97. Peterson, J. C.,, and L. Glicklich. 1960. The effect of ECHO 9 infection on the fetus. Am. J. Dis. Child. 100: 779– 780.

97a. Petitjean, J.,, F. Tron-Laporte,, M. Dommerques,, F. Freymuth,, F. Daffos,, J. C. Pons,, Y. Dumez,, G. Bercau,, J. F. Oury,, and P. Lebon. 1994. Involvement of enteroviruses in fetal infections, p. 200. Program Abstr. Prog. Clin. Virol

98. Philip, A. G. S.,, and E. J. Larson. 1973. Overwhelming neonatal infection with ECHO 19 virus. J. Pediatr. 82: 391– 397.

99. Pozzetto, B.,, O. G. Gaudin,, M. Aouni,, and A. Ros. 1989. Comparative evaluation of immunoglobulin M neutralizing antibody response in acute-phase sera and virus isolation for the routine diagnosis of enterovirus infection. J. Clin. Microbiol. 27: 705– 708.

100. Rabkin, C. S.,, E. E. Telzak,, M. S. Ho,, J. Goldstein,, Y. Bolton,, M. Pallansch,, L. Anderson,, E. Kilchevsky,, S. Solomon,, and W. J. Martone. 1988. Outbreak of echovirus 11 infection in hospitalized neonates. Pediatr. Infect. Dis. J. 7: 186– 190.

101. Rager-Zisman, B.,, and A. C. Allison. 1973. The role of antibody and host cells in the resistance of mice against infection by coxsackie B-3 virus. J. Gen. Virol. 19: 329– 338.

102. Rantakallio, P.,, A. L. Saukkonen,, and U. Krause. 1970. Follow-up study of 17 cases of neonatal coxsackie B5 meningitis and one with suspected myocarditis. Scand. J. Infect. Dis. 2: 25.

103. Rantasalo, I.,, K. Penthinen,, L. Saxen,, and A. Ojala. 1960. Echo 9 virus antibody status after an epidemic period and the possible teratogenic effect of the infection. Ann. Paediatr. Fenn. 6: 175– 184.

104. Reyes, M. P.,, E. M. Ostrea,, J. Roskamp,, and A. M. Lerner. 1983. Disseminated neonatal echovirus 11 disease following antenatal maternal infection with a virus-positive cervix and virus-negative gastrointestinal tract. J. Med. Virol. 12: 155– 159.

105. Reyes, M. P.,, D. Zalenski,, F. Smith,, F. M. Wilson,, and A. M. Lerner. 1986. Coxsack-ievirus-positive cervices in women with febrile illnesses during the third trimester in pregnancy. Am. J. Obstet.Gynecol. 155: 159– 161.

106. Rorabaugh, M. L.,, L. E. Berlin,, F. Heldrich,, K. Roberts,, L. A. Rosenberg,, T. Doran,, and J. F. Modlin. 1993. Aseptic meningitis in infants younger than 2 years of age: acute illness and neurologic complications. Pediatrics 92: 206– 211.

107. Rorabaugh, M. L.,, L. E. Berlin,, L. Rosenberg,, M. Rossman,, M. Allen,, and J. F. Modlin. 1992. Absence of neuro-developmental sequelae from aseptic meningitis, abstr. 1047, p. 177A. Abstr. Soc. Pediatr. Res. 1992.

108. Rosenberg, H. S. 1987. Cardiovascular effects of congenital infections. Am.f. Cardiovasc. Pathol. 1: 147– 156.

109. Sells, C. J.,, R. L. Carpenter,, and C. G. Ray. 1975. Sequelae of central-nervous-system enterovirus infections. N. Engl. J. Med. 293: 1– 4.

110. Selzer, G. 1969. Transplacental infection of the mouse fetus by coxsackie viruses. Isr. J. Med. Sci. 5: 125– 127.

111. Sever, J. L.,, R. J. Huebner,, and G. A. Costellano. 1963. Serologic diagnosis "en masse" with multiple antigens. Am. Rev. Respir. Dis. 88: 342.

112. Shattuck, K. E.,, and T. Chonmaitree. 1992. The changing spectrum of neonatal meningitis over a fifteen-year period. Clin. Pediatr. 31: 130– 136.

113. Siegel, M.,, and M. Greenberg. 1955. Incidence of poliomyelitis in pregnancy. Its relations to maternal age, parity and gestational period. N. Engl. f. Med. 253: 841– 847.

114. Siegel, M.,, and M. Greenberg. 1956. Poliomyelitis in pregnancy: effect on fetus and newborn infant. J. Pediatr. 49: 280– 288.

115. Skeels, M. R.,, J. J. Williams,, and F. M. Ricker. 1981. Perinatal echovirus infection. N. Engl. J. Med. 305: 1529.

116. Soike, K. 1967. Coxsackie B-3 virus infection in the pregnant mouse. J. Infect. Dis. 117: 203– 208.

117. Spector, S. A.,, and R. C. Straube. 1983. Protean manifestations of perinatal enterovirus infections. West. J. Med. 138: 847– 851.

118. Squires, R. F. 1992. Are polioviruses a cause of schizophrenia? Br. J. Psychiatry 161: 427.

119. Ujevich, M. M.,, and R. JafFe. 1980. Pancreatic islet cell damage. Its occurrence in neonatal coxsackievirus encephalomyocarditis. Arch. Pathol. Lab. Med. 104: 438– 441.

120. Valduss, D.,, D. L. Murray,, P. Kama,, K. Lapour,, and J. Dyke. 1993. Use of intravenous immunoglobulin in twin neonates with disseminated coxsackie Bl infection. Clin. Pediatr. 32: 561– 563.

121. van Saene, H. K. F.,, C. P. Stoutenbeek,, R. Faber-Nijholt,, and J. J. M. van Saene. 1992. Selective decontamination of the digestive tract contributes to the control of disseminated intravascular coagulation in severe liver impairment. J. Pediatr. Gastroenterol. Nutr. 14: 436– 442.

122. Weaver, H. M.,, and G. Steiner. 1944. Acute anterior poliomyelitis during pregnancy. Am. J. Obstet. Gynecol. 47: 495– 505.

123. Weinstein, L.,, W. L. Aycock,, and R. F. Feemster. 1951. The relation of sex, pregnancy and menstruation to susceptibility in poliomyelitis. N. Engl. J. Med. 245: 54– 58.

124. Wilfert, C. M.,, R. J. Thompson,, T. R. Sunder,, A. O'Quinn,, J. Zeller,, and J. Blacharsh. 1981. Longitudinal assessment of children with enteroviral meningitis during the first three months of life. Pediatrics 67: 811– 815.

125. Wilson, C. W.,, D. K. Stevenson,, and A. M. Arvin. 1989. A concurrent epidemic of respiratory syncytial virus and echovirus 7 infections in an intensive care nursery. Pediatr. Infect. Dis. J. 8: 24– 29.

126. Wong, S. N.,, A. Y. C. Tarn,, T. H. K. Ng,, W. F. Ng,, C.Y. Tong,, and T. S. Tang. 1989. Fatal coxsackie Bl virus infection in neonates. Pediatr. Infect. Dis. J. 8: 638– 641.

127. Woodruff, J. F. 1980. Viral myocarditis. Am. J. Pathol. 101: 427– 479.

128. Wyatt, H. V. 1979. Poliomyelitis in the fetus and the newborn. A comment on the new understanding of the pathogenesis . Clin. Pediatr. 18: 33– 38.

129. Zeichner, S. L.,, and S. A. Plotkin. 1988. Mechanisms and pathways of congenital infections. Clin. Perinatol. 15: 163– 188.