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Sepsis-like disease in infants due to human parechovirus type 3 during an outbreak in Australia

Ameneh Khatami1, Brendan J McMullan2, Murray Webber3

  • 1The Children's Hospital at Westmead.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|October 11, 2014
PubMed

Insights

Human parechovirus (HPeV) infections in infants can cause severe sepsis-like illness. This study details an Australian outbreak of HPeV-3, finding all infants recovered without complications, though long-term effects remain unknown.

Area of Science:

  • Pediatric Infectious Diseases
  • Virology
  • Public Health Epidemiology

Background:

  • Human parechoviruses (HPeVs) cause diverse clinical presentations in children, from mild to severe sepsis-like illness or meningoencephalitis.
  • An outbreak of human parechovirus type 3 (HPeV-3) occurred in New South Wales, Australia, prompting this investigation.

Purpose of the Study:

  • To describe the clinical characteristics, laboratory findings, and outcomes of infants hospitalized during an HPeV-3 outbreak.
  • To report the largest series of HPeV-3 infection in infants to date and the first documented outbreak in Australia.

Main Methods:

  • Retrospective review of medical records for infants admitted to 5 hospitals in New South Wales during the HPeV-3 outbreak.
  • Inclusion criteria: confirmed HPeV infection via reverse transcription polymerase chain reaction (RT-PCR).
  • Data collected: clinical presentation, laboratory markers, intensive care unit (ICU) admission, and patient outcomes.

Main Results:

  • 118 infants were identified with HPeV infection, predominantly presenting with sepsis-like syndrome (fever, tachycardia, irritability) and rash.
  • 75% of infected infants were younger than 2 months; 25% required ICU admission and were significantly younger than non-ICU patients.
  • HPeV was detected in 95% of cerebrospinal fluid samples, despite only 4% showing pleocytosis. Brain MRI revealed white matter changes in some infants. All patients recovered without complications at follow-up.

Conclusions:

  • Infants with HPeV-3 infection presented with a severe sepsis-like syndrome requiring a high rate of ICU admissions.
  • This study reports the largest series and first Australian outbreak of HPeV-3 in infants.
  • All infants recovered from the acute infection, but long-term sequelae are currently unknown.
Abstract

Keywords:
epidemichuman parechovirus 3infantneonatesepsis-like syndrome

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