1209. Enteroviruses are frequent etiologic agents of sepsis-like illness among neonates in Kuwait
Session: Poster Abstract Session: Other Viral Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • Abstract-30394-Prof. Widad-Kuwait.png (602.3 kB)
  • Background: Sepsis in neonates is usually due to an invasive infection that is often associated with high morbidity and mortality. Although bacterial infections are the most common cause of neonatal sepsis, blood cultures remain negative in several cases implying other potential causes of sepsis-like illness in neonates. Neonatal enteroviral sepsis is a rare but fulminant infection with multisystem involvement, often presenting with carditis, hepatitis and/or multi-organ failure. This study evaluated the role of enteroviruses (EVs) as etiologic agents of sepsis among neonates in Kuwait.

    Methods: A total of 139 hospitalized neonates presenting with sepsis-like illness and blood cultures negative for bacterial pathogens were investigated. Enteroviral RNA in blood specimens was detected by a sensitive, single-step reverse-transcription PCR (RT-PCR) and hybridization of amplicons with an EV-specific probe. Specific genotypes of EVs were identified by DNA sequencing of genotype-specific VP4-VP2 region of EV genome. Serotyping was done by virus neutralization test using type-specific antiserum.

    Results: All 139 neonates presented with sepsis-like illness (fever, irritability, poor feeding and symptoms of flu and gastrointestinal disturbance) and were uniformly negative for aerobic/anaerobic bacterial blood cultures. Fifty-six (40%) neonates had further complications of sepsis, such as carditis (n=34), hepatitis (n=15) or multi-organ involvement (n=7). Enteroviral RNA was detected in 34 of 139 (24%) blood specimens. Genotyping studies identified coxsackievirus B types (CBs) as most common EVs, accounting for 19 of 34 (56%) enteroviral sepsis episodes in neonates. Of 34 carditis cases, 18 were positive for CBs by serotyping including all 10 EV-RNA-positive samples. Following the diagnosis of enteroviral sepsis, the neonates were appropriately managed and only one fatality due to liver failure was observed in the cohort.

    Conclusion: Our data show that EVs are responsible for 24% of neonatal sepsis cases due to non-bacterial causes in Kuwait. The data advocate that EVs should be considered in the differential diagnosis of sepsis-like illness among neonates, particularly those with negative blood cultures for bacterial pathogens.


    Subject Category: P. Pediatric and perinatal infections

    Widad AL-Nakib, FRCPath, FACULTY OF MEDICINE, Kuwait, Kuwait, Suhail Ahmad, PhD, Faculty of Medicine, Kuwait, Kuwait and Ajmal Dalwai, PhD, Kuwait University, Safat, Kuwait

    Disclosures:

    W. AL-Nakib, None

    S. Ahmad, None

    A. Dalwai, None

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