First reported case of Human Parechovirus encephalitis in an adult patient complicated by Refractory Status Epilepticus

Abstract

HighlightsHuman Parechovirus (HPeV) infections are common amongst young children. However, data in adult cases are lacking.We report a unique case of HPeV meningoencephalitis in an adult complicated by Refractory Status Epilepticus (RSE).This case expands the epidemiological knowledge of HPeV and when to test for it in adults.

Human parechovirus are emerging pathogens with broad spectrum of clinical syndromes in adults

“…[44][45][46][47][48][49]73 Myalgia is a more common presentation, which occurs sporadically 42,44,48,73 or as outbreaks. 46,47,49 Generally, myalgia involving muscles of the extremities (can persist for days or weeks), 19,40,[44][45][46][47][48][49]73 moderate to high grade fever, 42,[45][46][47][48][49]70,73,74 weakness, 39,[45][46][47]49,70,74 sore throat 42,45,47,49,73 and scrotal pain (in male) 42,[45][46][47]49 are the most common symptoms in adult infected with HPeV. Other notable symptoms includes diarrhea 19,…”

“…42,43,[45][46][47][48]70,73 Systemic symptoms like cough, dyspnea, and chest pain are seen in patients with cardiopulmonary disease, [39][40][41]71,72 while body weakness, inability to walk, reduced muscle tone, dysarthria, malaise, paresthesia, deafness and seizure (or convulsion) are mostly associated with CNS disease. 39,70,74 The acute stage of the infection usually lasts 1 to 7 days except in people with severe diseases and those who develop Prognosis depends on PeV genotype, age of the patient, the system involved, and background medical condition. 39,44,70,71,74 Both PeV-A3 and 1 have been associated with severe disease presentations and cause mortality in adult.…”

“…71 Subsequently, the rate of PeV infection in adults increases and becomes apparent. PeVs are now recognized as important pathogens outside the pediatric age group and cause various clinical conditions in adults, among which are, upper and lower respiratory illnesses, 19,71,72 diarrhea, 19,43 myalgia, 42,[44][45][46][47][48][49]73 myocarditis, 39,40 pericarditis, 41 encephalitis, 39,74 epilepsy, 74 scrotal effusion, 45 mouth ulcer 45 and other forms of CNS disease presentations. 19,74 In particular, PeV-A3 was found as a cause of uterine contraction leading to bleeding per vaginum at 37 weeks gestational age in a 28-year old woman who ended up with a cesarean section.…”

“…[45][46][47]49 The infections can be more severe in the elderly and those with other background medical conditions. 19,39,44,71,74 Therefore, with frequent circulation and potential threats of HPeVs in children, most especially PeV-A3, it is not surprising that many adults develop an asymptomatic infection with no overt clinical disease or nonspecific symptoms that go unchecked since many clinicians are not familiar with the presentations.…”

Parechovirus A prevalence in adults in The Netherlands

“…Overall, the clinical relevance of HPeV infections in adults remains largely unknown. Several studies have found a very low HPeV prevalence in adults compared to children [2][3][4][5][6], although cases of adults experiencing severe illness caused by HPeV have been described [7][8][9][10]. We performed a retrospective study to identify the HPeV prevalence in adults in a tertiary hospital in Amsterdam, The Netherlands, and to determine the clinical relevance of these viruses in adults.…”