Adverse Effects of Maternal Enterovirus Infection on the Pregnancy Outcome: a Prospective and Retrospective Pilot Study

Overview

Journal Virol J

Publisher Biomed Central

Specialty Microbiology

Date 2018 Apr 18

PMID 29661198

Citations 9

Authors

Z Khediri

C Vauloup-Fellous

A Benachi

J M Ayoubi

L Mandelbrot

O Picone

Affiliations

Soon will be listed here.

Abstract

Background: Enteroviruses account for about one billion infections worldwide each year, the majority remain asymptomatic. Data on enterovirus infections during pregnancy appear to be very rare. Several cases have been reported in the literature of fetal and neonatal complications attributed to these viruses, but prospective data on these infections during pregnancy are not available.

Objective: To estimate the prevalence of enterovirus infections in febrile syndromes in pregnant women, and in case of in utero fetal death (IUFD).

Methods: Ttri-centric observational cohort study. We performed prospective inclusion for patients with fever during a four-month period. We also analyzed the amniotic fluid in patients with unexplained IUFD retrospectively during a five-year period. Investigations of enteroviruses are made by RT-PCR from routine biological samples (amniocentesis, RT-PCR in maternal blood or CSF).

Results: Prospectively, 33 patients were included during the study period. We have identified 4 cases of confirmed enterovirus infection (12.4%). We have recorded a severe form of perinatal enterovirus infection involving the vital prognosis of the newborn. In the retrospective cohort of 75 IUFD cases, we had only one case of enterovirus-positive RT-PCR in amniotic fluid during 5 years, meaning a frequency of 1.3%. We did not had any positive EV case in case of early miscarriage, but the limited number of inclusions cannot help us to conclude.

Conclusion: Enteroviruses are probably an underestimated cause of obstetric and neonatal complications. Investigation of enterovirus by PCR should be discussed during pregnancy and peripartum in case of febrile syndrome with no obvious bacterial cause, and unexplained IUFD.

Citing Articles

Coxsackievirus Group B Infections during Pregnancy: An Updated Literature Review.

Longo C, Saito M, Castro P, Traina E, Werner H, Elito Junior J J Clin Med. 2024; 13(16).

PMID: 39201064 PMC: 11355224. DOI: 10.3390/jcm13164922.

Case series: Congenital enterovirus infection-associated haemophagocytic lymphohistiocytosis and subsequent neutropaenia.

Penner J, Burns J, Breuer J, Gilmour K, Bamford A, Rao A EJHaem. 2024; 5(4):784-788.

PMID: 39157618 PMC: 11327720. DOI: 10.1002/jha2.931.

Differential immunophenotype of circulating monocytes from pregnant women in response to viral ligands.

Farias-Jofre M, Romero R, Xu Y, Levenson D, Tao L, Kanninen T BMC Pregnancy Childbirth. 2023; 23(1):323.

PMID: 37149573 PMC: 10163583. DOI: 10.1186/s12884-023-05562-0.

Enterovirus B types cause severe infection in infants aged 0-3 months.

Yang X, Duan L, Zhan W, Tang Y, Liang L, Xie J Virol J. 2023; 20(1):5.

PMID: 36624466 PMC: 9830867. DOI: 10.1186/s12985-023-01965-9.

A Rare Presentation of Hand, Foot, and Mouth Disease During Pregnancy.

Alam M, Rokaya N, Mahat S, Upadhyaya A, Rokaya P Cureus. 2022; 14(8):e28401.

PMID: 36043199 PMC: 9411823. DOI: 10.7759/cureus.28401.

References

Dommergues M, Petitjean J, Aubry M, Delezoide A, Narcy F, Fallet-Bianco C . Fetal enteroviral infection with cerebral ventriculomegaly and cardiomyopathy. Fetal Diagn Ther. 1994; 9(2):77-8. DOI: 10.1159/000263911. View

Ouellet A, Sherlock R, Toye B, Fung K . Antenatal diagnosis of intrauterine infection with coxsackievirus B3 associated with live birth. Infect Dis Obstet Gynecol. 2004; 12(1):23-6. PMC: 1784589. DOI: 10.1080/1064744042000210357. View

Yen H, Lien R, Fu R, Chang L . Hepatic failure in a newborn with maternal peripartum exposure to echovirus 6 and enterovirus 71. Eur J Pediatr. 2003; 162(9):648-9. DOI: 10.1007/s00431-003-1269-9. View

Tassin M, Martinovic J, Mirand A, Peigue-Lafeuille H, Picone O, Benachi A . A case of congenital Echovirus 11 infection acquired early in pregnancy. J Clin Virol. 2013; 59(1):71-3. DOI: 10.1016/j.jcv.2013.11.003. View

Hwang J, Lee K, Kim Y, Shim H, Bae Y, Hwang J . Pregnancy loss following coxsackievirus b3 infection in mice during early gestation due to high expression of coxsackievirus-adenovirus receptor (CAR) in uterus and embryo. Exp Anim. 2014; 63(1):63-72. PMC: 4160930. DOI: 10.1538/expanim.63.63. View

Moss P, HEFFERNAN C, Thurston J, Robertson L . Enteroviruses and congenital abnormalities. Br Med J. 1967; 2(5544):110-1. PMC: 1841315. DOI: 10.1136/bmj.2.5544.110-c. View

Williams E, Embleton N, Clark J, Bythell M, Platt M, Berrington J . Viral infections: contributions to late fetal death, stillbirth, and infant death. J Pediatr. 2013; 163(2):424-8. DOI: 10.1016/j.jpeds.2013.02.004. View

Pillet S, Billaud G, Omar S, Lina B, Pozzetto B, Schuffenecker I . Multicenter evaluation of the ENTEROVIRUS R-gene real-time RT-PCR assay for the detection of enteroviruses in clinical specimens. J Clin Virol. 2009; 47(1):54-9. DOI: 10.1016/j.jcv.2009.09.033. View

Johansson M, Holmstrom S, Abebe A, Jacobsson B, Ekman G, Samuelson A . Intrauterine fetal death due to echovirus 11. Scand J Infect Dis. 1992; 24(3):381-5. DOI: 10.3109/00365549209061347. View

10.

Bonnin A, Tassin M, Vauloup-Fellous C, Letamendia E, Stos B, Bonnet D . Case of a healthy infant born following antenatal enterovirus myocarditis and hydrops. J Clin Virol. 2014; 61(3):459-62. DOI: 10.1016/j.jcv.2014.08.028. View

11.

Antona D, Leveque N, Chomel J, Dubrou S, Levy-Bruhl D, Lina B . Surveillance of enteroviruses in France, 2000-2004. Eur J Clin Microbiol Infect Dis. 2007; 26(6):403-12. DOI: 10.1007/s10096-007-0306-4. View

12.

Verboon-Maciolek M, Groenendaal F, Cowan F, Govaert P, van Loon A, de Vries L . White matter damage in neonatal enterovirus meningoencephalitis. Neurology. 2006; 66(8):1267-9. DOI: 10.1212/01.wnl.0000208429.69676.23. View

13.

Bendig J, Franklin O, Hebden A, Backhouse P, Clewley J, Goldman A . Coxsackievirus B3 sequences in the blood of a neonate with congenital myocarditis, plus serological evidence of maternal infection. J Med Virol. 2003; 70(4):606-9. DOI: 10.1002/jmv.10437. View

14.

Yu W, Tellier R, Wright Jr J . Coxsackie Virus A16 Infection of Placenta with Massive Perivillous Fibrin Deposition Leading to Intrauterine Fetal Demise at 36 Weeks Gestation. Pediatr Dev Pathol. 2015; 18(4):331-4. DOI: 10.2350/15-01-1603-CR.1. View

15.

Bryce F, Conway S, Batcup G . Coxsackie virus AI6 infection adversely affecting the outcome of a pregnancy. J Infect. 1988; 16(3):307-8. DOI: 10.1016/s0163-4453(88)97820-6. View

16.

Soudee S, Schuffenecker I, Aberchih J, Josset L, Lina B, Baud O . [Neonatal enterovirus infections reported in France in 2012]. Arch Pediatr. 2014; 21(9):984-9. DOI: 10.1016/j.arcped.2014.06.022. View

17.

Mostoufizadeh M, Lack E, Gang D, Perez-Atayde A, DRISCOLL S . Postmortem manifestations of echovirus 11 sepsis in five newborn infants. Hum Pathol. 1983; 14(9):818-23. DOI: 10.1016/s0046-8177(83)80304-9. View

18.

Kao Y, Hung H, Chi H . Congenital coxsackievirus B5 infection: report of one case. Acta Paediatr Taiwan. 2006; 46(5):321-3. View

19.

PIRAINO F, Sedmak G, RAAB K . Echovirus 11 infections of newborns with mortality during the 1979 enterovirus season in Milwaukee, Wis. Public Health Rep. 1982; 97(4):346-53. PMC: 1424347. View

20.

Konstantinidou A, Anninos H, Spanakis N, Kotsiakis X, Syridou G, Tsakris A . Transplacental infection of Coxsackievirus B3 pathological findings in the fetus. J Med Virol. 2007; 79(6):754-7. DOI: 10.1002/jmv.20887. View