title: Atypical presentation of human bocavirus: Severe respiratory tract infection complicated with encephalopathy.
abstract: Human bocavirus (HBOV) has been reported as a worldwide distributed respiratory pathogen. It has also been associated with encephalitis recently by detection of the virus in cerebrospinal fluid (CSF) of patients presented with encephalitis. This retrospective study aimed to present clinical features of HBOV infections in children with respiratory symptoms and describe unexplained encephalopathy in a subgroup of these patients. Results of 1,143 pediatric nasal samples from mid-December 2013 to July 2014 were reviewed for detection of HBOV. A multiplex real time polymerase chain reaction assay was used for viral detection. Medical records of the patients were retrospectively analyzed. HBOV was detected in 30 patients (2.6%). Median age was 14 months (5-80). Clinical diagnoses were upper respiratory tract infection (n = 10), bronchopneumonia (n = 9), acute bronchiolitis (n = 5), pneumonia (n = 4), acute bronchitis (n = 1), and asthma execarbation (n = 1). Hospitalization was required in 16 (53.3%) patients and 10 (62.5%) of them admitted to pediatric intensive care unit (PICU). Noninvasive mechanical ventilation modalities was applied to four patients and mechanical ventilation to four patients. Intractable seizures developed in four patients while mechanically ventilated on the 2nd-3rd days of PICU admission. No specific reason for encephalopathy was found after a thorough investigation. No mortality was observed, but two patients were discharged with neurological sequela. HBOV may lead to respiratory infections in a wide spectrum of severity. This report indicates its potential to cause severe respiratory infections requiring PICU admission and highlights possible clinical association of HBOV and encephalopathy, which developed during severe respiratory infection.
authors.affiliation: Department of Pediatrics, Pediatric Infectious Disease Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Hacer
authors.initials: H
authors.lastname: Akturk
authors.affiliation: Department of Pediatrics, Pediatric Intensive Care Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Guntulu
authors.initials: G
authors.lastname: Sık
authors.affiliation: Department of Pediatrics, Pediatric Infectious Disease Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Nuran
authors.initials: N
authors.lastname: Salman
authors.affiliation: Department of Pediatrics, Pediatric Infectious Disease Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Sutcu
authors.affiliation: Department of Pediatrics, Pediatric Neurology Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Burak
authors.initials: B
authors.lastname: Tatli
authors.affiliation: Department of Microbiology and Clinical Microbiology, National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Meral Akcay
authors.initials: MA
authors.lastname: Ciblak
authors.affiliation: Department of Radiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Oguz Bulent
authors.initials: OB
authors.lastname: Erol
authors.affiliation: Department of Pediatrics, Pediatric Infectious Disease Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Selda Hancerli
authors.initials: SH
authors.lastname: Torun
authors.affiliation: Department of Pediatrics, Pediatric Intensive Care Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Agop
authors.initials: A
authors.lastname: Citak
authors.affiliation: Department of Pediatrics, Pediatric Infectious Disease Unit, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Ayper
authors.initials: A
authors.lastname: Somer
mesh_terms: D001927:Brain Diseases / Q000209:etiology* / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D056661:Human bocavirus / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D060885:Multiplex Polymerase Chain Reaction; D009296:Nasal Cavity / Q000821:virology; D010322:Parvoviridae Infections / Q000473:pathology*; D060888:Real-Time Polymerase Chain Reaction; D012141:Respiratory Tract Infections / Q000150:complications* / Q000473:pathology*; D012189:Retrospective Studies
keywords: encephalopathy; human bocavirus; pediatric intensive care unit; respiratory tract infections