Perinatal Enterovirus Infections

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.