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Human parechovirus type 3 central nervous system infections in Israeli infants

Nesrin Ghanem-Zoubi1, Maayan Shiner, Lester M Shulman

  • 1Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel. n_ghanem@rambam.health.gov.il

Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology
|July 2, 2013
PubMed

Insights

Human parechoviruses (HPeV) caused CNS infections in young Israeli infants during summer 2008. Early PCR detection of HPeV in cerebrospinal fluid (CSF) is crucial for timely diagnosis and treatment in infants with fever or CNS illness.

Area of Science:

  • Virology
  • Pediatric Neurology
  • Infectious Diseases

Background:

  • Human parechoviruses (HPeV) are known causes of central nervous system (CNS) infections in children globally.
  • The prevalence and impact of HPeV in Israeli infants with CNS infections were previously uncharacterized.

Purpose of the Study:

  • To determine the detection rate of HPeV in enterovirus-negative cerebrospinal fluid (CSF) samples from Israeli children aged 0-5 years.
  • To investigate the clinical presentation and outcomes of HPeV infections in infants.

Main Methods:

  • Retrospective analysis of 367 CSF samples collected between 2007-2009 from children with suspected CNS infection or unexplained fever.
  • Nested reverse transcription-polymerase chain reaction (RT-PCR) assay for HPeV RNA detection.
  • Molecular sequencing for HPeV typing and analysis of medical records.

Main Results:

  • Human parechovirus 3 (HPeV3) RNA was identified in 13 CSF samples (3.5% overall, 11.3% in infants <3 months during summer 2008).
  • All HPeV3-positive cases occurred in infants under 3 months old and presented without pleocytosis.
  • Affected infants recovered without short-term complications.

Conclusions:

  • HPeV, particularly HPeV3, is a significant cause of summertime febrile/CNS illness in young infants in Israel during periods of high viral activity.
  • Including HPeV PCR in CSF diagnostics for neonates and young infants with fever or CNS symptoms is recommended.
  • Rapid HPeV identification can potentially reduce unnecessary antibiotic use and shorten hospitalization.
Abstract

Keywords:
CNSCSFCentral nervous systemHPeVIQRInfantsLOSNeonateParechovirusRT-PCRUTIViral infectionsWBCcentral nervous systemcerebrospinal fluidhuman parechovirusinterquartile rangeslength of stayreverse transcriptase polymerase chain reactionurinary tract infectionwhite blood cells

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