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Characteristics and outcomes of human parechovirus infection in infants (2008–2012)

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Abstract

Human parechoviruses (HPeVs) cause a spectrum of disease ranging from self-limiting illness to severe disease and, sometimes, death. We describe the clinical characteristics and outcomes of HPeV infection in infants. The study describes the clinical and laboratory characteristics and outcomes of infants with HPeV infection during 2008–2012, from three paediatric hospitals in London each with a paediatric intensive care unit. The infants were retrospectively identified through laboratory and patient discharge databases and diagnosed through HPeV PCR. Fifty infants were identified. Half required admission to PICU. Infants less than 3 months were more likely to require PICU (16/25: p < 0.01). Clinical signs at presentation were often indistinguishable from those of bacterial sepsis and meningitis, but inflammatory markers were nearly always (95 % of cases) within normal ranges. Brain MRI showed white matter changes in 10/12 infants. Three of 19 infants with follow-up data (16 %) had significant neurological sequelae.

Conclusion: HPeV may cause severe disease and long-term neurological sequelae in young infants. HPeV should be considered in infants with clinical features of sepsis/meningitis with normal CSF microscopy. Prospective observational studies are warranted to better define the epidemiology of infection and thus inform future treatment trials.

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Abbreviations

ALT:

alanine transaminase

BAL:

broncho-alveolar lavage

CI:

confidence interval

CSF:

cerebrospinal fluid

EV:

enterovirus

HPeV:

human parechovirus

INR:

international normalised ratio

IQR:

interquartile range

MRI:

magnetic resonance imaging

NPA:

nasopharyngeal aspirate

PCR:

polymerase chain reaction

PICU:

paediatric intensive care unit

RNA:

ribonucleic acid

UTR:

untranslated region

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Acknowledgments

The authors thank Dr Muir and Dr Yen for supporting the study with permission to access the local NHS virology laboratory databases; Peter Nutter for extracting the data from the Imperial College Virology database; Catherine O’Sullivan for helping with proforma completion at St Mary’s Imperial College.

Conflict of interests

None declared.

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Correspondence to Stefania Vergnano.

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Communicated by Peter de Winter

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Vergnano, S., Kadambari, S., Whalley, K. et al. Characteristics and outcomes of human parechovirus infection in infants (2008–2012). Eur J Pediatr 174, 919–924 (2015). https://doi.org/10.1007/s00431-014-2483-3

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  • DOI: https://doi.org/10.1007/s00431-014-2483-3

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