Coxsackievirus B4 infection in premature twin newborns caused lethal meningoencephalitis and severe myocarditis, with viral sequences identified in the brain and heart.
Case Report (n=2)
This case report demonstrates that Coxsackievirus B4 infection in neonates can cause fatal systemic disease including severe myocarditis and meningoencephalitis by infecting select target cells.
Coxsackievirus B4 (CB4) is a picornavirus associated with a variety of human diseases, including neonatal meningoencephalitis, myocarditis and type 1 diabetes. We report the pathological findings in twin newborns who died during an acute infection. The twins were born 1 month premature but were well and neurologically intact at birth. After a week they developed acute lethal neonatal sepsis and seizures. Histopathology demonstrated meningoencephalitis and severe myocarditis, as well as pancreatitis, adrenal medullitis and nephritis. Abundant CB4 sequences were identified in nucleic acid extracted from the brain and heart. In situ hybridization with probes to CB4 demonstrated infection of neurons, myocardiocytes, endocrine pancreas and adrenal medulla. The distribution of infected cells and immune response is consistent with reported clinical symptomatology where systemic and neurological diseases are the result of CB4 infection of select target cells.
Bissel et al. (2014) conducted a case report in Coxsackievirus B4 myocarditis and meningoencephalitis (n=2). Coxsackievirus B4 infection was evaluated on Pathological findings. Coxsackievirus B4 infection in premature twin newborns caused lethal meningoencephalitis and severe myocarditis, with viral sequences identified in the brain and heart.