Neonatal enterovirus infection can range from asymptomatic infection to overwhelming sepsis and death. Severe disease may include hepatic necrosis with disseminated intravascular coagulation (DIC), meningoencephalitis, and myocarditis. The disseminated form with hepatic failure and myocarditis is often fatal. Case fatality rates of 0%-42% have been reported. In one series of 146 neonatal infections, 61 had aseptic meningitis, 43 had a nonspecific febrile illness, and 42 had hepatic necrosis with coagulopathy.

Note: In 2022 and 2023, pediatric invasive group A streptococcal (iGAS) infections and noninvasive group A streptococcal infection cases have been associated with respiratory infections due to enterovirus among other viruses. Concurrent or preceding viral infections, including varicella (chickenpox), may increase risk for iGAS infection. Severe outcomes of iGAS infections include necrotizing fasciitis, streptococcal toxic shock syndrome, and death.