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Congenital Skin Lesions Caused byIntrauterine Infection with Coxsackievirus B3 !" !" #$ % & ' $ ( &) *+ ,-../+.0 "$1 2345.6789:*599-795 %;-995 -" 2 -=& &#x";&#x 5;.80; $ % & ' $ 9/ ,-/**5? "$ , ! "0 " )&75 ,-../.80 "$& 19 CR-00/11_umbr Uhr 326 Black Bogen) thiocyanate-phenol-chlorophorm method [6],one step reversetranscriptase PCR (Hoffmann-LaRoche,Germany) was per-(5'-CGGTACCTTTGTAGCGCTTGTTTTA-3',5'-CGGACAC-CCAAAGTAGTCGGTTCC-3',amplified product 496 bp).(5'-CCCCGGACTGAGTATCAATA-3',5'-CAGTTAGGATTA-GCGGCATTC-3',amplified product 300 bp).DNA fragmentsDNA sequencing (AmpliTaq,FS Dye Terminator sequencing kit;ABI PRISMª 310 Genetic Analyser,Perkin Elmer,Germany).A549 cells prepared on microscopic glass slides.Following nested PCR,DNA amplicons of 300 bp werefeces of the newborn and from the motherÕs throat imme-diatelly after delivery (Figure 2).CVB3 was identified asthe etiological agent by DNA sequencing.Virus sheddingthe first 6 months of life.ery.Serotype CVB3-specific IgM was positive for 4 weeksand IgG was still present in the boyÕs serum at the age of1year.Intrauterine enteroviral infections in late pregnancy aredifficult to confirm.The clinical picture seen in neonatesdisease including aseptic meningitis,meningoencephalitis,myocarditis and/or hepatitis [3,7,8].This paper reports awith a remarkable bullous-necrotic rash.The diagnosis wasods.neonatal aseptic meningitis [9].Other cutaneous findingshave rarely been reported,especially in neonates.Bowdenet al.[5] observed a case of dermal hematopoiesis causedby congenital coxsackievirus B2 infection.Necrotic skin le-al.[4] in a neonate with fatal echovirus 19 infection.In ourcase,congenital skin lesions at different stages of develop-ment were found.Immediately after birth,the rash sug-gested neonatal varicella infection.However,the motherwas not typical for chicken pox.CVB3 could be identifiedby molecular biological methods.In addition,there wa
sdue to maternal viremia.Mild respiratory symptoms as de-sackievirus infections in adults.Fever,fatigue,nausea,diar-symptoms in children.The infections occurred during thesummer,a typical period for the seasonal spread of en-teroviruses in temperate climates.2days after delivery.Infants with an onset of diseaseInfants with an onset of diseaseModlin[3] postulated that thetiming of maternal infection in relation to delivery is an im-portant determinant for the prognosis of neonatal disease. % A' ( )'* + ( , )- ( . / /00 + 123+ 2) 4 5) + 6 7( /0 //( /1 /- ) % 9+ ) ( ( ( , )- ( 19 CR-00/11_umbr Uhr 327 Black Bogen) *! !! B C ! CD @ 2! ; 9 A" " 9..+19?29??E9?.+! BB !! B!2( ; 9 &@ # 2# & 9..?1782A.8EA...!" $ D0 " $F, &F2( " @ $#99 & ##&&#" & 9.*71?928/7E8/*9/ F 0 &" #F D& $ &- D G2( ; # 2;# &#" $ F& 9..517/27*9E7*599&&& & F , F H F 20 2 # &$ A9 0F&9..71A2A/.EA959AD FB ! " C' " - & & $ $# ! F 9..+17829+**E9++997I F -!# B ( G % ,F &B!! ; 7- &&"$ & ! & # @ & @ &-$# " 9..*19?/2A9.*EAA/*95 F $ B BFB B F D 2( 2 $ $ & - "" ! , 9..?1A/29A/9E9A/89? B (B! , $B D & 2F# " " & " & 99 & , 9..?19529?5E9??
delivery,the fetus has likely acquired IgG antibodies pro-tecting against serious sequelae.However,as our case ofmaternal infection 2 weeks before delivery illustrates,othermitted neonatal enteroviral diseases,including the serotypeof the virus [10],prematurity and/or gender [7].Virus isolation in cell culture is regarded as the ÒgoldstandardÓfor diagnosing enteroviral infections in neonates[11].However,in this case,virus cultures in human embry-successful.Reasons may be a low yield of infectious virus,restricted susceptibility of cell cultures used,or loss of in-vesicles.To achieve an early as well as an accurate diagno-sis,PCR technology is increasingly becoming the standardmethod in medical virology.PCR detection of virus in CSF,blood,vesicles or tissue can be considered as etiological ev-idence.In our case,investigation of swabs from vesicles didnot produce unequivocally positive PCR results,howeverfirmed acute infection.The indirect immunofluorescenceassay,used in this case,has not yet been established as aroutine method.This test is recommended for rapid identi-his test is recommended for rapid identi-detection of enteroviral serotype-specific antibodies [13].In comparison,the neutralization assay,considered theÒgold standardÓfor serological diagnosis of enteroviral in-fections,is time-consuming and expensive.To date,neither causal therapy nor specific prophylaxisfor coxsackievirus and echovirus infections are available.gamma or hyperimmune globulin and leukocyte interferon[10,14] or the transfusion of maternal plasma [15].How-ever,there is no evidence that such treatments prevent thefatal outcome of disease.At present,intensive supportivecare,isolation of the infected infant and strict hygiene arethe most important measures.( 9 @D F F20# &" $ & 9.+519/528+?E8./A % #JK F D 2 &0!H-� C$#99 ( , &- 9.+717+2?/9E?/*7F & %2 & # ; ! 9.++19?2A77EA585 D ( ( , & F !2% " 9. & , 9..919/2*++E*+.? @& D# D2,"" # 2# "&," 9.+.1A/299/5E999/8! "$ (2 #" & D( $ & " $-# - # "; "9.+*198A29?8E9?. 19 CR-00/11_umbr Uhr 328 Black Boge