Epidemiology of Sepsis-like Illness in Young Infants

Jong, Eveline P. de; Beuken, Monique G. A. van den; Elzakker, Erika P. M. van; Wolthers, Katja C.; Sprij, Arwen; Lopriore, Enrico; Walther, Frans J.; Brus, F

doi:10.1097/inf.0000000000001718

Cited by 39 publications

(25 citation statements)

References 44 publications

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“…Thus, detection of PeV-A3 RNA in the CSF samples of severely ill infants may not be a sign of active virus replication in the CNS but rather a consequence of a systemic inflammatory response. This is supported by several studies reporting that PeV-A3 positive CSF samples often do not show increase in white blood cell count [96,141,142,143,144,145]. However, as a counter to this, our group has shown that PeV-A3 is capable of infecting neuronal cell lines and PeV-A3 isolates replicated human neuroblastoma cell lines more efficiently than PeV-A1, suggesting a neural tropism of PeV-A3 [146].…”

Section: Pev-a3 Stands Out Amongst the Pev-a Genotypessupporting

confidence: 64%

Parechovirus A Pathogenesis and the Enigma of Genotype A-3

Sridhar

Karelehto

Brouwer

et al. 2019

Viruses

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Parechovirus A is a species in the Parechovirus genus within the Picornaviridae family that can cause severe disease in children. Relatively little is known on Parechovirus A epidemiology and pathogenesis. This review aims to explore the Parechovirus A literature and highlight the differences between Parechovirus A genotypes from a pathogenesis standpoint. In particular, the curious case of Parechovirus-A3 and the genotype-specific disease association will be discussed. Finally, a brief outlook on Parechovirus A research is provided.

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Section: Pev-a3 Stands Out Amongst the Pev-a Genotypessupporting

confidence: 64%

Parechovirus A Pathogenesis and the Enigma of Genotype A-3

Sridhar

Karelehto

Brouwer

et al. 2019

Viruses

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“…HSV-1 and HSV-2 were not detected. The predominance of enterovirus is consistent with previously reported data in young febrile children without a source [8,[10][11][12]. Of those who had positive viral detections, the majority were single viruses; however 17/224 (7.6%) of subjects had two or more viruses detected.…”

Section: Discussionsupporting

confidence: 91%

A multicenter evaluation of viral bloodstream detections in children presenting to the Emergency Department with suspected systemic infection

Rostad

Kanwar

et al. 2021

BMC Pediatr

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Background Fever is a common symptom in children presenting to the Emergency Department (ED). We aimed to describe the epidemiology of systemic viral infections and their predictive values for excluding serious bacterial infections (SBIs), including bacteremia, meningitis and urinary tract infections (UTIs) in children presenting to the ED with suspected systemic infections. Methods We enrolled children who presented to the ED with suspected systemic infections who had blood cultures obtained at seven healthcare facilities. Whole blood specimens were analyzed by an experimental multiplexed PCR test for 7 viruses. Demographic and laboratory results were abstracted. Results Of the 1114 subjects enrolled, 245 viruses were detected in 224 (20.1%) subjects. Bacteremia, meningitis and UTI frequency in viral bloodstream-positive patients was 1.3, 0 and 10.1% compared to 2.9, 1.3 and 9.7% in viral bloodstream-negative patients respectively. Although viral bloodstream detections had a high negative predictive value for bacteremia or meningitis (NPV = 98.7%), the frequency of UTIs among these subjects remained appreciable (9/89, 10.1%) (NPV = 89.9%). Screening urinalyses were positive for leukocyte esterase in 8/9 (88.9%) of these subjects, improving the ability to distinguish UTI. Conclusions Viral bloodstream detections were common in children presenting to the ED with suspected systemic infections. Although overall frequencies of SBIs among subjects with and without viral bloodstream detections did not differ significantly, combining whole blood viral testing with urinalysis provided high NPV for excluding SBI.

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“…Since most infants with PeV-positive CSF have no pleocytosis (2,9,26,27), our data underscore the need for clinicians to consider testing for PeV regardless of CSF leukocyte count values in order to optimize diagnosis and management of infants presenting with symptoms that necessitate a sepsis work-up. Differentiation of PeV types for clinical management may not be necessary, since no specific treatment or differences in clinical course is noticed between the two PeV types; however, epidemiological studies should consider PeV typing to see if clinical course and outcomes vary between PeV types in future outbreaks.…”

Section: Discussionmentioning

confidence: 82%

Emergence of Parechovirus A4 Central Nervous System Infections among Infants in Kansas City, Missouri, USA

et al. 2019

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Among known parechovirus (PeV) types infecting humans, PeV-A3 (formerly HPeV3) and PeV-A1 (formerly HPeV1) are associated with pediatric central nervous system (CNS) infections. The prevalence of PeV-A3 among hospitalized infants with sepsis-like illness and viral CNS infection is well described; however, the contribution of PeV-A4 to infant CNS infection is relatively unexplored. We report the first 11 U.S. cases of PeV-A4 CNS infections occurring in Kansas City infants during 2010 to 2016 and compare the clinical presentation with that of PeV-A3. PeV-positive cerebrospinal fluid (CSF) specimens from 2010 to 2016 underwent sequencing for genotyping. Among all PeV-CSF positives, PeV-A4 was detected in 11 CSF samples from 2010 to 2016. PeV-A4 was first detected in 2010 (n ϭ 1/4), followed by detections in 2014 (n ϭ 1/39), 2015 (n ϭ 6/9), and 2016 (n ϭ 3/33). The median age of PeV-A4-infected infants in weeks (median, 4; range, 1 to 8) was similar to that of infants infected with PeV-A3 (median, 4; range, 0.25 to 8). Clinical characteristics of PeV-A4 (n ϭ 11) were compared with those of select PeV-A3-infected children (n ϭ 34) with CNS infections and found to be mostly similar, although maximum temperature was higher (P ϭ 0.017) and fever duration was shorter (P ϭ 0.03) for PeV-A4 than for PeV-A3. Laboratory test results were also similar between genotypes, although they showed significantly lower peripheral white blood cell (P ϭ 0.014) and absolute lymphocyte (P ϭ 0.04) counts for PeV-A4 infants. Like PeV-A3, PeV-A4 caused summer-fall seasonal clusters of CNS infections in infants, with mostly similar presentations. Further surveillance is necessary to confirm potential differences in laboratory findings and in fever intensity/duration.

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Epidemiology of Sepsis-like Illness in Young Infants

Cited by 39 publications

References 44 publications

Parechovirus A Pathogenesis and the Enigma of Genotype A-3

Parechovirus A Pathogenesis and the Enigma of Genotype A-3

A multicenter evaluation of viral bloodstream detections in children presenting to the Emergency Department with suspected systemic infection

Emergence of Parechovirus A4 Central Nervous System Infections among Infants in Kansas City, Missouri, USA

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