van der Meulen Marijke, van Doornum Gerard J J, Corel Linda J A, Dalinghaus Michiel, Fraaij Pieter L A, de Hoog Matthijs
Erasmus MC-Sophia Kinderziekenhuis, Afd. Kindergeneeskunde, Rotterdam, The Netherlands.
Ned Tijdschr Geneeskd. 2009;153:A152.
In the spring and summer of 2008 two seriously ill male infants were admitted to a paediatric intensive care unit. Initially, both had a fever, were drinking less and were pale complexioned. Physical examination revealed tachycardia, slow capillary filling and liver enlargement. Within a few hours, both infants developed circulatory and respiratory failure. A chest radiograph showed that the heart was enlarged and echocardiography revealed that the pump function of both ventricles was severely diminished. Myocarditis caused by Coxsackie virus B3 was diagnosed when the virus was demonstrated in serum and faeces. At the last follow-up, one infant still had severe pump function disorders, and the other one died. Coxsackie virus B3 is a non-polio enterovirus that usually causes mild clinical syndromes but is also associated with myocarditis and overwhelming, systemic neonatal infections. In neonates with mild symptoms one should be alert to progression to circulatory insufficiency, especially if the mother experiences a flu-like illness in the perinatal period. Early recognition of heart failure and adequate diagnostic testing for cardiotropic viruses is important as morbidity and mortality is considerable.
2008年春夏，两名重病男婴被收治入儿科重症监护病房。起初，两人均发烧、摄水量减少且面色苍白。体格检查发现心动过速、毛细血管充盈缓慢及肝脏肿大。数小时内，两名婴儿均出现循环和呼吸衰竭。胸部X光片显示心脏扩大，超声心动图显示两个心室的泵功能严重受损。当在血清和粪便中检测到柯萨奇病毒B3时，确诊为由该病毒引起的心肌炎。在最后一次随访时，一名婴儿仍有严重的泵功能障碍，另一名婴儿死亡。柯萨奇病毒B3是一种非脊髓灰质炎肠道病毒，通常引起轻度临床综合征，但也与心肌炎及严重的全身性新生儿感染有关。对于有轻微症状的新生儿，应警惕病情进展为循环功能不全，尤其是如果母亲在围产期患流感样疾病。由于发病率和死亡率相当高，早期识别心力衰竭并对嗜心性病毒进行充分的诊断检测很重要。
