Predicting Severe Short-Term Neurologic Outcomes in Human Parechovirus Meningoencephalitis

Area of Science:

• Pediatric Neurology
• Infectious Diseases
• Virology

Background:

• Human parechovirus (PeV) is an emerging pathogen causing meningoencephalitis (ME) in infants.
• A 2022 US outbreak offered a chance to study PeV ME clinical features and severe disease predictors.

Purpose of the Study:

• To analyze the clinical presentation of infants with PeV ME.
• To identify predictors of severe disease and abnormal brain MRI in infants with PeV ME.

Main Methods:

• Multicenter retrospective review of infants diagnosed with PeV ME.
• Analysis of demographics, clinical symptoms, lab results, and neuroimaging.
• Logistic regression to determine predictors of complicated disease and abnormal brain MRI.

Main Results:

• 139 infants with PeV ME were identified; median age was 19 days.
• Fever was common (89.2%) and linked to milder disease.
• Complicated disease (30.2%) associated with hypothermia, somnolence, poor feeding, seizures, apnea, and need for ventilation/support.
• Younger age and seizures predicted abnormal MRI.

Conclusions:

• PeV can cause severe infant ME despite nonspecific symptoms and normal labs, necessitating high clinical suspicion.
• Recommend PeV testing in infant sepsis workups, neuroimaging for high-risk infants, and developmental follow-up.