PCR for the identification of enteroviral infection in febrile infants during non-summer months

INTRODUCTION: Enteroviruses are believed to be important pathogens in infants, however, their overall contribution to fever in this age group, especially during non-summer months, is unknown. The availability of PCR for the diagnosis of enteroviral infection prompted an epidemiological investigation of the seasonal incidence of enteroviral infections in febrile infants. METHODS: As part of an on-going study, all unimmunized, febrile infants aged 1-90 days, admitted to Primary Children's Medical Center (Salt Lake City, UT) for a sepsis evaluation were enrolled. Specimens of blood, urine, and cerebrospinal fluid were tested for enteroviruses using a PCR assay (Roche Molecular Systems). Sequencing of PCR products was done to distinguish polio from non-polio enteroviruses. The results of all bacterial cultures, as well as information on outcome and charges was also collected. RESULTS: 130 infants were enrolled between 12/96 and 4/97. 13/130 (10%) were positive for enteroviruses on at least one sample. The incidence of enteroviral infection ranged from 2.5% in January to 14.6% in March. Sequencing confirmed that these were non-polio enteroviruses. One infant had a concomitant urinary tract infection requiring antibiotic treatment. All other infants recovered spontaneously from their infections. For infants with enteroviral infection alone, the average length of stay was 3.5 days with an average charge of $5,000. CONCLUSIONS: Non-polio enteroviral infections are common causes of fever in infants even during winter months. The use of PCR to identify these infants should be considered. Early identification may decrease length of hospital stay and unnecessary antibiotic administration.