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Human Parechovirus Type 3 and 4 Associated With Severe Infections in Young Children

Kolehmainen, Pekka MSc*†‡; Jääskeläinen, Anne PhD; Blomqvist, Soile PhD; Kallio-Kokko, Hannimari PhD; Nuolivirta, Kirsi MD, PhD; Helminen, Merja MD, PhD; Roivainen, Merja PhD; Lappalainen, Maija MD, PhD§; Tauriainen, Sisko PhD†‡

The Pediatric Infectious Disease Journal: November 2014 - Volume 33 - Issue 11 - p 1109–1113
doi: 10.1097/INF.0000000000000401
Original Studies

Background: The symptoms observed in children with human parechovirus (HPeV) infection vary widely from asymptomatic or mild gastrointestinal infections to more severe central nervous system infections and sepsis-like disease. Many of the disease associations are, however, only suggestive. In this study, we examined the connection between HPeV and acute otitis media, lower respiratory infections and suspected central nervous system infections.

Methods: An HPeV specific real-time reverese transcriptase polymerase chain reaction was used to detect HPeV RNA. We analyzed altogether 200 middle-ear fluid samples, 192 nasopharyngeal aspirates, 79 cerebrospinal fluid specimens and 50 serum and 5 fecal or fecal culture samples. Positive samples were typed by sequencing the VP1 region.

Results: Seven (8%) of 85 children with suspected central nervous system infections were positive for HPeV. Of these, 4 (all in autumn 2012 and from children <3 months of age) were typed to be HPeV4, whereas 1 child had HPeV3. HPeV4 was detected from stool, serum and cerebrospinal fluid. The children with acute otitis media tested HPeV positive in 2.5% episodes. In the lower respiratory cases, HPeV was absent.

Conclusions: The findings reported in this study suggest that HPeV4 can cause sepsis-like disease in young infants and be present in cerebrospinal fluid. Furthermore, this report shows that HPeV findings in children with more severe symptoms occur also in Finland.

Supplemental Digital Content is available in the text.

From the *Department of Virology, Haartman Institute, University of Helsinki, Helsinki; Department of Virology, University of Turku, Turku; Department of Virology, University of Tampere, Tampere; §HUSLAB, Department of Virology and Immunology, Helsinki University Central Hospital; National Institute for Health and Welfare (THL), Department of Infectious Disease Surveillance and Control, Virology Unit, Helsinki; and Center for Child Research, Tampere University and University Hospital, Tampere, Finland.

Accepted for publication April 25, 2014.

The study was funded by the Academy of Finland, the Medical research fund of the Tampere University Hospital, HUSLAB (Helsinki University Central Hospital) and the Paulo Foundation.

The authors have no other 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 (

Address for correspondence: Pekka Kolehmainen, MSc, University of Helsinki, Haartman Institute, Department of Virology, Haartmaninkatu 3, 00290 Helsinki, Finland. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc.