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Published on: December 10, 2013
Characteristics and outcomes of human parechovirus infection in infants (2008-2012)
Stefania Vergnano1, Seilesh Kadambari, Katrina Whalley
1Division of Clinical Science, Paediatric Infectious Diseases Research Group, St George's University of London, Jenner Wing, Level 2, Room 2.215E, Mail Point J2C, London, SW17 0RE, UK, stev@doctors.org.uk.
Insights
Human parechoviruses (HPeVs) can cause severe illness and lasting neurological problems in infants. Early consideration of HPeV is crucial for infants presenting with sepsis-like symptoms and normal cerebrospinal fluid findings.
Area of Science:
- Virology
- Pediatric Infectious Diseases
- Neurology
Background:
- Human parechoviruses (HPeVs) are known to cause a range of illnesses in infants, from mild to severe, and can be fatal.
- Clinical presentation of HPeV infection in infants often mimics bacterial sepsis or meningitis.
- Normal inflammatory markers and cerebrospinal fluid microscopy are common in HPeV infections, complicating diagnosis.
Purpose of the Study:
- To describe the clinical characteristics and outcomes of HPeV infection in infants.
- To identify risk factors for severe disease and intensive care unit admission.
- To highlight the potential for long-term neurological sequelae.
Main Methods:
- Retrospective analysis of infants diagnosed with HPeV infection via PCR between 2008-2012.
- Data collected from three London pediatric hospitals with pediatric intensive care units (PICUs).
- Review of clinical data, laboratory results, and neuroimaging (Brain MRI).
Main Results:
- Fifty infants were identified with HPeV infection; half required PICU admission.
- Infants under 3 months old were significantly more likely to need PICU care.
- Brain MRI revealed white matter changes in 10 of 12 infants; 16% of those with follow-up data experienced significant neurological sequelae.
Conclusions:
- HPeV infection can lead to severe disease and long-term neurological deficits in young infants.
- HPeV should be considered in the differential diagnosis of infants presenting with sepsis/meningitis symptoms and normal CSF microscopy.
- Further prospective studies are needed to understand HPeV epidemiology and guide treatment strategies.
Unlabelled:
Human parechoviruses (HPeVs) cause a spectrum of disease ranging from self-limiting illness to severe disease and, sometimes, death. We describe the clinical characteristics and outcomes of HPeV infection in infants. The study describes the clinical and laboratory characteristics and outcomes of infants with HPeV infection during 2008-2012, from three paediatric hospitals in London each with a paediatric intensive care unit. The infants were retrospectively identified through laboratory and patient discharge databases and diagnosed through HPeV PCR. Fifty infants were identified. Half required admission to PICU. Infants less than 3 months were more likely to require PICU (16/25: p < 0.01). Clinical signs at presentation were often indistinguishable from those of bacterial sepsis and meningitis, but inflammatory markers were nearly always (95 % of cases) within normal ranges. Brain MRI showed white matter changes in 10/12 infants. Three of 19 infants with follow-up data (16 %) had significant neurological sequelae.
Conclusion:
HPeV may cause severe disease and long-term neurological sequelae in young infants. HPeV should be considered in infants with clinical features of sepsis/meningitis with normal CSF microscopy. Prospective observational studies are warranted to better define the epidemiology of infection and thus inform future treatment trials.
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