Enteroviral infections in the immunocompromised host

In contrast to most viral infections, which are controlled by the cellular immune system and may cause disease in patients that suffer from a cellular defect, e.g. after transplantation or HIV infection, the enteroviruses cause a lytic infection that is controlled mainly by neutralising antibody. Severe enteroviral infections are observed with agammaglobulinaemia and in neonates, but usually not in adults with a cellular immune defect. The main manifestation of the infection in agammaglobulinaemia patients is a slowly progressive meningoencephalitis that is sometimes difficult to diagnose. Patients are treated with intravenous immunoglobulins, but with variable success. In the neonate, immaturity of the immune system is responsible for severe infections, in particular when transmitted by the mother during delivery. These infections may present as sepsis with hepatic necrosis, meningoencephalitis or myocarditis. It remains to be established, whether immunoglobulin treatment is effective in the neonate with severe enteroviral disease.