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Chapter 11 : Nonpolio Enteroviruses and the Febrile Infant

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Abstract:

This chapter focuses on the epidemiology, clinical features, and laboratory aspects of nonpolio enteroviral infection in infants, primarily those less than 3 months of age. Despite many common clinical features, enteroviruses vary considerably in their organ tropism. The clinical manifestations of enteroviral infection are strikingly similar, despite the serotype-dependent differences in pathogenesis. On the basis of these clinical features, one cannot predict the presence or absence of enteroviral meningitis. Furthermore, there is considerable overlap in the signs and symptoms caused by the various viruses that are associated with febrile illness in young infants. The distinctive as well as overlapping features of disease caused by enteroviruses, respiratory syncytial virus, and influenza viruses in the young infant are illustrated. Despite the increasing emphasis on rapid diagnostic techniques for direct detection of viral antigens and nucleic acid, virus isolation in cell culture remains the only reliable way of demonstrating most enteroviruses in clinical specimens. Virus culture of specimens from multiple sites, perhaps with the addition of PCR techniques, can provide a sensitive, rapid, often specific diagnosis of enteroviral disease in symptomatic young infants.

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11

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Upper Respiratory Tract Infections
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Lower Respiratory Tract Infections
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Figures

Image of FIGURE 1
FIGURE 1

Cumulative number of admissions per month during 2 years of study. EV, enteroviral infection; INFL A, influenza virus A; RSV, respiratory syncytial virus. Reproduced with permission from reference .

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11
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Image of FIGURE 2
FIGURE 2

Chain of events in enteroviral (EV) infections. CNS, central nervous system.

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11
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Image of FIGURE 3
FIGURE 3

Coxsackievirus B5 infections in a 5-week-old infant. WBC., leukocytes; R/O, rule out

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11
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Image of FIGURE 4
FIGURE 4

Replication of coxsackie virus A9, B3, and B4 and echovirus 5, 9, and 11 in mixed blood mononuclear cells from healthy adult donors. Values are means ± deviations. Reprinted from reference .

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11
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Image of FIGURE 5
FIGURE 5

Peak temperature on day of admission in previously healthy infants less than 3 months of age hospitalized with enteroviral infection. Data are from reference .

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11
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Image of FIGURE 6
FIGURE 6

Clinical features of 82 hospitalized infants less than 3 months old with enteroviral (EV) infection. Data are from reference . LRI, lower respiratory tract infection; URI, upper respiratory tract infection.

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11
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Image of FIGURE 7
FIGURE 7

Clinical presentation of 108 hospitalized infants with enteroviral infection. URI, upper respiratory tract infection. Data are from reference .

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11
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Image of FIGURE 8
FIGURE 8

Main clinical features and organ involvement in hospitalized febrile infants less than 3 months of age. Comparison is between infants infected with enteroviruses, influenza virus, and respiratory syncytial virus (RSV).

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11
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Image of FIGURE 9
FIGURE 9

Recovery of echoviruses from clinical specimens in combination of CMK, HEL, RD, and GM cells. Data are from reference .

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11
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References

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Tables

Generic image for table
TABLE 1

Frequency of symptomatic enteroviral infections in cord blood antibody-positive and -negative young infants infected with enteroviruses

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11
Generic image for table
TABLE 2

Bacteria and viruses detected in previously healthy infants less than 3 months of age with suspected sepsis

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11
Generic image for table
TABLE 3

Frequency of positive blood and CSF cultures in echovirus- and group B coxsackievirus-infected infants

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11
Generic image for table
TABLE 4

Blood and CSF leukocytes in infants <3 months of age hospitalized with symptomatic enteroviral infections: comparison of echovirus- and group B enteroviruses-infected infants

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11
Generic image for table
TABLE 5

Frequency of enterovirus isolation

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11
Generic image for table
TABLE 6

Enterovirus isolation from infants <3 months of age who had symptomatic enteroviral infection

Citation: Dagan R, Menegus M. 1995. Nonpolio Enteroviruses and the Febrile Infant, p 239-254. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch11

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