Human Parechovirus 3 Causing Sepsis-like Illness in Children From Midwestern United States

Abstract

: To our knowledge, this is the first multiyear prevalence report of HPeV CNS infection in the United States. HPeV CNS infection was detected mostly in male infants with sepsis-like illness during the late summer/autumn season. Routine seasonal CSF testing in infants for HPeV plus enterovirus may improve etiologic detection and clinical management of infantile sepsis-like presentations.

Detection of Viruses in Young Children With Fever Without an Apparent Source

“…7,28 We tested for HHV-6 in plasma rather than whole blood, to avoid detecting latent virus in circulating mononuclear cells where it can be latent. 29 As in other recent studies, 28,30 we detected most parechoviruses in children younger than 6 months.…”

Human Parechoviruses, New Players in the Pathogenesis of Viral Meningitis

“…The majority (54-80%) of the children also show sepsis-like illness, defined as fever or hypothermia with signs of circulatory and/or respiratory dysfunction defined by tachycardia or bradycardia, low blood pressure and/or decreased saturation (Benschop et al, 2006a;Harvala et al, 2009;Selvarangan et al, 2011;Wolthers et al, 2008). Additional clinical symptoms frequently seen in HPeV3 infections are maculopapular rash, gastrointestinal symptoms and respiratory symptoms (Benschop et al, 2006a;Selvarangan et al, 2011;Verboon-Maciolek et al, 2008a;Wolthers et al, 2008).…”

“…Screening of CSF samples show HPeV3 to be the dominant type found in children, in particular neonates (Benschop et al, 2008c;Harvala et al, 2009Harvala et al, , 2011Pineiro et al, 2010;Renaud et al, 2011;Selvarangan et al, 2011;Verboon-Maciolek et al, 2008aWatanabe et al, 2007;Wolthers et al, 2008). These infections account for approximately 3-17% of CNS infections reported as meningitis or encephalitis (Harvala et al, 2009;Pineiro et al, 2010;Watanabe et al, 2007;Wolthers et al, 2008;Yamamoto et al, 2009), far exceeding the percentage of herpes simplex virus infections.…”

Human picornaviruses associated with neurological diseases and their neutralization by antibodies

“…Such illnesses typically present with fever, seizures, irritability, respiratory and gastrointestinal problems, and occasional rash, and are indistinguishable from severe EV infections [34,105]. The fraction of symptomatic HPeV-3-infected infants that develop sepsis-like illness can exceed 80 %; most such patients require hospitalization and up to one-third of them are admitted to the ICU [104][105][106]. The CNS symptoms of HPeV-3 infection can include meningitis, meningoencephalitis, encephalitis or cerebral haemorrhage, with occasional white-matter alterations [107,108].…”

“…They have been documented in Europe [99], North America [100], Asia [101] and Australia [102], and are regularly associated with a variety of clinical presentations, from mild gastrointestinal or respiratory illness to life-threatening conditions in neonates [36,96,103]. It can cause systemic infections with possible neurological involvement in infants, which are collectively described as 'sepsis-like illnesses' [98,99,104]. Such illnesses typically present with fever, seizures, irritability, respiratory and gastrointestinal problems, and occasional rash, and are indistinguishable from severe EV infections [34,105].…”