Human parechovirus-3 infection in nine neonates and infants presenting symptoms of hemophagocytic lymphohistiocytosis

Yuzurihara, Saeko Shimodera; Ao, Kota; Hara, Takuma; Tanaka, Fumiko; Mori, Masaaki; Kikuchi, Nobuyuki; Kai, Satoru; Yokota, Shumpei

doi:10.1007/s10156-012-0420-9

Cited by 45 publications

(28 citation statements)

References 11 publications

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“…HPeV3 is mainly reported as a pediatric pathogen, particularly for children under 1 year of age. It is capable of causing more severe disease, such as neonatal sepsis, encephalitis, sudden unexpected death in infancy (SUDI), and paralysis (33)(34)(35), likely due in part to central nervous system involvement. Cases of HPeV3 infection may present with gastrointestinal and respiratory symptoms, but this virus has also been detected in healthy individuals (36,37).…”

Section: Discussionmentioning

confidence: 99%

Metagenomic Analysis of Viruses in Feces from Unsolved Outbreaks of Gastroenteritis in Humans

et al. 2015

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bThe etiology of an outbreak of gastroenteritis in humans cannot always be determined, and ϳ25% of outbreaks remain unsolved in New Zealand. It is hypothesized that novel viruses may account for a proportion of unsolved cases, and new unbiased highthroughput sequencing methods hold promise for their detection. Analysis of the fecal metagenome can reveal the presence of viruses, bacteria, and parasites which may have evaded routine diagnostic testing. Thirty-one fecal samples from 26 gastroenteritis outbreaks of unknown etiology occurring in New Zealand between 2011 and 2012 were selected for de novo metagenomic analysis. A total data set of 193 million sequence reads of 150 bp in length was produced on an Illumina MiSeq. The metagenomic data set was searched for virus and parasite sequences, with no evidence of novel pathogens found. Eight viruses and one parasite were detected, each already known to be associated with gastroenteritis, including adenovirus, rotavirus, sapovirus, and Dientamoeba fragilis. In addition, we also describe the first detection of human parechovirus 3 (HPeV3) in Australasia. Metagenomics may thus provide a useful audit tool when applied retrospectively to determine where routine diagnostic processes may have failed to detect a pathogen. Outbreaks of acute gastroenteritis are associated with significant global morbidity and mortality, particularly in pediatric populations (1). Bacterial pathogens are well-described causes of gastroenteritis, e.g., Escherichia coli O157:H7, Salmonella, Campylobacter, and Shigella (2, 3), but are known to occur less frequently than viral pathogens as the cause of acute gastroenteritis (4). Noroviruses, sapoviruses, group A rotaviruses, enteric adenoviruses, and astroviruses have been recognized as the main etiological agents in viral gastroenteritis, although it has been suggested that a number of other viruses may also be involved (5, 6). Parasites such as Dientamoeba fragilis have also been implicated in gastroenteritis; however, there is still debate surrounding their pathogenicity (2, 7).In New Zealand, no causative agent is identified in approximately 25% of reported gastroenteritis outbreaks at the conclusions of public health investigations (8). A proportion of unsolved cases may be due to the presence of a novel pathogen. Viral pathogens are particularly problematic to discover because well-established methods such as electron microscopy, PCR, or viral culture are not always effective; they may be too specific, lack high-throughput capability, or not be sensitive enough to detect low numbers of organisms within a sample (9). High-throughput sequencing holds promise for resolving the etiology of unsolved gastroenteritis outbreaks, as large volumes of unbiased metagenomic data are produced, allowing for the sequences from all viruses, bacteria, parasites, and fungi present in the sample to be revealed (10). Any knowledge gained from identifying previously unknown pathogens causing outbreaks of gastroenteritis will facilitate public health investigati...

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Section: Discussionmentioning

confidence: 99%

Metagenomic Analysis of Viruses in Feces from Unsolved Outbreaks of Gastroenteritis in Humans

et al. 2015

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“…Hemophagocytic lymphohistiocytosis (HLH) can be either familial or induced by a wide array of infectious agents, including HPeV. [41][42][43] Note that HPeV3 sepsis is capable of causing increased blood ferritin level, cholesterol level, C-reactive protein level, liver enzyme levels, and pancytopenia in the absence of bone marrow confirmation of HLH. HPeV3 sepsis can also be associated with coagulopathy and severe hepatitis.…”

Section: Epidemiologymentioning

confidence: 99%