Department of Pediatrics, Graduate School of Medicine, Kobe University, Kobe 650-0017, Japan.
Hyogo Prefectural Institute of Public Health Science, Kakogawa 675-0003, Japan.
Int J Environ Res Public Health. 2023 Feb 6;20(4):2843. doi: 10.3390/ijerph20042843.
We report a case of vertical transmission of Coxsackievirus (CV)-A6 with severe congenital pneumonia/sepsis. A male infant presented with severe respiratory symptoms at birth and was treated with full cardiopulmonary support, including inhaled nitric oxide. Three days before delivery, his older brother was diagnosed with hand, foot, and mouth disease (HFMD). His mother developed transient fever 1 day before delivery and presented a blister on her thumb 2 days after delivery. A multiplex polymerase chain reaction test on day 2 was positive for human rhinovirus/enterovirus. CV-A6 was later detected in the serum, tracheal aspirate, and stool of the patient sampled on day 6, and in the maternal serum sampled on the day of delivery. He was diagnosed with congenital CV-A6 pneumonia/sepsis caused by vertical transmission, based on VP1 consensus sequences used for typing of the virus that demonstrated a 100% match between the mother and infant. Further, the strain was closely related to the lethal CV-A6-Changchun strains in the phylogenetic analysis of the P2 region, which contributes to the pathogenicity. In conclusion, congenital CV-A6 infection should be considered if a woman exhibits HFMD symptoms during the perinatal period. Detailed virologic examination is useful for understanding its pathogenesis.
我们报告了一例柯萨奇病毒 A6（Coxsackievirus A6，CV-A6）垂直传播导致严重先天性肺炎/败血症的病例。一名男性婴儿出生时即出现严重呼吸症状，接受了包括吸入一氧化氮在内的心肺全面支持治疗。分娩前 3 天，其哥哥被诊断为手足口病（hand, foot, and mouth disease，HFMD）。其母亲在分娩前 1 天出现短暂发热，分娩后 2 天拇指出现水疱。分娩当天，患儿第 2 天的多重聚合酶链反应（polymerase chain reaction，PCR）检测显示人类鼻病毒/肠道病毒阳性。随后，患儿第 6 天的血清、气管抽吸物和粪便以及母亲分娩当天的血清中均检测到 CV-A6。基于病毒 VP1 区序列进行基因分型显示，病毒与母亲和婴儿之间存在 100%的匹配，因此诊断为先天性 CV-A6 肺炎/败血症，由垂直传播引起。此外，在 P2 区的系统进化分析中，该菌株与致死性 CV-A6-长春株密切相关，这有助于了解其致病性。总之，如果女性在围产期出现手足口病症状，应考虑先天性 CV-A6 感染。详细的病毒学检查有助于了解其发病机制。
