Human parechoviruses as an important viral cause of sepsislike illness and meningitis in young children.
BACKGROUND
Enteroviruses (EVs) belong to the family Picornaviridae and are a well-known cause of neonatal sepsis and viral meningitis. Human parechoviruses (HPeVs) type 1 and 2, previously named echovirus 22 and 23, have been associated with mild gastrointestinal or respiratory symptoms in young children. Six HPeV genotypes are currently known, of which HPeV3 is associated with neonatal sepsis and meningitis.


METHODS
Cerebrospinal fluid samples from children aged <5 years previously tested by EV-specific polymerase chain reaction (PCR) during 2004-2006 were selected (N= 761). Samples from 716 of those children were available for retrospective testing by HPeV-specific real-time PCR. The prevalence of EV and HPeV in these samples was compared. Data on clinical presentation of children infected with HPeV were retrospectively documented.


RESULTS
HPeV was found in cerebrospinal fluid samples from 33 (4.6%) of the children. Yearly prevalence of HPeV in cerebrospinal fluid varied remarkably: 8.2% in 2004, 0.4% in 2005, and 5.7% in 2006. EV was detected in 14% (108 of 761 samples), with no variation in yearly prevalence. Children with HPeV in cerebrospinal fluid presented with clinical symptoms of sepsislike illness and meningitis, which led to hospitalization and antibiotic treatment.


CONCLUSIONS
EV-specific PCRs do not detect HPeVs. The addition of an HPeV-specific PCR has led to a 31% increase in detection of a viral cause of neonatal sepsis or central nervous system symptoms in children aged <5 years. HPeV can be considered to be the second cause of viral sepsis and meningitis in young children, and rapid identification of HPeV by PCR could contribute to shorter duration of both antibiotic use and hospital stay.
Department of Medical Microbiology, Laboratory of Clinical Virology, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. k.c.wolthers@amc.uva.nl
Katja C
KC
Wolthers
Kimberley S M
KS
Benschop
Janke
J
Schinkel
Richard
R
Molenkamp
Rosemarijn M
RM
Bergevoet
Ingrid J B
IJ
Spijkerman
H Carlijn
HC
Kraakman
Dasja
D
Pajkrt
D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid / Q000821:virology*; D009426:Netherlands / Q000453:epidemiology; D030061:Parechovirus / Q000235:genetics / Q000302:isolation & purification*; D010850:Picornaviridae Infections / Q000134:cerebrospinal fluid / Q000453:epidemiology / Q000821:virology*; D016133:Polymerase Chain Reaction / Q000379:methods; D015995:Prevalence; D012189:Retrospective Studies; D012621:Seasons; D018805:Sepsis / Q000134:cerebrospinal fluid / Q000821:virology*