ECHO 9 Virus Infection or Galactosemia

The brief case report titled "Fatal Neonatal Illness Associated with ECHO 9 (Coxsackie A-23) Virus" by Rawls et al. which appeared in Pediatrics, 33:278, may have given an erroneous interpretation of the cause of death. At nine days of age the infant was noted to be lethargic, anorexic, and irritable with jaundice and hepatomegaly. Certainly these are all signs compatible with severe galactosemia. In addition the authors demonstrated galactosuria both by yeast fermentation and paper chromatography.

Because of the lack of family history of galactosemia plus the isolation of ECHO 9 virus from tissues at necropsy the authors concluded the fatal illness was associated with an ECHO 9 virus infection.