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Characteristics of Young Infants in Whom Human Parechovirus, Enterovirus or Neither Were Detected in Cerebrospinal Fluid During Sepsis Evaluations

Sharp, Justin MD*; Harrison, Christopher J. MD*†; Puckett, Kelley BS*; Selvaraju, Suresh B. PhD*†; Penaranda, Silvia BS; Nix, W. Allan BS; Oberste, M. Steven PhD; Selvarangan, Rangaraj BVSc, PhD, D(ABMM)*†

Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e318276b328
Original Studies
Abstract

Background: Human parechovirus (HPeV) causes central nervous system (CNS) infection in infants. To further understand HPeV CNS infection, we describe its clinical, laboratory and epidemiologic characteristics from a Midwestern US tertiary care center. Because HPeV CNS infections have appeared clinically and seasonally similar to enterovirus (EV) infections, we retrospectively compared characteristics of young infants undergoing sepsis evaluations in whom HPeV, EV or neither were detected in cerebrospinal fluid (CSF).

Methods: HPeV real-time reverse-transcription polymerase chain reaction (RT-PCR) assay was performed on frozen nucleic acid extracts of CSF specimens submitted for EV RT-PCR assay from children seen at our hospital in 2009. HPeV genotyping was performed by sequencing of the viral protein 1 region. Clinical data were abstracted from medical records retrospectively for EV-positive, HPeV-positive and age-matched controls in whom neither virus was detected from CSF testing.

Results: HPeV was detected in 66 of the 388 (17%) CSF specimens whereas EV was detected in 54 of the 388 (14%) from June through October 2009. Genotyping identified HPeV3 in 51 of the 66 (77%) positive CSF specimens. Males predominated (61%) with the most common presenting symptoms (91%) being fever and irritability. All HPeV-positive patients were <5 months of age. Eight required admission to the pediatric intensive care unit. In multivariate analysis, lower peripheral white blood cell counts with lower absolute lymphocyte count values, higher maximum temperatures, longer fever duration, absence of pleocytosis and longer hospitalization were independently associated with HPeV patients compared with patients with EV or patients negative for both HPeV and EV.

Conclusions: Our data indicate that HPeV3, an emerging CNS pathogen of infants in the United States, should be considered in sepsis-like presentation even without CSF pleocytosis. Addition of HPeV RT-PCR to EV RT-PCR assay for CSF specimens of patients <6 months of age could reduce hospital stay and costs while improving clinical management

Author Information

From the *Children’s Mercy Hospitals and Clinics; University of Missouri School of Medicine, Kansas City, MO; and Centers for Disease Control and Prevention, Atlanta, GA.

Accepted for publication September 28, 2012.

Presented at Infectious Disease Society of America, Vancouver, Canada, 2010.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Rangaraj Selvarangan, BVSc, PhD, D(ABMM), Associate Professor, UMKC-SOM, Director, Microbiology Laboratory, Children’s Mercy Hospital, Kansas City, MO-64108. E-mail: rselvarangan@cmh.edu.

© 2013 Lippincott Williams & Wilkins, Inc.