Hey Fletch...can I read your notes?

Last night, Kendra confessed that she never considered the severity of Joe's illness. It was God's grace, because it remained at the forefront of my mind since arriving in the PICU. Since we want to chronicle this event in the life of our family and remember how God answered our prayers and spared Joe's life, I took the time to research the enterovirus. Back in school, I would occasionally share my notes with classmates (except for Dr. Jody Burkes...JBB was smarter than me, and my notes would have hindered her advancement into medicine). Anyhow, I thought you might want to cheat and look at the notes I have taken this week, it's a bit medical, but remarkable when you consider the potential.

The Human Enterovirus:
How do you get it?
"...(a family of viruses) found throughout the world, which are transmitted from person to person through fecal-oral contact..."

What is it?
The Enterovirus family includes the Polio virus:
"...Polioviruses, the prototypic enteroviruses...has been eradicated in the United States"

The Enterovirus family also includes a variety of Non-Polio viruses:
"The non-polio enteroviruses continue to be responsible for a wide spectrum of disease in persons of all ages, although infection and illness occur most commonly in infants and young children."

In adults, the Enterovirus can cause really bad diarrhea and vomiting, but what does it do in babies like Joe?
"...Although many enterovirus serotypes cause the same self-limited clinical syndromes in neonates as they do in older persons...some are capable of producing fatal disease in the newborn infant..."

"...The group B coxsackievirus serotypes 2 to 5 and echovirus 11 are most frequently associated with overwhelming, systemic neonatal infections..."

"...The outcome of neonatal infection is strongly influenced by the presence or absence of passively acquired maternal antibody specific for the infecting enterovirus serotype..."

"...Early symptoms may be mild and nonspecific, including listlessness, anorexia, and transient respiratory distress. (Note: this is how Kendra found him on Thursday morning last week). Approximately one-third of cases have a biphasic illness with a period of one to seven days of apparent well-being interspersed between the initial symptoms and the appearance of more serious manifestations..." (We now believe that Christian, Caroline, Kendra and I all had minor versions of this virus in early June and probably harbored the virus for a few weeks before inoculating Joe).

"...Generalized enterovirus disease in the newborn most often occurs in one of two characteristic clinical syndromes: myocarditis or fulminant hepatitis. Neonatal myocarditis, which is often accompanied by encephalitis and sometimes by hepatitis, is characteristically a manifestation of group B coxsackievirus infection. Fulminant hepatitis presents with hypotension (low blood pressure), profuse bleeding, jaundice, and multiple organ failure..." (Joe had representations of both syndromes, plus the potential of long term damage to his brain).

"...The management of neonatal enteroviral disease is supportive. (This was the case with Joe, they couldn't do anything to cure him, they only treated him by reacting to his symptoms). Infants in congestive heart failure require judicious fluid management and administration of inotropic agents and diuretics. The profuse bleeding and coagulopathy that result from hepatic failure necessitate frequent replacement therapy with packed red blood cells, platelets, and fresh-frozen plasma. Vitamin K should be administered intravenously in pharmacologic doses..." (Joe had each of these given to him throughout the week)

"...Large doses of IVIG, which have been reported to improve outcome in at least one case, may be justified given the extremely poor prognosis. Pleconaril, an orally administered experimental anti-picornavirus drug, is undergoing evaluation in infants with serious enterovirus infections. It is available on a compassionate use basis from the manufacturer, ViroPharma Inc., Exton, PA..." (Again, they treated Joe proactively with IVIG and when they researched the availability of Peconaril it turned out that it is no longer even being made, so it was not an option - even for compassionate use!).

I hope the information helps! asked our doctor today about Joe's continued prognosis and he said that it could have gone either way. We are thankful for God's goodness!

Quietly Making Noise,

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