Asymptomatic (Subclinical) Meningitis in One of Premature Triplets with Simultaneous Enteroviral Meningitis: A Case Report

Abstract

Most enterovirus infection in the neonate and young infant is asymptomatic, but serious disease may occur, especially if acquired perinatally. We report the first case, to our knowledge, of asymptomatic enterovirus aseptic meningitis, and of concurrent enterovirus aseptic meningitis in premature triplets. Ten-week-old, 31-week-estimated gestational age premature triplet boys were diagnosed with enterovirus aseptic meningitis on the same day. Two of the triplets developed symptoms on the day of admission, while the third remained symptom free throughout the infection. All three recovered completely and are healthy more than a decade later.

Keywords

enterovirus infection - asymptomatic aseptic meningitis - prematurity - simultaneous infection - triplets

• References

• 1 Khetsuriani N, Lamonte-Fowlkes A, Oberst S, Pallansch MA ; Centers for Disease Control and Prevention. Enterovirus surveillance—United States, 1970–2005. MMWR Surveill Summ 2006; 55 (8) , SS (Suppl. 08) 1-20
• 2 Strong BS, Young SA. Intrauterine coxsackie virus, group B type 1, infection: viral cultivation from amniotic fluid in the third trimester. Am J Perinatol 1995; 12 (2) 78-79
• 3 Willems A, Benne CA, Timmer A, Bergman KA. Fatal illness associated with pulmonary hypertension in a neonate caused by intrauterine echovirus 11 infection. Am J Perinatol 2006; 23 (1) 59-61
• 4 Collaborative Antiviral Study Group Study 106 Aims. Available at: http://clinicaltrials.gov/ct2/show/NCT00031512 . Accessed August 9, 2011
• 5 Kazzi NJ, Cepeda EE, Budev H. Fatal echovirus type 7 in a premature infant. Am J Perinatol 1988; 5 (3) 236-238
• 6 Freund MW, Kleinveld G, Krediet TG, van Loon AM, Verboon-Maciolek MA. Prognosis for neonates with enterovirus myocarditis. Arch Dis Child Fetal Neonatal Ed 2010; 95 (3) F206-F212
• 7 Abzug MJ. Presentation, diagnosis, and management of enterovirus infections in neonates. Paediatr Drugs 2004; 6 (1) 1-10
• 8 Tebruegge M, Curtis N. Enterovirus infections in neonates. Semin Fetal Neonatal Med 2009; 14 (4) 222-227
• 9 Birenbaum E, Handsher R, Kuint J , et al. Echovirus type 22 outbreak associated with gastro-intestinal disease in a neonatal intensive care unit. Am J Perinatol 1997; 14 (8) 469-473
• 10 Pasquinelli L. Enterovirus infections. Pediatr Rev 2006; 27 (2) e14-e15
• 11 Morens DM. Enteroviral disease in early infancy. J Pediatr 1978; 92 (3) 374-377
• 12 Dagan R. Nonpolio enteroviruses and the febrile young infant: epidemiologic, clinical and diagnostic aspects. Pediatr Infect Dis J 1996; 15 (1) 67-71
• 13 Hawkes MT, Vaudry W. Nonpolio enterovirus infection in the neonate and young infant. Paediatr Child Health (Oxford) 2005; 10 (7) 383-388
• 14 Grangeot-Keros L, Broyer M, Briand E , et al. Enterovirus in sudden unexpected deaths in infants. Pediatr Infect Dis J 1996; 15 (2) 123-128
• 15 Jenista JA, Powell KR, Menegus MA. Epidemiology of neonatal enterovirus infection. J Pediatr 1984; 104 (5) 685-690
• 16 Rorabaugh ML, Berlin LE, Heldrich F , et al. Aseptic meningitis in infants younger than 2 years of age: acute illness and neurologic complications. Pediatrics 1993; 92 (2) 206-211
• 17 Berlin LE, Rorabaugh ML, Heldrich F, Roberts K, Doran T, Modlin JF. Aseptic meningitis in infants <2 years of age: diagnosis and etiology. J Infect Dis 1993; 168 (4) 888-892
• 18 Chiou CC, Liu WT, Chen SJ , et al. Coxsackievirus B1 infection in infants less than 2 months of age. Am J Perinatol 1998; 15 (3) 155-159
• 19 Schlesinger Y, Sawyer MH, Storch GA. Enteroviral meningitis in infancy: potential role for polymerase chain reaction in patient management. Pediatrics 1994; 94 (2 Pt 1) 157-162
• 20 Faulkner RS, MacLeod AJ, Van Rooyen CE. Virus meningitis-seven cases in one family. Can Med Assoc J 1957; 77 (5) 439-444