Problemi speciali
Le infezioni da enterovirus nel neonato e nel lattante
Enteroviral infections in newborns and infants
Marcello Sandoni1, Lidia Ciardo1, Caterina Tamburini1, Lucia Marrozzini2, Alessandra Boncompagni2, Cecilia Rossi2, Isotta Guidotti2, Elisabetta Garetti2, Katia Rossi2, Licia Lugli2, Lorenzo Iughetti1,3, Alberto Berardi2
1Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia, Modena
2UO di Terapia Intensiva Neonatale, Dipartimento di Scienze Mediche e Chirurgiche Materno-Infantili e dell’Adulto,
Azienda Ospedaliero-Universitaria Policlinico, Modena
3UO di Pediatria, Azienda Ospedaliero-Universitaria Policlinico, Modena
Settembre 2023 - pagg. 437 -443 | DOI: 10.53126/MEB42437
Abstract
Enteroviruses (EV) are a relevant source of infection in paediatric patients. The majority of cases concerns the neonatal period and the first months of life. Due to their extreme epidemiological fluctuations, molecular epidemiology is crucial to understand the circulation of main serotypes in a specific area and period. The gold standard for the diagnosis currently relies on Polymerase Chain Reaction (PCR) assay to detect EV RNA in biological samples (usually cerebrospinal fluid and plasma, but also throat swabs and faeces). EV infections usually have a benign course and prognosis. Nevertheless, they may become life threatening, especially when the onset of symptoms occurs in the first days of life. Mortality is associated with myocarditis, hepatitis and multi-organ failure. Neurodevelopmental sequelae have been reported in cases of severe infection with central nervous system involvement (such as meningo-encephalitis). Even though the use of specific antiviral agents in severe neonatal infections has been reported in single cases or studies including few neonates, the current treatment of EV infections remains mainly supportive and further studies are needed to endorse the use of these drugs in clinical practice.
Riassunto
Gli enterovirus (EV) rappresentano una fonte di infezione prominente nella popolazione pediatrica. La maggior parte dei casi interessano il periodo neonatale e i primi mesi di vita, epoca in cui le infezioni hanno maggiore rilevanza dal punto di vista clinico. La marcata variabilità epidemiologica degli EV rende cruciale la cosiddetta epidemiologia molecolare, volta a identificare le varianti sierotipiche maggiormente circolanti in determinate aree e periodi di tempo. La diagnosi di tali infezioni si basa attualmente sull’identificazione di RNA virale in campioni biologici (solitamente liquor e sangue, ma anche materiale respiratorio o campioni di feci) mediante Polymerase Chain Reaction (PCR). Le infezioni da EV presentano generalmente un decorso benigno con un’ottima prognosi; possono tuttavia presentare caratteristiche di maggiore severità, specialmente quando esordiscono nei primi giorni di vita. I quadri clinici associati a mortalità più elevata sono miocardite, epatite e insufficienza multiorgano. Nei casi di infezione severa con coinvolgimento del sistema nervoso centrale (meningo-encefalite) sono descritte sequele neurocognitive a lungo termine. Nonostante l’uso di agenti antivirali sia riportato in singoli casi o studi coinvolgenti un piccolo numero di neonati con infezione severa, il trattamento di queste infezioni rimane a oggi prevalentemente di supporto e ulteriori studi saranno necessari per confermare l’effettiva utilità di questi farmaci nella pratica clinica.
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Corrispondenza: marrozzini.lucia@aou.mo.it