title: Sepsis-like disease in infants due to human parechovirus type 3 during an outbreak in Australia.
abstract: BACKGROUND
  Infections with human parechoviruses (HPeVs) are associated with a wide range of clinical presentations in children, ranging from mild or asymptomatic infections to severe sepsis-like presentations or meningoencephalitis.
  
  
  METHODS
  We reviewed medical records of infants admitted to 5 hospitals in New South Wales, Australia, during an outbreak of HPeV-3 infection. Data were collected on clinical presentation, laboratory markers, and outcome of infants with HPeV infection confirmed by reverse transcription polymerase chain reaction.
  
  
  RESULTS
  We identified 118 infected infants. Most presented with an acute sepsis-like syndrome with high fever, tachycardia, poor perfusion, and severe irritability. Other common features were erythrodermic rash, abdominal distension, edema, and hepatitis. The age range of infants was 4 days to 9.5 months; 75% were <2 months old, including all but 1 of the 30 infants (25%) admitted to intensive care units (ICUs), who as a group, were significantly younger than infants not admitted to ICUs. Only 4% of evaluable cerebrospinal fluid samples had pleocytosis, but HPeV was detected in 95%. Brain magnetic resonance imaging on a small number of children demonstrated white matter changes and diffusion restriction. Sequencing of the VP1 gene confirmed HPeV-3 in all samples tested. All children recovered without ongoing complications at last follow-up.
  
  
  CONCLUSIONS
  We report the largest series of HPeV-3 infection in infants, and the first outbreak in Australia. Infants presented with a severe sepsis-like syndrome with a high rate of ICU admissions, but all recovered from the acute infection without complications. Long-term sequelae are unknown.
authors.affiliation: The Children's Hospital at Westmead.
authors.forename: Ameneh
authors.initials: A
authors.lastname: Khatami
authors.affiliation: Sydney Children's Hospital, Sydney.
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: McMullan
authors.affiliation: The John Hunter Children's Hospital, Newcastle.
authors.forename: Murray
authors.initials: M
authors.lastname: Webber
authors.affiliation: The Children's Hospital at Westmead.
authors.forename: Phoebe
authors.initials: P
authors.lastname: Stewart
authors.affiliation: Sydney Children's Hospital, Sydney.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Francis
authors.affiliation: The John Hunter Children's Hospital, Newcastle.
authors.forename: Karin J
authors.initials: KJ
authors.lastname: Timmers
authors.affiliation: Wollongong Hospital, Wollongong, New South Wales.
authors.forename: Elicia
authors.initials: E
authors.lastname: Rodas
authors.affiliation: The Victorian Infectious Diseases Reference Laboratory, Melbourne, Victoria.
authors.forename: Julian
authors.initials: J
authors.lastname: Druce
authors.affiliation: The Children's Hospital at Westmead.
authors.forename: Bhavesh
authors.initials: B
authors.lastname: Mehta
authors.affiliation: The Children's Hospital at Westmead.
authors.forename: Nichola A
authors.initials: NA
authors.lastname: Sloggett
authors.affiliation: New South Wales Ministry of Health, Public Health Officer Training Program, Sydney.
authors.forename: Germaine
authors.initials: G
authors.lastname: Cumming
authors.affiliation: The Victorian Infectious Diseases Reference Laboratory, Melbourne, Victoria.
authors.forename: Georgina
authors.initials: G
authors.lastname: Papadakis
authors.affiliation: The Children's Hospital at Westmead Discipline of Paediatrics and Child Health, and Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, University of Sydney, New South Wales, Australia.
authors.forename: Alison M
authors.initials: AM
authors.lastname: Kesson
mesh_terms: D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009517:New South Wales / Q000453:epidemiology; D030061:Parechovirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D010850:Picornaviridae Infections / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D018805:Sepsis / Q000473:pathology* / Q000821:virology
keywords: epidemic; human parechovirus 3; infant; neonate; sepsis-like syndrome