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Cluster of Parechovirus Infections Observed in Young Infants

Researchers warned about outward indications of parechovirus central nervous system (CNS) infection, predicated on a cluster of 23 young infants admitted to an individual children’s hospital over a 6-week period.

From April 12 to May 24 of the year, 23 previously healthy infants ages 5 days to a few months were admitted to a Tennessee children’s hospital for human parechovirus meningoencephalitis, reported Romney Humphries, PhD, of Vanderbilt University INFIRMARY in Nashville, and co-authors in Morbidity and Mortality Weekly Report.

Most infants offered fever, fussiness, and poor feeding without significant cerebrospinal fluid (CSF) inflammation, the researchers said.

When parechovirus is circulating, clinicians should think about testing for this in young infants, including people that have normal CSF parameters, Humphries and colleagues urged.

“The rapid detection of parechovirus in CSF by multiplex molecular panels can limit antibiotic administration and improve patient management,” they wrote. “Parents with young infants, especially people that have infants aged

The report follows a CDC health alert issued 14 days ago that warned about parechovirus infections in neonates and young infants in multiple states.

Human parechovirus is one of the family Picornaviridae and is split into several genotypes. Parechovirus genotype 1 is most prevalent and commonly causes respiratory and gastrointestinal symptoms. Genotype 3 is in charge of most unfortunate cases, with a bi-annual pattern of circulation that peaks during summertime. These cases can include severe sepsis-like disease and CNS infection. Infants younger than a few months have an elevated threat of severe illness.

The 23 infants admitted to a healthcare facility had a median age of 24 days; 13 were girls and 10 were boys. Five patients were preterm, born at 28-36 weeks’ gestation. Mean hospital stay was 4.5 days (range 1-26 days).

Almost all children became symptomatic locally; one preterm infant became symptomatic in the neonatal intensive care unit (NICU). Most patients (70%) had siblings in the home or were subjected to other children.

Four infants had leukopenia. Twenty-two patients had a CSF cell count performed; seven specimens showed an increased white blood cell count, including three with probable blood contamination during collection.

Four infants developed severe disease requiring treatment in the NICU. Brain MRI of the NICU patients showed white matter diffusion in keeping with typical parechovirus meningoencephalitis in every four infants.

Antibiotics were initially prescribed for the 23 infants but were discontinued for 13 patients within 24 hours of detecting parechovirus. Most infants (91.3%) recovered without complications. One patient was scheduled for a follow-up assessment for possible late-onset hearing loss and hypercoagulation evaluation. Another had persistent seizures and could experience severe developmental delay.

Known reasons for this cluster of CNS infections are unclear, Humphries and co-authors noted. In 2018, 19 cases were detected over 5 months at a healthcare facility. Cases didn’t peak in 2020, perhaps because of social isolation through the COVID-19 pandemic, the researchers suggested. Up to now, 29 cases have already been detected at a healthcare facility in 2022, like the 23 in this report.

Although parechovirus infection isn’t a reportable disease, the Tennessee Department of Health was notified.

  • Judy George covers neurology and neuroscience news for MedPage Today, authoring brain aging, Alzheimers, dementia, MS, rare diseases, epilepsy, autism, headache, stroke, Parkinsons, ALS, concussion, CTE, sleep, pain, and much more. Follow

Disclosures

Humphries reported relationships with bioMerieux, Momentum BioSciences, Specific Diagnostics, Qiagen, Merck, Pattern Bioscience, Qpex Biopharma, Torus, and Accelerate Diagnostics. Co-authors reported relationships with the NIH.

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