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Data reveal potential diagnostic hallmark of HPeV3
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Because of the potential for serious complications associated with human parechovirus type 3, an accurate diagnosis is key. Recently published findings indicate that one diagnostic marker for this illness may be a rash on the hands and soles.
Akihiko Saitoh, MD, PhD, of the department of pediatrics at Niigata University Graduate School of Medical and Dental Sciences in Japan, and colleagues reported the results of a retrospective analysis, in which they looked at data on 15 neonates with human parechovirus type 3 (HPeV3). The neonates were seen at the largest pediatric hospital in Japan between November 2010 and September 2011.
Akihiko Saitoh
The researchers said all of the children in the study developed a rash, about 3 days after developing a fever, which was the most common presentation of illness.
“The most striking finding was that 80% of patients developed a distinctive palmar-plantar erythematous rash, which disappeared after a median of 3 days,” the researchers said.
A rash is also typically seen with Kawasaki disease; however, Saitoh and colleagues said there are some important differences between these patients and those with Kawasaki disease.
“None of the present patients had other typical signs of [Kawasaki disease], which include conjunctival injection, changes in the mucosa of oropharynx, cervical lymphadenopathy, and elevation of inflammatory makers ([white blood cell] count and [C-reactive protein]),” the researchers wrote.
Akihiko Saitoh, MD, PhD, can be reached at 1-757 Asahimachi-dori Niigata, 951-8510 Japan; email: asaitoh@med.niigata-u.ac.jp.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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José R. Romero, MD
Reports of the exanthems associated with HPeV3 infections have described them as maculopapular or erythematous but have lacked details of their clinical evolution. Shoji and colleagues address this with their report containing detailed information about HPeV3-associated exanthems, as well as the clinical presentation of these patients. They report that while only 20% of patients had rash present on admission, all subsequently developed an erythematous or maculopapular exanthem. The exanthem, found primarily on the extremities and involving the palms and soles in 80% of patients, resolved within a week.
As reported by the authors, the finding of palmar and plantar erythema may serve as a diagnostic clue of HPeV3 infection. However, it should not dissuade physicians from excluding other, albeit, rarer but serious and treatable causes, of the finding such as Kawasaki disease, staphylococcal or streptococcal toxic shock syndrome, etc.
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