A respiratory swab found the virus that was making newborns septic

Enterovirus infections can cause severe disease in neonates, and in a
newborn the presentation is sepsis: a very sick baby, with no obvious cause.

In 2023, a cluster of neonatal enterovirus infections occurred in **San
Diego, California**. It was initially suspected to be echovirus 11, and
subsequently identified as Coxsackie B4 and B5.

What found it

**Respiratory panel polymerase chain reaction testing for
rhinovirus-enterovirus facilitated diagnosis of enterovirus infection in
these infants.**

A respiratory viral panel is the test ordered for a child with a cough. It
includes a combined rhinovirus/enterovirus target — and that target is what
flagged an enterovirus in babies being worked up for sepsis.

The diagnosis came from a test nobody orders for this question.

Why that matters clinically

A neonatal sepsis evaluation is built around bacteria: blood cultures, a
lumbar puncture, empirical antibiotics. Enterovirus testing is a specific
request that has to be thought of, and if it is not, a viral cause can go
unidentified while the baby is treated for something else.

**Respiratory virus panel PCR testing in neonates can be a useful diagnostic
tool for enterovirus sepsis evaluations.**

An inexpensive, widely available test, repurposed.

And a correction to expectations

**Coxsackie virus as well as echovirus can cause severe disease in
neonates.**

Echovirus 11 has been the focus of recent concern about severe neonatal
enterovirus disease. This cluster was Coxsackie — so a clinician assuming
echovirus, and a laboratory looking only for it, would have missed the answer
here.

*Source: Sanchez R, Capossela E, Speziale M, et al. Notes from the Field:
Respiratory Viral Panel as an Early Diagnostic Tool for Neonatal Enterovirus
Infection — San Diego, California 2023. MMWR, Centers for Disease Control and
Prevention.*