What is the clinical evidence from this study?

Study design: Case Report. Population: Coagulopathy associated with Coxsackievirus B1 (CVB1) infection (n=1). Intervention: Intrauterine coxsackievirus B1 (CVB1) infection. Primary outcome: Resolution of coagulopathy.

What does this research mean for the field?

Intrauterine coxsackievirus B1 infection can cause recurrent, biphasic coagulation disorders in neonates corresponding to primary and secondary viremia phases. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To describe a rare case of recurrent neonatal coagulopathy caused by intrauterine Coxsackievirus B1 infection and characterize the clinical course associated with secondary viremia.

December 30, 2022The Pediatric Infectious Disease Journal

Disease Not To Be Ignored: The Second Viremia of Coxsackie

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Key result

Targeted transfusion and gamma globulin resolve repeated coagulation disorders in neonatal intrauterine CVB1 infection.

Why the study?

Neonatal coxsackievirus B1 infection can cause severe clinical manifestations including repeated coagulation disorder, but its clinical course and monitoring remain unclear.

Key Points

To describe a rare case of recurrent neonatal coagulopathy caused by intrauterine Coxsackievirus B1 infection and characterize the clinical course associated with secondary viremia.
Evaluated a 5-day-old male neonate presenting with generalized petechiae and ecchymoses whose mother experienced peripartum fever.
Performed placental histopathology, RT-PCR for enteroviral nucleic acid, and metagenomic next-generation sequencing (mNGS) on peripheral blood.
Administered intravenous gamma globulin (2 g/kg), plasma (20 mL/kg), platelets (20 mL/kg), and prothrombin complex (20 U/kg) with serial coagulation monitoring.
Initial laboratory testing revealed severe coagulopathy with platelet count 7 × 10^9/L, prothrombin time >100 s, and activated partial thromboplastin time >150 s, while inflammatory markers were normal.
Placental histology confirmed chorioamnionitis with positive RT-PCR for Coxsackievirus B, and peripheral blood mNGS exclusively detected Coxsackievirus B1.
Coagulation markers normalized four days post-transfusion but relapsed two days later, requiring repeat prothrombin complex and plasma until stabilization on hospital day eight, with viral clearance on repeat mNGS.

Study Design

Type

Case Report (n=1)

Structured PICO

Population

A 5-day-old male neonate with repeated coagulation disorder caused by intrauterine coxsackievirus B1 (CVB1) infection, followed for 1 month after discharge.

Exposure

Gamma globulin 2 g/kg, plasma 20 mL/kg 4 times, prothrombin complex 20 U/kg 3 times, and platelet 20 mL/kg 2 times

Outcome

Resolution of coagulopathy and platelet count

Neonatal coxsackievirus B1 infection can present with repeated coagulation disorders, requiring careful monitoring through the second viremia phase.

Limitations

The course of neonatal coxsackievirus infection is relatively long, and whether the mNGS method can be used to monitor coxsackievirus load to determine the course of illness needs further study.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Raises awareness for enterovirus testing in neonates presenting with sepsis-like illness and myocarditis; leaves open need for prospective antiviral trials.

Cite This Study

Junjie Ning (2022) conducted a case report in Coagulopathy associated with Coxsackievirus B1 (CVB1) infection (n=1). Intrauterine coxsackievirus B1 (CVB1) infection was evaluated on Resolution of coagulopathy. Intrauterine coxsackievirus B1 (CVB1) infection in a 5-day-old neonate caused repeated coagulation disorders that successfully resolved following targeted transfusion and gamma globulin therapy.

synapsesocial.com/papers/6aaca47ef3f3e14d29258cc2 https://doi.org/10.1097/inf.0000000000003821

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Implication

Raises awareness for enterovirus testing in neonates presenting with sepsis-like illness and myocarditis; leaves open need for prospective antiviral trials.

Disease Not To Be Ignored: The Second Viremia of Coxsackie

Key Points

Study Design

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Disease Not To Be Ignored: The Second Viremia of Coxsackie

Key Points

Study Design

Structured PICO

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider