Characteristics of Young Infants in Whom Human Parechovirus, Enterovirus or Neither Were Detected in Cerebrospinal Fluid During Sepsis Evaluations

Abstract

Background-Human Parechovirus (HPeV) causes central nervous system (CNS) infection in infants. To further understand HPeV CNS infection, we describe its clinical, laboratory and epidemiologic characteristics from a Midwestern U.S. tertiary care center. Because HPeV CNS infections have appeared clinically and seasonally similar to enterovirus (EV) infections, we retrospectively compared characteristics of young infants undergoing sepsis evaluations in whom HPeV, EV or neither were detected in CSF.

Parechovirus Encephalitis and Neurodevelopmental Outcomes

“…Similar changes have been described in neonatal enterovirus 42,43 where, interestingly, an absence of CSF pleocytosis often occurs. 16,40 Furthermore, these imaging findings are reminiscent of perinatal WM injury from other causes that are known to result in periventricular leukomalacia and a high risk of cerebral palsy. 44,45 The periventricular and subcortical WM is vulnerable in young children, especially premature infants, and similar patterns of cellular damage can be initiated by ischemia, inflammation, or both.…”

“…We note that a similar proportion of girls and ex-premature infants were reported, although not highlighted, by Verboon-Maciolek et al 3 This female predominance among HPeV encephalitis cases is in contrast to a male predominance in studies of HPeV3 with "sepsislike" disease. 11,14,16,20,23 Other studies of HPeV3 CNS infection include relatively few, if any, cliniciandiagnosed encephalitis cases. 6,8,11,14,16,20,22,26,27,41 Among these cases, young age and female gender were prominent (data not presented).The MRI findings of bilateral symmetrical WM abnormalities with diffusion restriction, where present, should encourage clinicians to consider testing for HPeV in cases of neonatal encephalitis/encephalopathy.…”

“…2,5,6,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] As a result, the syndrome of CNS infection with HPeV is inadequately characterized. Further definition of HPeV CNS syndromes are needed because although many infants have benign outcome after CNS infection, 4,8,13,16 there have been isolated reports of adverse neurodevelopmental outcomes with HPeV3 in the context of abnormal neuroimaging. 3,26,27 Encephalitis is the most severe manifestation of HPeV CNS infection and rigorous case definitions for encephalitis have been published in the past 10 years in studies from California, 28 the United Kingdom, 29 and France, 30 as well as consensus definitions from the Brighton Collaboration 31 and the International Encephalitis Consortium.…”

“…2,[8][9][10][11][12][13][14] HPeV3 central nervous system (CNS) infection is associated with young age (<3 months) and absence of CSF pleocytosis. 2,4,6,9,[11][12][13][14][15][16][17][18][19][20] Most reports of HPeV infection of the CNS have been retrospective series identified through sampling of archived laboratory specimens, without application of clinical case definitions for encephalitis. 2,5,6,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] As a result, the syndrome of CNS infection with HPeV is inadequately characterized.…”

Parechovirus como agente etiológico de meningitis y/o sepsis viral en lactantes

“…En los exámenes de laboratorio general destacaron parámetros inflamatorios bajos, leucopenia y aumento de transaminasas, en el contexto de un cuadro viral, lo que ha sido reportado en estudios previos 32,35 . El paciente con HPeV positivo en LCR, presentó un análisis citoquímico de líquido cefalorraquídeo normal para la edad la cual es una de las diferencias descritas al comparar meningoencefalitis por HPeV con EV 37,38 . En el contexto clínico y de laboratorio presentado existe un patrón de sospecha que debe confirmarse con un diagnóstico virológico específico.…”