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The CVB have long been recognized as significant pathogens of infants and children. Although the major route for transmission of the CVB is fecal-oral, vertical transmission from mother to infant is also possible. This review will focus on the more common or clinically relevant CVB-related syndromes, their diagnosis, treatment, and prevention.

Unlabelled: Ten neonates with coxsackie B viral infection presented over a 3-month period. Clinical features included meningoencephalitis, thrombocytopenia, disseminated intravascular coagulopathy, cardiomyopathy, and hepatitis. Eight infants had multiorgan disease, four with severe myocardial dysfunction, of whom two died. All of the infants with severe disease developed symptoms within 7 days of age. In infants presenting within 10 days of birth, in all cases there were symptoms compatible with maternal infection prior to delivery. Severity was associated with perinatal transmission. Enteroviral polymerase chain reaction of CSF, urine, stool or throat swab was positive in nine of the ten babies. Seven of the infants were treated with a 7-day course of the new anti-picornaviral drug pleconaril (5 mg/kg 3 times daily)., Conclusion: These cases highlight the importance of not missing coxsackie B viral infection in the differential diagnosis of the septic neonate, especially as there is now a potential treatment.

In a population-based setting, we traced serum samples collected at time of birth from 55 mothers whose children later developed insulin-dependent diabetes (IDDM) and matched them pairwise to control subjects who gave birth at the same hospital during the same month. The sera were analysed for IgM antibodies to coxsackie B virus serotypes 2, 3 and 4 (CBV-2, 3 and 4) using a type-specific mu-antibody-capture radioimmunoassay. Despite a decreased power due to the close matching by time of birth we found a significantly higher frequency of CBV-3 IgM at delivery in mothers whose children later became diabetic compared to their matched control subjects. When using the presence of CBV-3 IgM as a risk factor the Mantel-Haenszel odds ratio estimate (95% confidence limits) was 2.57 (1.02; 7.31), p = 0.043. For CBV-2 and CBV-4, respectively no significant difference was found between mothers of patients and control subjects. According to the odds ratio estimate for CBV-3 and the proportion of exposed mothers among patients estimated in this study the aetiological fraction for this risk determinant would be 27%. In conclusion, this study indicates that children of mothers who expressed CBV IgM at delivery are at increased risk for developing childhood onset IDDM. A fetal infection with CBV similar to rubella virus may initiate autoimmunity or cause persistent infection that may lead to progressive beta-cell destruction.

Following an influenza-like illness four patients developed severe pains in the calf muscles. All patients showed elevated levels of serum-creatinin-phosphokinase (CPK) and Coxsackie-B-virus-titers; with the exception of electromyographic abnormalities the other laboratory findings were normal. Because of the diagnosis, myalgia cruris epidemica, only symptomatic treatment was performed. Differential diagnostic and aetiological aspects are discussed.

Two cases of neonatal coxsackie virus B2 infection are described. One infant presented with meningitis and enteritis, the other with rhinitis, meningoencephalitis, and enteritis. Both infants made good recoveries. The virus infection could also be demonstrated in all nonimmune family members, most of whom gave a history of recent mild febrile disease (pharyngitis, diarrhea). Enterovirus infections may be suspected in cases of neonatal meningitis or myocarditis associated with gastrointestinal signs, especially 1. when it is during the hot season July-October, 2. when there has been febrile illness in other family members recently. For an effective and rapid isolation of the agent, rectal swabs or stool specimens not only from the patient, but also from household contacts should be sent to the virus laboratory on several consecutive days. Meningitic infection may be proved by an early c.s.f. sample. For serodiagnosis a first blood specimen should be drawn as soon as possible, a second one some days later. The importance of rapid virological diagnosis and of stringent hygienic measures to prevent spread of the infection is stressed.

We report three cases of the Gianotti-Crosti syndrome (papulovesicular-acro-located syndrome of childhood), a self-limited common disease of childhood, which may be caused by various viral infections. The hepatitis B virus, however, is excluded by definition as a causal agent. The syndrome is characterized by itching papulo-vesicular skin lesions measuring 1-5 mm in diameter and localized to the limbs and face. The clinical and terminological differences between the HBsAG negative Gianotti-Crosti syndrome and the HBsAG positive Gianotti disease are emphasized.

A case of hand-foot-and-mouth disease is reported in a 20-year-old female patient. Infection by Coxsackie A 16-virus was diagnosed by serology.

150 sera from newborn infants were examined by means of counter current electrophoresis for precipitating antibodies against Coxsackie virus Group B and Group A, Type 9 to detect pre- or perinatal Coxsackie virus infections. Fresh Coxsackie virus infections were observed in 16 sera, more than 50% of these sera showed an abnormally high level of IgM.