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

Sano, Kentaro; Hamada, Hiromichi; Hirose, Shoko; Sugiura, Kenta; Harada, Satoko; Koizumi, Mai; Hara, Mayumi; Nishihara, Haruna; Taira, Masakatsu; Ogura, Atsushi; Ogawa, Tomoko; Takanashi, Jun‐ichi

doi:10.1111/ped.13467

Cited by 23 publications

(25 citation statements)

References 38 publications

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“…Since most infants with PeV-positive CSF have no pleocytosis (2,9,26,27), our data underscore the need for clinicians to consider testing for PeV regardless of CSF leukocyte count values in order to optimize diagnosis and management of infants presenting with symptoms that necessitate a sepsis work-up. Differentiation of PeV types for clinical management may not be necessary, since no specific treatment or differences in clinical course is noticed between the two PeV types; however, epidemiological studies should consider PeV typing to see if clinical course and outcomes vary between PeV types in future outbreaks.…”

Section: Discussionmentioning

confidence: 82%

Emergence of Parechovirus A4 Central Nervous System Infections among Infants in Kansas City, Missouri, USA

et al. 2019

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Among known parechovirus (PeV) types infecting humans, PeV-A3 (formerly HPeV3) and PeV-A1 (formerly HPeV1) are associated with pediatric central nervous system (CNS) infections. The prevalence of PeV-A3 among hospitalized infants with sepsis-like illness and viral CNS infection is well described; however, the contribution of PeV-A4 to infant CNS infection is relatively unexplored. We report the first 11 U.S. cases of PeV-A4 CNS infections occurring in Kansas City infants during 2010 to 2016 and compare the clinical presentation with that of PeV-A3. PeV-positive cerebrospinal fluid (CSF) specimens from 2010 to 2016 underwent sequencing for genotyping. Among all PeV-CSF positives, PeV-A4 was detected in 11 CSF samples from 2010 to 2016. PeV-A4 was first detected in 2010 (n ϭ 1/4), followed by detections in 2014 (n ϭ 1/39), 2015 (n ϭ 6/9), and 2016 (n ϭ 3/33). The median age of PeV-A4-infected infants in weeks (median, 4; range, 1 to 8) was similar to that of infants infected with PeV-A3 (median, 4; range, 0.25 to 8). Clinical characteristics of PeV-A4 (n ϭ 11) were compared with those of select PeV-A3-infected children (n ϭ 34) with CNS infections and found to be mostly similar, although maximum temperature was higher (P ϭ 0.017) and fever duration was shorter (P ϭ 0.03) for PeV-A4 than for PeV-A3. Laboratory test results were also similar between genotypes, although they showed significantly lower peripheral white blood cell (P ϭ 0.014) and absolute lymphocyte (P ϭ 0.04) counts for PeV-A4 infants. Like PeV-A3, PeV-A4 caused summer-fall seasonal clusters of CNS infections in infants, with mostly similar presentations. Further surveillance is necessary to confirm potential differences in laboratory findings and in fever intensity/duration.

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Section: Discussionmentioning

confidence: 82%

Emergence of Parechovirus A4 Central Nervous System Infections among Infants in Kansas City, Missouri, USA

et al. 2019

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“…With the advent of more sensitive molecular assays, HPeV is now recognised as a small but significant cause of illness in infants aged < 3 years. HPeV was detected in 3–8% of children presenting to emergency with undifferentiated fever in European studies 6 , 7 and appears to be more common in younger children and in children requiring hospital admission, where up to 15–20% of children with fever without source are HPeV‐positive 8 , 9 . Serological data from Europe and Japan show that 90% of infants have been infected with at least one HPeV subtype by the age of 2 years 5 …”

Section: Virology and Epidemiologymentioning

confidence: 99%

“…Stool testing appears to be most sensitive (95–98%), followed by CSF testing (84–95%) 12 , 36 . Characteristically, CSF pleocytosis is mild or absent in HPeV3 central nervous system infection, in contrast to other causes of encephalitis 8 , 12 , 14 , 18 , 19 , 23 …”

Section: Diagnosis Of Parechovirusmentioning

confidence: 99%

Parechovirus: an important emerging infection in young infants

Britton

Jones

Macartney

et al. 2018

Medical Journal of Australia

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Epidemics of human parechovirus (HPeV) causing disease in young children have occurred every 2 years in Australia since 2013. HPeV genotype 3 caused the epidemic from late 2017 to early 2018. Most HPeV infections cause no or mild symptoms including gastroenteritis or influenza-like illness. Characteristically, young infants present with fever, irritability and on occasions a diffuse rash ("red, hot and angry" babies). Severe disease can manifest as meningoencephalitis, seizures or sepsis-like presentations (including septic shock), or less common presentations including signs of surgical abdomen. Testing for HPeV by specific molecular tests is indicated in children younger than 6 months of age with characteristic presentations without another confirmed diagnosis including febrile illnesses with other suggestive features (eg, rash, seizures), sepsis syndromes (including shock), and suspected meningoencephalitis (which may be detected by magnetic resonance imaging only). There are no effective antiviral therapies. Treatment is primarily supportive, including management of complications. Some infants with severe HPeV infection may have adverse neurodevelopment. Follow-up by a paediatrician is recommended.

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“…reported lower rates of sepsis, severe sepsis and septic shock (64, 11 and 7%, respectively); however, their study included hospital and PICU admissions . In another series of hospitalised children, sepsis criteria were met in 91% of children with HPeV . Systemic inflammatory response syndrome (SIRS) was manifested by most children with HPeV, yet it did not translate into increased mortality consistent with recent studies validating sepsis definitions .…”

Section: Discussionmentioning

confidence: 77%

“…There are four species, parechovirus A to D, with 19 types of parechovirus A, known as human parechovirus (HPeV) 1–19 . Since its first report of disease in children in 2004, an increasing body of literature from around the world has described HPeV3 infections in neonates and infants causing sepsis‐like illness and central nervous system (CNS) infection, with the potential to cause impaired neurodevelopmental outcomes . Previous reports indicate substantial morbidity, with 9–50% of hospital admissions requiring PICU admission, yet there is a paucity of data specifying severity, management and outcomes of infants with HPeV infection requiring PICU admission (Table ).…”

Section: Literature Review On Previously Published Reports On Human Pmentioning

confidence: 99%

Paediatric intensive care admissions during the 2015–2016 Queensland human parechovirus outbreak

McKenna

Joseph

Sargent

et al. 2019

J Paediatrics Child Health

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Aim: The human parechovirus (HPeV) has emerged as a pathogen causing sepsis-like presentations in young infants, but there is a lack of data on HPeV presentations requiring intensive care support. We aimed to characterise the clinical presentation, disease severity, management and outcome of a population-based cohort of children with microbiologically confirmed HPeV infection requiring admission to paediatric intensive care units (PICUs) in Queensland, Australia during a recent outbreak. Methods: This was a multicentre retrospective study of children admitted to PICU between 1 January 2015 and 31 December 2016 with confirmed HPeV infection. Results: Thirty infants (median age 20 days) with HPeV genotype 3 were admitted to PICU, representing 16% of all children with HPeV admitted to hospital and 6.4% of non-elective PICU admissions in children <1 year of age. Children requiring PICU admission were younger than children admitted to hospital (P = 0.001). Apnoea, haemodynamic instability with tachycardia and seizures represented the main reasons for PICU admission. Eleven children (37%) required mechanical ventilation for a median duration of 62 h, 22 (73%) received fluid boluses and 7 (23%) were treated with vasoactive agents for a median duration of 53 h. Median length of stay was 2.62 days. A total of 24 children (80%) fulfilled sepsis criteria, 14 (47%) severe sepsis and 7 (23%) septic shock criteria. Eight (27%) had abnormal brain magnetic resonance imaging. No patient died. Conclusions: We confirm that HPeV infection is an important cause of sepsis-like syndrome in infants with substantial associated morbidity. Optimal management and long-term outcomes require further investigation.

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

Abstract: HPeV and EV are important causal viruses of FWS. Characteristic clinical pictures exist in these virus infections, but further research is needed to accumulate more cases to produce a comprehensive picture of these virus infections.

Cited by 23 publications

References 38 publications

Emergence of Parechovirus A4 Central Nervous System Infections among Infants in Kansas City, Missouri, USA

Emergence of Parechovirus A4 Central Nervous System Infections among Infants in Kansas City, Missouri, USA

Parechovirus: an important emerging infection in young infants

Paediatric intensive care admissions during the 2015–2016 Queensland human parechovirus outbreak

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