Routine testing of infants for human parechovirus may improve detection of sepsis-like illness

Selvarangan R. Pediatr Infect Dis J. 2011;30:238-242.

Routine seasonal testing of infants, especially in those aged 6 months or younger, for human parechovirus type 3 may improve detection of this sepsis-like illness, researchers found.

Human parechovirus has been detected mostly in pediatric patients presenting with either mild respiratory or gastrointestinal illness, or severe neurologic illness, including febrile seizure, encephalitis, encephalomyelitis or flaccid paralysis.

Using frozen nucleic acid extracts from enterovirus-negative cerebrospinal fluid (CSF) collected from pediatric patients at the Children’s Mercy Hospitals and Clinics in Kansas City, Mo., from 2006 (n=242), 2007 (n=324) and 2008 (n=218), researchers used a two-step human parechovirus (HPeV) real-time reverse-transcription polymerase chain reaction (RT-PCR) test to detect the presence of the virus in the central nervous system (CNS). The study, conducted by Rangaraj Selvarangan, BVSc, PhD, and colleagues, was published recently in The Pediatric Infectious Disease Journal.

HPeV was detected in 7% of the total samples; four of 218 in 2006, 54 of 320 in 2007 and zero of 242 in 2008. Most infections occurred in the late summer or fall; the mean age for patients with detectable HPeV CNS infections was 6.6 ± 4.4 weeks (range, 1 week to 7 months) and tended to be male (71%). HPeV and enterovirus detection was compatible for 207 (17% and 20%). HPeV-3 genotype was found in 52 of 53 samples sequenced.

Corresponding demographic and clinical data were obtained from patients’ medical records. HPeV associated clinical symptoms had prompted clinicians to rule out sepsis (66%) or sepsis/meningitis (19%). Sepsis-like syndrome was defined as the combination of irritability plus either fever or hypothermia, with changes in appetite and activity, with or without perfusion. Meningitis was defined by changes in mental status or nuchal rigidity plus CSF findings of pleocytosis.

Fever (98%), irritability (95%) and rash (58.6%) were the most common presentation combination in patients with an HPeV infection of the CNS. Irritability was the most common presenting symptom (98%); 81% presented with fever, and all had fever during hospitalization with at least one value more than 39·C. Five patients were hypothermic at presentation. Neurologic manifestations were rare (5%).

“Addition of HPeV RT-PCR assay to the enterovirus RT-PCR assay on pediatric CSF specimens (particularly infants <6 months) could reduce hospital stay, antibiotic usage, and hospitalization costs,” researchers wrote. “It may be useful to detect HPeV in other specimen types (blood, stool, respiratory secretions) from patients during sepsis-like illness; to enable less invasive procedure for specimen collection and testing for HPeV.”

Disclosure: The authors report no relevant financial disclosures.

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