Re: Coxsackie Virus and Pregnancy

Posted By HFH MD  NL on September 24, 1998 at 10:03:23:

In Reply to: Coxsackie Virus and Pregnancy posted by Brian on September 23, 1998 at 16:48:55:






I saw the 8/14 response to Amy about coxsackie virus and pregnancy.  Our 14-month
old has been diagnosed with this virus and my wife is 5 weeks pregnant.
She's visiting the doctor tomorrow, but suspects she's infected because of
a sore throat.  Are there statistics on outcomes?  For example, we have read
that the fetus gets infected 20% of the time when the mother contracts
rubella and 3% of the time when the mother gets chicken pox in the first
trimester. There are also statistics on the distribution of the severity
of the problems that babies face when infected during the first trimester
with those viruses.  Are similar statistics available for coxsackie?  Thanks.
We are unaware of any such statistics that would answear your question. However I provide you with the following information taken from a data base called REPROTOX. you can further explore it through the attached reference list.
Coxsackie viruses are a heterogeneous group of enteroviruses,
that are usually divided into two major subgroups (A and B).  Some
Coxsackie viruses may be associated with congenital infection of
the newborn.  Coxsackie viral myocarditis has been described in a
number of neonates (1-4).  Coxsackie virus infections have also
been associated with perinatal deaths (5-7,11).  
     It is not known how often pregnant women may transmit a
Coxsackie virus to the offspring either during gestation or at
delivery since most pregnant women infected with this virus have
mild, if any, symptoms.  A study of seven women with nonspecific
febrile illnesses during the third trimester of pregnancy showed
colonization of the cervix, throat, and/or rectum in four of them
(8).  It is known that mice infected with a Coxsackie virus during
pregnancy develop viremia with transplacental passage of the virus
and an increased incidence of abortion (9).  Abnormal cardiac
development has also been seen in the offspring of mice infected
during pregnancy with a Coxsackie virus (10).  Some investigators
suspect an association between prenatal Coxsackie virus infection
and an increased incidence of congenital heart defects (14).  The
possibility that a prenatal Coxsackie B virus infection may
increase the risk of childhood diabetes is also under
investigation (15,16).  
     In humans, evidence of intrauterine fetal acquisition of a
Coxsackie virus consists of IgM antibody titres in cord blood of
affected offspring (11).  In a population of less than 100 women,
a comparison of IgM antibody titres from women with normal
pregnancies and women who had experienced a spontaneous abortion
suggested that infection with a Coxsackie virus may be a causative
agent in some cases of spontaneous abortion (12,13).  The small
number of women in this study could reveal no more than suggestive
data that must be investigated further in larger studies.
Selected References
1. Repke JT et al: Fetal viral myocarditis and congenital
complete heart block in a pregnancy complicated by systemic lupus
erythematosis. A case report. J Reprod Med 32:217-20, 1987.
2. Garel D et al: [Neonatal myocardial infarct associated with
maternal-fetal infection due to Coxsackie B4 virus]. Arch Fr
Pediatr 43:495-6, 1986.
3. Wagner HR: Cardiac disease in congenital infections. Clin
Perinatol 8:481-97, 1981.
4. Assensio AM et al: [Prenatal viral infections and congenital
heart disease]. Minerva Pediatr 31:1077-84, 1979.
5. Christensen KK: Infection as a predominant cause of perinatal
mortality. Obstet Gynecol 59:499-508, 1982.
6. Baker DA, Phillips CA: Maternal and neonatal infection with
coxsackievirus. Obstet Gynecol 55[Suppl]:12S-15S, 1980.
7. Batcup G et al: Placental and fetal pathology in Coxsackie
virus A9 infection: a case report. Histopathology 9:1227-35, 1985.
8. Reyes MP et al: Coxsackievirus-positive cervices in women with
febrile illnesses during the third trimester in pregnancy. Am J
Obstet Gynecol 155:159-61, 1986.
9. Modlin JF, Crumpacker CS: Coxsackievirus B infection in
pregnant mice and transplacental infection of the fetus. Infect
Immun 37:222-6, 1982.
10. Lansdown AB: Coxsackievirus B3 infection in pregnancy and its
influence on foetal heart development. Br J Exp Pathol 58:378-85,
1977.
11. Brady WK, Purdon A Jr: Intrauterine fetal demise associated
with enterovirus infection. South Med J 79:770-2, 1986.
12. Axelsson C, Bondestam K, Frisk G, Bergstrom S, Diderholm H:
Coxsackie B virus infections in women with miscarriage. J Med
Virol 39: 282-5, 1993.
13. Frisk G, Diderholm H: Increased frequency of coxsackie B virus
IgM in women with spontaneous abortion. J Infect 24: 141-5, 1992.
14. Koro'lkova EL, Lozovskaia LS, Tadtaeva LI, Khellenov EA: [The
role of prenatal Coxsackievirus infection in the etiology of
congenital heart defects in children]. Kardiologiia 29:68-71,
1989.
15. Clements GB, Galbraith DN, Taylor KW: Coxsackie B virus
infection and onset of childhood diabetes. Lancet 346:221-2, 1995.
16. Dahlquist GG, Ivarsson S, Lindberg B, Forsgren M: Maternal
enteroviral infection during pregnancy as a risk factor for
childhood IDDM. A population-based case-control study. Diabetes
44:408-13, 1995.