Levy Avrohom, Ross Ann, Delle Donne Andrew
Pediatrics, Jersey Shore University Medical Center, Neptune, USA.
Neonatology, Jersey Shore University Medical Center, Neptune, USA.
Cureus. 2024 Oct 30;16(10):e72714. doi: 10.7759/cureus.72714. eCollection 2024 Oct.
Neonates who develop fever have a high risk for serious infection, and while the standard of care involves performing a full sepsis evaluation, current guidelines do not include viral polymerase chain reaction (PCR) testing of the cerebrospinal fluid as a standard of care, which means that cases of viral meningitis can be missed. This case presentation discusses a neonate who had a fever at four days of life who then underwent a full sepsis evaluation. A respiratory viral panel demonstrated rhino/enterovirus positivity. A lumbar puncture was consistent with aseptic meningitis and newborn was prophylactically covered with acyclovir until the cerebrospinal fluid PCR confirmed enterovirus positivity and was negative for herpes simplex virus. The neonate experienced thrombocytosis and elevated transaminase levels, which resolved before discharge. Acyclovir was discontinued following a pediatric infectious disease consultation. The patient steadily improved, passed all screenings, and was discharged on day 16 with follow-up appointments arranged, including developmental pediatrics and repeat hearing screenings. Despite the viral panel indicating a respiratory virus, the presence of a respiratory virus in a neonate does not necessarily reduce the risk of a serious bacterial illness, especially in infants younger than 29 days. Viral meningitis can be associated with substantial complications and, so viral PCR testing of the cerebrospinal fluid allows clinicians to monitor for the development of severe disease and set up outpatient follow-ups for potential long-term sequelae of viral meningitis, such as neurodevelopmental delays.
出现发热的新生儿发生严重感染的风险很高，虽然护理标准包括进行全面的败血症评估，但当前指南并未将脑脊液病毒聚合酶链反应（PCR）检测作为护理标准，这意味着病毒性脑膜炎病例可能会被漏诊。本病例报告讨论了一名出生四天时发热的新生儿，随后对其进行了全面的败血症评估。呼吸道病毒检测显示鼻病毒/肠道病毒呈阳性。腰椎穿刺结果符合无菌性脑膜炎，新生儿预防性使用阿昔洛韦，直到脑脊液PCR确认肠道病毒呈阳性且单纯疱疹病毒检测为阴性。该新生儿出现了血小板增多症和转氨酶水平升高，这些在出院前均已恢复正常。在咨询儿科传染病专家后停用了阿昔洛韦。患儿病情稳步好转，通过了所有筛查，并于第16天出院，同时安排了随访预约，包括发育儿科和重复听力筛查。尽管病毒检测显示为呼吸道病毒，但新生儿感染呼吸道病毒并不一定会降低严重细菌感染的风险，尤其是对于29天以下的婴儿。病毒性脑膜炎可能会伴有严重并发症，因此脑脊液病毒PCR检测可让临床医生监测严重疾病的发展情况，并为病毒性脑膜炎的潜在长期后遗症（如神经发育迟缓）安排门诊随访。
