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Year-Round, Routine Testing of Multiple Body Site Specimens for Human Parechovirus in Young Febrile Infants
Cristina Tomatis Souverbielle1, Huanyu Wang2, John Feister1
1Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
Insights
Routine year-round testing for human parechovirus (PeV-A) in infants increased diagnostic yield and identified PeV-A infections throughout the year. PeV-A type 3 was most common, often detected in blood and cerebrospinal fluid (CSF).
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Molecular Diagnostics
Background:
- Human parechovirus (PeV-A) infections can cause febrile illness in young infants.
- Understanding the epidemiology and clinical presentation of PeV-A is crucial for diagnosis and management.
- Current diagnostic approaches may not fully capture the spectrum of PeV-A infections.
Purpose of the Study:
- To evaluate the impact of routine year-round specimen testing from multiple body sites for PeV-A in febrile infants.
- To determine the diagnostic yield and seasonal patterns of PeV-A infections.
- To better define the clinical manifestations and common PeV-A types in this population.
Main Methods:
- Incorporation of PeV-A reverse-transcriptase polymerase chain reaction (RT-PCR) into routine infant evaluations (≤60 days old) for fever/suspected sepsis.
- Retrospective review of electronic medical records for PeV-A positive cases between July 2013 and September 2016.
- Genotyping of detected PeV-A, including specific RT-PCR and sequencing for PeV-A type 3.
Main Results:
- PeV-A was detected in 9% (130/1475) of evaluated infants, with positive results in blood (77%), nonsterile sites (65%), and cerebrospinal fluid (CSF) (41%).
- PeV-A type 3 was the predominant type (85%) and the only type found in CSF.
- Infections occurred year-round, though most were diagnosed between July and December; fever, fussiness, and lymphopenia were common clinical signs.
Conclusions:
- Routine year-round testing enhances the detection of PeV-A infections in infants.
- PeV-A infections, particularly type 3, occur throughout the year and can manifest without CSF pleocytosis.
- Coinfections are common, highlighting the need for comprehensive diagnostic workups.
Objectives:
To test our hypothesis that routine year-round testing of specimens from multiple body sites and genotyping of detected virus would describe seasonal changes, increase diagnostic yield, and provide a better definition of clinical manifestations of human parechovirus (PeV-A) infections in young febrile infants.
Study Design:
PeV-A reverse-transcriptase polymerase chain reaction (RT-PCR) analysis was incorporated in routine evaluation of infants aged ≤60 days hospitalized at Nationwide Children's Hospital for fever and/or suspected sepsis-like syndrome beginning in July 2013. We reviewed electronic medical records of infants who tested positive for PeV-A between July 2013 and September 2016. Genotyping was performed with specific type 3 RT-PCR and sequencing.
Results:
Of 1475 infants evaluated, 130 (9%) tested positive for PeV-A in 1 or more sites: 100 (77%) in blood, 84 (65%) in a nonsterile site, and 53 (41%) in cerebrospinal fluid (CSF). Five infants (4%) were CSF-only positive, 31 (24%) were blood-only positive, and 20 (15%) were nonsterile site-only positive. PeV-A3 was the most common type (85%) and the only type detected in CSF. Although the majority (79%) of infections were diagnosed between July and December, PeV-A was detected year-round. The median age at detection was 29 days. Fever (96%), fussiness (75%), and lymphopenia (56%) were common. Among infants with PeV-A-positive CSF, 77% had no CSF pleocytosis. The median duration of hospitalization was 41 hours. Four infants had bacterial coinfections diagnosed within 24 hours of admission; 40 infants had viral coinfections.
Conclusions:
Although most frequent in summer and fall, PeV-A infections were encountered in every calendar month within the 3-year period of study. More than one-half of patients had PeV-A detected at more than 1 body site. Coinfections were common. PeV-A3 was the most common type identified and the only type detected in the CSF.
