Enterovirus and Parechovirus viraemia in young children presenting to the emergency room: Unrecognised and frequent

Cordey, Samuel; L’Huillier, Arnaud G.; Turin, Lara; Gervaix, Alain; Posfay‐Barbe, Klara M.; Kaiser, Laurent

doi:10.1016/j.jcv.2015.05.003

Cited by 22 publications

(16 citation statements)

References 18 publications

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“…Additional molecular tests are needed to speed up diagnosis of conditions asso ciated with enterovirus infections. 5 Several studies have evaluated testing blood specimens, [7][8][9][10][11][12] but as yet no assessment has been done in a large cohort of paediatric patients.…”

Section: Introductionmentioning

confidence: 99%

Assessment of blood enterovirus PCR testing in paediatric populations with fever without source, sepsis-like disease, or suspected meningitis: a prospective, multicentre, observational cohort study

Lafolie

Labbé²,

L'Honneur

et al. 2018

The Lancet Infectious Diseases

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Background Enteroviruses are the most frequent cause of acute meningitis and are seen increasingly in sepsis-like disease and fever without source in the paediatric population. Detection of enterovirus in cerebrospinal fluid (CSF) specimens by PCR is the gold standard diagnostic test. Our aim was to assess a method of detecting enterovirus in blood specimens by PCR. MethodsWe did a prospective, multicentre, observational study at 35 French paediatric and emergency departments in 16 hospitals. We recruited newborn babies (aged ≤28 days) and infants (aged >28 days to ≤2 years) with fever without source, sepsis-like disease, or suspected meningitis, and children (aged >2 years to ≤16 years) with suspected meningitis, who were admitted to a participating hospital. We used a standardised form to obtain demographic, clinical, and laboratory data, which were anonymised. Enterovirus PCR testing was done in blood and CSF specimens. Findings Between June 1, 2015, and Oct 31, 2015, and between June 1, 2016, and Oct 31, 2016, we enrolled 822 patients, of whom 672 had enterovirus PCR testing done in blood and CSF specimens. Enterovirus was detected in 317 (47%) patients in either blood or CSF, or both (71 newborn babies, 83 infants, and 163 children). Detection of enterovirus was more frequent in blood samples than in CSF specimens of newborn babies (70 [99%] of 71 vs 62 [87%] of 71; p=0·011) and infants (76 [92%] of 83 vs 62 [75%] of 83; p=0·008), and was less frequent in blood samples than in CSF specimens of children (90 [55%] of 163 vs 148 [91%] of 163; p<0·0001). Detection of enterovirus was more frequent in blood samples than in CSF specimens of infants aged 2 years or younger with fever without source (55 [100%] of 55 vs 41 [75%] of 55; p=0·0002) or with sepsis-like disease (16 [100%] of 16 vs nine [56%] of 16; p=0·008). Detection of enterovirus was less frequent in blood than in CSF of patients with suspected meningitis (165 [67%] of 246 vs 222 [90%] of 246; p<0·0001).Interpretation Testing for enterovirus in blood by PCR should be an integral part of clinical practice guidelines for infants aged 2 years or younger. This testing could decrease the length of hospital stay and reduce exposure to antibiotics for low-risk patients admitted to the emergency department with febrile illness.Funding University Hospital Clermont-Ferrand.

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Section: Introductionmentioning

confidence: 99%

Assessment of blood enterovirus PCR testing in paediatric populations with fever without source, sepsis-like disease, or suspected meningitis: a prospective, multicentre, observational cohort study

Lafolie

Labbé²,

L'Honneur

et al. 2018

The Lancet Infectious Diseases

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“…The clinical spectrum of HPeV and EV infections varies from fever to severe systemic disease, including sepsis and meningoencephalitis, which might engender severe neuropsychological sequelae. 5 Several studies have specifically examined HPeV and EV prevalence in European countries and the USA, [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] but their prevalence and clinical characteristics remain largely unknown in Asian countries.…”

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confidence: 99%

Prevalence and characteristics of human parechovirus and enterovirus infection in febrile infants

Sano

Hamada

Hirose

et al. 2018

Pediatrics International

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“…HPeV may cause death among young patients, with one relatively large study reporting mortality from HPeV infection among young infants as high as 6%30. HPeV3 may be associated with more severe clinical symptoms particular in very young infants compared to other HPeV types, is the predominant type associated with CNS infection and/or sepsis-like presentations in early infancy and is the most common type identified in cerebrospinal fluid (CSF) samples12303132333435363738. The range and severity of clinical manifestations and prognosis of HPeV3 infection is not well defined.…”

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confidence: 99%

An outbreak of severe infections among Australian infants caused by a novel recombinant strain of human parechovirus type 3

Nelson

Vuillermin

Hodge

et al. 2017

Sci Rep

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Human parechovirus types 1–16 (HPeV1–16) are positive strand RNA viruses in the family Picornaviridae. We investigated a 2015 outbreak of HPeV3 causing illness in infants in Victoria, Australia. Virus genome was extracted from clinical material and isolates and sequenced using a combination of next generation and Sanger sequencing. The HPeV3 outbreak genome was 98.7% similar to the HPeV3 Yamagata 2011 lineage for the region encoding the structural proteins up to nucleotide position 3115, but downstream of that the genome varied from known HPeV sequences with a similarity of 85% or less. Analysis indicated that recombination had occurred, may have involved multiple types of HPeV and that the recombination event/s occurred between March 2012 and November 2013. However the origin of the genome downstream of the recombination site is unknown. Overall, the capsid of this virus is highly conserved, but recombination provided a different non-structural protein coding region that may convey an evolutionary advantage. The indication that the capsid encoding region is highly conserved at the amino acid level may be helpful in directing energy towards the development of a preventive vaccine for expecting mothers or antibody treatment of young infants with severe disease.

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Enterovirus and Parechovirus viraemia in young children presenting to the emergency room: Unrecognised and frequent

Cited by 22 publications

References 18 publications

Assessment of blood enterovirus PCR testing in paediatric populations with fever without source, sepsis-like disease, or suspected meningitis: a prospective, multicentre, observational cohort study

Assessment of blood enterovirus PCR testing in paediatric populations with fever without source, sepsis-like disease, or suspected meningitis: a prospective, multicentre, observational cohort study

Prevalence and characteristics of human parechovirus and enterovirus infection in febrile infants

An outbreak of severe infections among Australian infants caused by a novel recombinant strain of human parechovirus type 3

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