Comparison of epidemiology and clinical characteristics of infections by human parechovirus vs. those by enterovirus during the first month of life

Abstract

Human parechoviruses (HPeV) have been recently recognized as important viral agents in paediatric infections. The aims of this study were to investigate the HPeV infection prevalence in infants <1 month in Spain and, secondly, to analyse the clinical and epidemiological characteristics of the infected patients compared with those infected by enterovirus (EV). Infants <1 month with neurological or systemic symptoms were included in a multicentre prospective study. EV and HPeV detection by RT-PCR and genotyping were performed in cerebrospinal fluids (CSF), sera or throat swabs. Out of the total of 84 infants studied during 2013, 32 were EV positive (38 %) and 9 HPeV positive (11 %). HPeV-3 was identified in eight cases and HPeV-5 in one. Mean age of HPeV-positive patients was 18 days. Diagnoses were fever without source (FWS) (67 %), clinical sepsis (22 %) and encephalitis (11 %). Leukocytes in blood and CSF were normal. Pleocytosis (p = 0.03) and meningitis (p = 0.001) were significantly more frequent in patients with EV infections than with HPeV.Conclusions: Although HPeV-3 infections were detected less frequently than EV, they still account for approximately 10 % of the cases analysed in infants younger than 1 month. HPeV-3 was mainly associated with FWS and without leukocytosis and pleocytosis in CSF. In these cases, HPeV screening is desirable to identify the aetiologic agent and prevent unnecessary treatment and prolonged hospitalization. What is Known:• Human parechovirus may be a cause of fever and clinical sepsis in the neonatal period.• HPeV-3 might be one of the main agents causing severe neonatal neurological infections. What is New: • This is the first multicenter prospective study focused on newborns and contributes to a better knowledge of these viral infections. Clinical characteristics of enterovirus and parechovirus infections are compared specifically in the neonatal period.• Knowledge of HPeV infections by paediatricians and neonatologists can guide the diagnosis of these patients and avoid unnecessary treatment and prolonged hospitalization.

Prevalence and characteristics of human parechovirus and enterovirus infection in febrile infants

“…EV peaked in August and September and was detected over a longer term than HPeV. The seasonal characteristics are similar to those in recent studies …”

“…In the present study the viral epidemiology of febrile infants aged <3 months near Tokyo, Japan was clarified (Table ). The prevalences of HPeV and EV of 19.6% and 30.4%, respectively, noted in the present study were similar to the 10.7% and 38.1% found in a recent Spanish study of infants up to 1 month of age using CSF, sera and throat swabs . Few reports have assessed the prevalence in Asia …”

Fifteen-minute consultation: enterovirus meningitis and encephalitis—when can we stop the antibiotics?

“…Only 18% had a predominance of lymphocytes. Studies investigating blood CRP have found a median (IQR) range of 17 (7–26) mg/L10 and 6 (4–13) mg/L11 and a mean (SD) of 10.8 (27) mg/L 12. The study by Sormunen et al 13 found that 93% of infants had a CRP <20 mg/L and the maximum CRP was 40 mg/L, and in the study by Michos et al 3 the CRP was <20 mg/L in 84% of patients (note units in the referenced published article were stated as mg/dL due to a typographical error).…”

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.…”