Myocarditis in the newborn infant: A study of an outbreak associated with coxsackie group B virus infection in a maternity home in Johannesburg

Abstract

Summary In October and November, 1952, at which time Bornholm disease was prevalent in Johannesburg, a number of babies became ill while in, or soon after discharge from, the maternity home in which they were born. Their ages at onset ranged from 5 to 17 days. Characteristically they showed a biphasictype of illness, the initial episode consisting of a few loose stools followed after an interval of three to eight days by a fulminating illness ending in a circulatory collapse. Of ten babies affected six died. The main clinical evidence for myocarditis was a tachycardia above 200 beats per minute and abnormal T 1 in the electrocardiogram. Post-mortem examination carriedout on three of the fatal cases revealed that the outstanding lesion was a patchy myocarditis. In one case a focus of encephalitis was also demonstrated. It was concluded that death resulted from acute heart failure and circulatory collapse. Bacteriological investigations failedto reveal a cause for this condition. In virus studies it was shown that the baby mice inoculated with suspension of the brains from two of the fatal cases developed lesions of the brain resembling those produced by Coxsackie group B virus. Fat pad lesions resembling those produced by Coxsackie group B virus were also seen in sections of these mice, as well as in baby mice inoculated with the feces from two of the babies who recovered. One of these viruses was established in serial passage, and it regularly produced fat pad lesions. It was typed in cross-immunity tests and shown to be a Coxsackie group B type 3 virus. It was concluded that in newborn babies Coxsackie group B virus may be a cause of an acute infection associated with a myocarditis, which may end fatally.