Human Parechovirus: an Emerging Cause of Sepsis-Like Syndrome in Infants Aged under 3 Months

Abstract

Purpose: This study aimed to investigate the clinical characteristics of human parechovirus (HPeV) infection in sepsis-like syndrome in infants aged under 3 months. Methods: Medical records of infants aged under 3 months with sepsis-like symptoms who were admitted between July 1, 2018 and August 31, 2018 were reviewed. A multiplex reverse transcription-polymerase chain reaction panel test was performed on the cerebrospinal fluid (CSF). Thirty-nine enrolled infants were categorized into three groups: 11 in group 1 (HPeV detected in the CSF), 13 in group 2 (enterovirus detected in the CSF), and 15 in group 3 (no virus detected in the CSF). Results: Compared with groups 2 and 3, a higher proportion of group 1 had tachycardia, tachypnea, apnea, and hypotension (P<0.05). A significantly lower white blood cell (WBC) count was noted in group 1 than in groups 2 and 3 (5,622±2,355/μL, 9,397±2,282/μL, and 12,312±7,452/μL, respectively; P=0.005). The CSF WBC count was lower in group 1 than in groups 2 and 3 (0.9±1.7/μL, 85.1±163.6/μL, and 3.7±6.9/μL, respectively; P=0.068). The proportion of patients requiring inotrope support (36.6% vs. 0% and 6.6%), mechanical ventilation (18.1% vs. 0% and 0%), and high flow nasal cannula (45.4% vs. 15.3% and 6.6%) was higher in group 1 than in groups 2 and 3. All patients recovered completely without complications. Conclusions: HPeV infection shows a severe clinical course and can cause a severe sepsis-like syndrome in infants aged under 3 months. Early diagnosis and proper treatment of HPeV infection are required.

Human parechovirus meningitis in children: state of the art

“…Almost all reports showed that the youngest (under 3 months of age and in particular neonates) were the most affected patients. [ 9 – 12 , 14 , 21 , 23 , 26 – 28 , 32 , 33 , 59 – 62 , 64 – 68 , 70 ]. Of note, an exceptional adolescent onset was reported in an immunosuppressed 17-year-old girl [ 58 ].…”

“…Fever was the most frequent presenting sign [ 1 , 41 , 44 – 47 , 49 , 50 , 52 – 58 ]. In fact, fever occurrence ranged between 80% and 100% [ 8 , 10 – 12 , 14 , 17 , 21 , 23 , 25 – 28 , 32 , 33 , 60 – 64 , 69 , 70 ]. However, in an American retrospective study, 2% of patients reported hypothermia (TC < 35 °C) instead of hyperthermia [ 68 ].…”

“…Other frequent symptoms included irritability, from 40 to 100%, poor feeding, from 42 to 81.8%, and tachycardia ranging from 63.6 to 77% [ 12 , 14 , 26 , 41 , 44 – 46 , 51 – 54 , 58 , 60 , 62 – 64 , 67 – 70 ]. In a few cases lethargy was the presenting symptom, with a prevalence between 14% and 51% [ 1 , 12 , 14 , 26 , 60 , 69 ].…”

“…Moreover, 15 reports evidenced the presence of seizures [ 1 , 10 , 11 , 21 , 26 , 28 , 45 , 50 , 58 , 62 , 65 – 68 , 70 ]. Their occurrence may vary from 3.1 to 65.2% [ 10 , 11 , 21 , 26 , 28 , 62 , 65 – 68 , 70 ].…”

“…Other symptoms involving the respiratory system have been described, including coryza, cough, breathing difficulties, apnea and tachypnea. Their reported occurrence varied from 37.5 to 18.2% [ 11 , 64 , 68 , 70 ].…”