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LETTER TO EDITOR
Year : 2018  |  Volume : 7  |  Issue : 2  |  Page : 479  

Coxsackie encephalitis in a child in Western India: Correspondence


1 Department of Pediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India
2 Department of Pediatrics, Kalawati Saran Children's Hospital, New Delhi, India

Date of Web Publication11-Jul-2018

Correspondence Address:
Dr. Anirban Mandal
Department of Pediatrics, Sitaram Bhartia Institute of Science and Research, B-16, Qutub Institutional Area, New Delhi - 110 016
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_294_17

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How to cite this article:
Mandal A, Sahi PK. Coxsackie encephalitis in a child in Western India: Correspondence. J Family Med Prim Care 2018;7:479

How to cite this URL:
Mandal A, Sahi PK. Coxsackie encephalitis in a child in Western India: Correspondence. J Family Med Prim Care [serial online] 2018 [cited 2019 Aug 25];7:479. Available from: http://www.jfmpc.com/text.asp?2018/7/2/479/236411



Dear Editor

After reading the case report by Shah and Ambulkar [1] in the latest issue of your journal with great interest, we feel that few clarification is required and also would like to make the following comments which is expected to benefit the general readers of JFMPC.

First, we strongly disagree with a diagnosis of “encephalitis” in the presented case. The 5½-year-old girl was hospitalized with acute onset fever, vomiting for 1 day, and one episode of generalized clonic convulsion without any postictal drowsiness. On examination, there were neither any signs of meningeal irritation nor focal neurological deficit. The diagnosis of encephalitis requires altered mental status lasting ≥24 h with no alternative cause identified.[2] Looking at the clinical picture, the patient appeared to be a case of viral “aseptic meningitis” rather than “encephalitis.”

Second, in view of the central nervous system involvement, hepatitis, myocarditis, myositis, and coagulopathy with thrombocytopenia and a previous rash, the authors' suspected a possible Coxsackie infection. They confirmed the diagnosis with a positive Coxsackie IgM ELISA. However, except the previous history of typical rashes, all other features can be present in a case of enteroviral infection other than coxsackie as well.[3] Furthermore, the coxsackie IgM ELISA has a poor specificity and can be positive in cases of other enteroviral infections (e.g., echovirus and poliovirus type 3) and infectious mononucleosis and in Mycoplasma pneumoniae infection as well.[4] A positive coxsackie IgM ELISA has also been found in asymptomatic children possibly secondary to a nonclinical infection.[5] The positive coxsackie IgM ELISA in this particular patient simply could be due to the infection 2 months back. Therefore, in this case, a definite diagnosis of coxsackievirus CNS infection would better have been done with a cerebrospinal fluid polymerase chain reaction.[6]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Shah I, Ambulkar H. Coxsackie encephalitis in a child in Western India. J Family Med Prim Care 2017;6:151-2.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Venkatesan A, Tunkel AR, Bloch KC, Lauring AS, Sejvar J, Bitnun A, et al. Case definitions, diagnostic algorithms, and priorities in encephalitis: Consensus statement of the international encephalitis consortium. Clin Infect Dis 2013;57:1114-28.  Back to cited text no. 2
    
3.
Noor A, Krilov LR. Enterovirus infections. Pediatr Rev 2016;37:505-15.  Back to cited text no. 3
    
4.
Swanink CM, Veenstra L, Poort YA, Kaan JA, Galama JM. Coxsackievirus B1-based antibody-capture enzyme-linked immunosorbent assay for detection of immunoglobulin G (IgG), IgM, and IgA with broad specificity for enteroviruses. J Clin Microbiol 1993;31:3240-6.  Back to cited text no. 4
    
5.
Frisk G, Friman G, Tuvemo T, Fohlman J, Diderholm H. Coxsackie B virus IgM in children at onset of type 1 (insulin-dependent) diabetes mellitus: Evidence for IgM induction by a recent or current infection. Diabetologia 1992;35:249-53.  Back to cited text no. 5
    
6.
Rhoades RE, Tabor-Godwin JM, Tsueng G, Feuer R. Enterovirus infections of the central nervous system. Virology 2011;411:288-305.  Back to cited text no. 6
    




 

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