2025 Volume 61 Issue 2 Pages 394-398
Echovirus 11（E-11）, a member of the Enterovirus genus, causes a broad spectrum of illnesses ranging from asymptomatic to life-threatening manifestations. In recent years, E-11 has been increasingly recognized as a cause of severe neonatal infections, often presenting with sepsis, multi-organ failure, and high mortality rates. In May 2023, an initial report from France described nine cases of severe E-11 infection. In Japan, severe neonatal fatalities due to E-11 have been reported since 2024. We present a case of neonatal E-11 infection. The mother, at 35 weeks and 2 days of gestation, was admitted to the obstetrics unit for persistent fever and abdominal pain. Laboratory findings revealed an elevated C-reactive protein（2.26mg/dL）with a normal white blood cell count. Suspecting chorioamnionitis, an emergency cesarean section was performed. The neonate had a birth weight of 2,561g and Apgar scores of 9 at both 1 and 5 minutes. Postpartum, the mother’s symptoms resolved, and the mother-newborn contact was permitted. On day three, the neonate developed apnea requiring respiratory support. On day four CSF sample was taken and E-11 PCR was positive. By the day eight, the infant developed liver failure, which rapidly progressed to multi-organ failure, and severe coagulopathy, leading to death. The clinical presentation suggested maternal E-11 infection with vertical transmission to the newborn. The mild CRP elevation with a normal white blood cell count further supported a viral rather than a bacterial infection. When maternal fever with abdominal pain occurs during pregnancy, given the increasing reports of severe neonatal E-11 infections, clinicians should maintain a suspicion of the possibility of E-11 infection. The timing and mode of delivery, as well as postnatal mother-infant contact, should be carefully considered.
