Two Cases Of Neonatal Human Parechovirus 3 Encephalitis

Pariani, Elena; Pellegrinelli, Laura; Pugni, Lorenza; Bini, P; Perniciaro, S.; Bubba, Laura; Prímache, V.; Amendola, Antonella; Barbarini, Mario; Mosca, Fabio; Binda, Sandro

doi:10.1097/inf.0000000000000412

Cited by 17 publications

(5 citation statements)

References 9 publications

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“…Severe PeV3 infections that required intensive care management were more common in younger infants (aged <3 weeks) in our investigation, as previously reported for untyped PeV infections [7]. We also identified seizures [3, 11, 24] associated with white matter changes as an important presentation, which was observed in 7 of 34 infants (6 of 7 in the ICU). As expected, all infants in our investigation who presented with seizures were evaluated for HSV infection and empirically treated with intravenous acyclovir.…”

Section: Discussionsupporting

confidence: 84%

Severe Parechovirus 3 Infections in Young Infants—Kansas and Missouri, 2014

Midgley

Jackson

Selvarangan

et al. 2017

Journal of the Pediatric Infectious Diseases Society

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Section: Discussionsupporting

confidence: 84%

Severe Parechovirus 3 Infections in Young Infants—Kansas and Missouri, 2014

Midgley

Jackson

Selvarangan

et al. 2017

Journal of the Pediatric Infectious Diseases Society

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“…Among PeVs, PeV-A3 is known to induce neurological signs like hypotonia, irritability, drowsiness, and seizures, and other generic signs and symptoms including fever, diarrhoea, abdominal distension, apnoea, and rash (de Crom et al, 2016). PeV infections have been reported in Italy since 2008 and the great majority of them have been due to PeV-A3 (Piralla et al, 2012;Pariani et al, 2014;Piralla et al, 2014;Bubba et al, 2017). There have been no reports of PeV-A5 circulating in Italy or of PeV-A5 in patients with sepsis-like and neurological syndromes.…”

Section: Discussionmentioning

confidence: 99%

Human parechovirus type 5 neurological infection in a neonate with a favourable outcome: A case report

Piralla

Perniciaro

Ossola

et al. 2019

International Journal of Infectious Diseases

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A B S T R A C TThe majority of parechovirus A type 5 (PeV-A5) infections have been reported in patients with gastrointestinal syndromes. In contrast, a sepsis-like illness associated with PeV-A5 infection has been reported only anecdotally. Herein, we report the first case in Italy of a PeV-A5 neurological infection presenting in a neonate with a sepsis-like syndrome. The patient, a healthy male infant born at 41 weeks of gestation, was highly distressed and inconsolable, and had been crying persistently, with poor breastfeeding, since the previous day. From day 2 to day 4, the newborn was feverish with mild irritability; breastfeeding was preserved and regularly supported. His clinical condition progressively improved, with defervescence on day 4. He was discharged after 7 days, and neurological examination results indicated only mild impairment in visual fixation and vertical eye tracking and mild axial hypotonia. The Italian PeV-A5 strain was phylogenetically related to three strains detected in Denmark in 2012, as well as to one detected in Australia and one in Greece in 2015, with an average nucleotide identity of 97.9% (range 95.9-100.0%). Enterovirus/PeV infection in the newborn should be ruled out in cases of infants with unexplained fever and/or a sepsis-like syndrome and/or meningoencephalitis. An aetiological diagnosis is essential to avoid the unnecessary administration of antibiotics and to plan longterm follow-up until schooling.

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“…A few reports have described long-term imaging follow-up, with mixed results. Pariani et al 24 and Amarnath et al 12 had resolution of imaging abnormalities at 2-month and 1-year follow-up, respectively. In 3 patients, Verboon-Maciolek et al 9 reported variable degrees of visible white matter injury at 3-month-to-7-year follow-up, with abnormalities ranging from mild periventricular gliosis to extensive white matter volume loss and cystic encephalomalacia.…”

Section: Discussionmentioning

confidence: 95%

Human Parechovirus Meningoencephalitis: Neuroimaging in the Era of Polymerase Chain Reaction–Based Testing

Sarma

Hanzlik

Krishnasarma

et al. 2019

AJNR Am J Neuroradiol

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Human parechovirus infection is an increasingly recognized cause of neonatal meningoencephalitis. We describe characteristic clinical features and brain MR imaging abnormalities of human parechovirus meningoencephalitis in 6 infants. When corroborated by increasingly available polymerase chain reaction-based testing of the CSF, the distinctive MR imaging appearance may yield a specific diagnosis that obviates costly and time-consuming further clinical evaluation. In our study, infants with human parechovirus presented in the first 35 days of life with seizures, irritability, and sepsis. MR imaging consistently demonstrated low diffusivity within the thalami, corpus callosum, and subcortical white matter with a frontoparietal predominance. T1 and T2 shortening connoting white matter injury along the deep medullary veins suggests venous ischemia as an alternative potential pathogenetic mechanism to direct neuroaxonal injury.

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Two Cases Of Neonatal Human Parechovirus 3 Encephalitis

Cited by 17 publications

References 9 publications

Severe Parechovirus 3 Infections in Young Infants—Kansas and Missouri, 2014

Severe Parechovirus 3 Infections in Young Infants—Kansas and Missouri, 2014

Human parechovirus type 5 neurological infection in a neonate with a favourable outcome: A case report

Human Parechovirus Meningoencephalitis: Neuroimaging in the Era of Polymerase Chain Reaction–Based Testing

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