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A Summer of Fevers and Fussiness: Eighteen Infants Admitted With Parechovirus Meningitis
Sarah J Calardo1, Niketa Raj2, Jonathan Miller
1From the Nemours Children's Hospital, Delaware, Wilmington, DE.
Insights
Parechovirus (PeV) meningitis commonly affects young infants, presenting with fever but often lacking cerebrospinal fluid (CSF) pleocytosis. Most infants experience uncomplicated hospital stays without neurological deficits.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Neurology
Background:
- Parechovirus (PeV) is an emerging cause of meningitis in infants.
- A significant increase in PeV meningitis cases was observed in summer 2022.
- Understanding PeV meningitis presentation and outcomes is crucial for timely diagnosis and management.
Purpose of the Study:
- To define the clinical presentation, illness spectrum, and outcomes of infants with PeV meningitis.
- To analyze data from a specific incidence spike in summer 2022.
- To inform diagnosis and treatment strategies for PeV meningitis.
Main Methods:
- Retrospective case series of infants aged 3 months and younger with positive PeV results on CSF FilmArray panel.
- Data collection included clinical and demographic information.
- Analysis focused on presentation, laboratory findings, and hospital course.
Main Results:
- Eighteen infants were identified, with a peak in July.
- Mean age was 28.7 days; mean length of stay was 50.5 hours.
- Fever was common, but CSF pleocytosis was infrequent (17%); neutropenia was present in 17%.
Conclusions:
- PeV meningitis should be considered in young infants with fever, even without CSF pleocytosis.
- Hospital stays were generally uncomplicated with no neurological deficits.
- Findings can aid other institutions in diagnosing and treating PeV meningitis.
Objective:
To define the presentation, spectrum of illness, and outcomes in infants with parechovirus (PeV) meningitis admitted to our inpatient general pediatrics service during a spike in incidence of admissions in summer 2022.
Patients And Methods:
This study is a retrospective case series of all patients aged 3 months and younger discharged from our institution with a CSF BioFire (BioFire Diagnostics, Salt Lake City, UT) FilmArray Polymerase Chain Reaction Meningitis/Encephalitis Panel result positive for PeV between January 1 and September 19, 2022. We collected and analyzed clinical and demographic data.
Results:
Eighteen infants with PeV meningitis were admitted within our time frame, with 8 (44%) of the admissions occurring in July. Patients' mean age was 28.7 days and mean length of stay was 50.5 hours. Although all had a history of fever, only 72% were febrile on presentation. Laboratory findings showed a procalcitonin of less than 0.5 ng/mL in 86% of the 14 patients who had it drawn and no cerebrospinal fluid (CSF) pleocytosis in 83% of the patients who had CSF cell counts sent. Neutropenia was present in 17%. Although 89% of infants were given initial antibiotics, antibiotics were discontinued in 63% once their CSF panel returned positive for PeV, and in all by 48 hours.
Conclusions:
Infants hospitalized with PeV meningitis were febrile and fussy, but experienced uncomplicated hospital stays without neurological deficits. Parechovirus meningitis must be considered as a common cause of acute viral meningitis in young infants even without CSF pleocytosis. This study, although limited in scope and follow-up, can potentially assist in the diagnosis and treatment of PeV meningitis at other institutions.
