Epidemiology and clinical characteristics of infants with human parechovirus or human herpes virus-6 detected in cerebrospinal fluid tested for enterovirus or herpes simplex virus

Abstract

Human parechovirus (HPeV) and human herpes virus-6 (HHV-6) are acquired commonly in infancy and associated with central nervous system infection. The prevalence of HPeV and HHV-6 in the cerebrospinal fluid (CSF) of infants tested for enterovirus (EV) and herpes-simplex virus (HSV) is unknown. All stored CSF samples from EV or HSV testing in infants less than 6 months of age at Children's Hospital Colorado between January 1, 2010 and December 31, 2011 were tested for HPeV, HHV-6, EV, and HSV by PCR. Clinical characteristics and epidemiological data were collected using retrospective electronic chart review. Of 239 infants tested, 29 cases of EV (12.1%), 7 cases of HPeV (2.9%), 5 cases of HHV-6 (2.1%), and 5 cases of HSV (2.1%) were identified with no bacterial co-infections. HPeV cases occurred between July and October in infants with median age of 24 days. Infants with HPeV had a median maximum temperature of 39 °C, median fever duration of 3 days and median peripheral white blood cell count of 5.2 × 10(3)/μL. HHV-6 cases occurred in infants with median age of 61 days without seasonality. Five percent of infants less than 6 months of age undergoing testing for EV or HSV have HPeV or HHV-6 in the CSF. Targeting testing of HPeV towards febrile infants less than 2 months of age with leukopenia in the late summer to early fall, and HHV-6 towards older infants may increase diagnostic yield. The clinical and fiscal impact of testing infants for HPeV and HHV-6 needs to be determined.

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

“…EV peaked in August and September and was detected over a longer term than HPeV. The seasonal characteristics are similar to those in recent studies …”

“…In contrast, in the EV group, pleocytosis and low glucose were observed in the CSF compared with the HPeV group (Table ). Higher CSF protein and pleocytosis have also been reported in EV compared with HPeV infection …”

“…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.…”

Laboratory Parameters of Cerebrospinal Fluid in Individuals With Enterovirus Meningitis: A Descriptive Study

“…It is a challenge to distinguish serious and benign bacterial and viral infections, especially in pediatric subjects 17 . The analysis of some of the CSF laboratory parameters (PCR, leukocytes, erythrocytes, glucose, and proteins) is often the first clue to the diagnosis 16,18 .…”

“…The establishment of an early etiological diagnosis, especially in infants, is essential for targeting interventions that save lives 17 . Therefore, studies that seek to show changes in the CSF settings according to the type of infection and age are necessary for the development of health strategies, especially in pediatrics.…”