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Human Parechovirus 3 in Infants

Expanding Our Knowledge of Adverse Outcomes

Joseph, Lindsay, MBBS*; May, Meryta, FRACP, FRCPA*; Thomas, Marion, FRACP*; Smerdon, Carla, MBBS; Tozer, Sarah, PhD‡,§; Bialasiewicz, Seweryn, PhD‡,§; McKenna, Ronan, FCICM*; Sargent, Philip, FCICM*,†; Kynaston, Anne, FRACP*; Heney, Claire, FRCPA; Clark, Julia E., FRACP*,§

The Pediatric Infectious Disease Journal: January 2019 - Volume 38 - Issue 1 - p 1–5
doi: 10.1097/INF.0000000000002136
Original Studies
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Background: Human parechovirus particularly genotype 3 (HPeV3) is an emerging infection affecting predominantly young infants. The potential for neurologic sequelae in a vulnerable subset is increasingly apparent. A review of 2 epidemics of human parechovirus (HpeV) infection in 2013 and in 2015 in Queensland, Australia, was undertaken, with an emphasis on identifying adverse neurodevelopmental outcome.

Methods: All hospitalized cases with laboratory-confirmed HPeV infection between October 2013 June 2016 were identified. Clinical, demographic, laboratory and imaging data were collected and correlated with reported developmental outcome.

Results: Laboratory-confirmed HPeV infections were identified in 202 patients across 25 hospitals; 86.6% (n = 175) were younger than 3 months 16.3% (n = 33) received intensive care admission. Of 142 cerebrospinal fluid samples which were HPeV polymerase chain reaction positive, all 89 isolates successfully genotyped were HPeV3. Clinical information was available for 145 children; 53.1% (n = 77) had follow-up from a pediatrician, of whom 14% (n = 11) had neurodevelopmental sequelae, ranging from hypotonia and gross motor delay to spastic quadriplegic cerebral palsy and cortical visual impairment. Of 15 children with initially abnormal brain magnetic resonance imaging, 47% (n = 7) had neurodevelopmental concerns, the remainder had normal development at follow-up between 6 and 15 months of age.

Conclusions: This is the largest cohort of HPeV3 cases with clinical data and pediatrician-assessed neurodevelopmental follow-up to date. Developmental concerns were identified in 11 children at early follow-up. Abnormal magnetic resonance imaging during acute infection did not specifically predict poor neurodevelopmental in short-term follow-up. Continued follow-up of infants and further imaging correlation is needed to explore predictors of long-term morbidity.

From the *Lady Cilento Children’s Hospital, Brisbane, Australia

Gold Coast University Hospital, Gold Coast, Australia

Child Health Research Centre, The University of Queensland

§School of Clinical Medicine, University of Queensland

Pathology Queensland, Brisbane, Australia.

Accepted for publication May 23, 2018.

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: Meryta May, FRACP, FRCPA, Lady Cilento Children’s Hospital, Brisbane, Australia. E-mail: Meryta.may@health.qld.gov.au.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.