Characteristics of Young Infants in Whom Human Parechovirus, Enterovirus or Neither Were Detected in Cerebrospinal Fluid during Sepsis Evaluations
Published Date:Mar 2013
Source:Pediatr Infect Dis J. 32(3):213-216.
Midwestern United States
Reverse Transcriptase Polymerase Chain Reaction
Sequence Analysis, DNA
Tertiary Care Centers
Pubmed Central ID:PMC4637937
Funding:CC999999/Intramural CDC HHS/United States
Human Parechovirus (HPeV) causes central nervous system (CNS) infection in infants. To further understand HPeV CNS infection, we describe its clinical, laboratory and epidemiologic characteristics from a Midwestern U.S. tertiary care center. Because HPeV CNS infections have appeared clinically and seasonally similar to enterovirus (EV) infections, we retrospectively compared characteristics of young infants undergoing sepsis evaluations in whom HPeV, EV or neither were detected in CSF.
HPeV real-time RT-PCR assay was performed on frozen nucleic acid extracts of CSF specimens submitted for EV RT-PCR assay from children seen at our hospital in 2009. HPeV genotyping was performed by sequencing of the viral protein 1 (VP1) region. Clinical data were abstracted from medical records retrospectively for EV-positive, HPeV-positive and age-matched controls in whom neither virus was detected from CSF testing.
HPeV was detected in 66/388 (17%) CSF specimens while EV was detected in 54/388 (14%) from June through October 2009. Genotyping identified HPeV3 in 51/66 (77%) positive CSF specimens. Males predominated (61%) with the most common presenting symptoms (91%) being fever and irritability. All HPeV positive patients were <5 months of age. Eight required admission to the pediatric intensive care unit. In multivariate analysis, lower peripheral WBC counts with lower ALC values, higher maximum temperatures, longer fever duration, absence of pleocytosis, and longer hospitalization were independently associated with HPeV patients compared to patients with EV or patients negative for both HPeV and EV.
Our data indicate that HPeV3, an emerging CNS pathogen of infants in the United States, should be considered in sepsis-like presentation even without CSF pleocytosis. Addition of HPeV RT-PCR to EV RT-PCR assay for CSF specimens of patients less than 6 months of age could reduce hospital stay and costs while improving clinical management.
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