title: Clinical utility of serum samples for human parechovirus type 3 infection in neonates and young infants: The 2014 epidemic in Japan.
abstract: During the 2014 human parechovirus type 3 (HPeV3) epidemic in Niigata, Japan, this prospective observational study identified HPeV3 from 43/85 (51%) febrile young infants <4 months using PCR analysis of serum (n = 42) and/or cerebrospinal fluid (CSF) (n = 32) and genetic sequencing of the VP1 region of HPeV3. HPeV3-infected patients (median age, 32 days; range, 4-113 days) were diagnosed as having sepsis (79%), sepsis-like syndrome (19%), or encephalitis with septic shock (2%). Other than fever, mottled skin (67%) was significantly more frequent in HPeV3-infected patients than other virus-infected patients (P = 0.005). The rate of HPeV3 RNA detection in CSF without pleocytosis was high (88%; 28/32). Among the 32 patients whose serum and CSF samples were available, all patients were positive for serum PCR; however, 4 (12%) patients were negative for CSF PCR. Serum HPeV3 RNA level on admission was associated with younger age (P = 0.002), bad temper (P = 0.041), and grunting (P = 0.008). Among 6 patients with sequential data on serum HPeV3 RNA level, levels decreased rapidly without specific therapy. In conclusion, serum samples at disease onset are the most useful compared to CSF in detection of HPeV RNA and serum HPeV3 RNA level on admission was associated with important clinical manifestations in HPeV3-infected patients.
authors.affiliation: Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Aizawa
authors.affiliation: Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Department of Medical Technology, Niigata University Graduate School of Health Sciences, Niigata, Japan.
authors.forename: Kanako
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Oishi
authors.affiliation: Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; Division of Infectious Diseases, Department of Pediatrics, University of California, San Diego, USA. Electronic address: asaitoh@med.niigata-u.ac.jp.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Saitoh
mesh_terms: D002555:Cerebrospinal Fluid / Q000821:virology; D058872:Epidemics; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007564:Japan / Q000453:epidemiology; D008297:Male; D030061:Parechovirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D010850:Picornaviridae Infections / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D044967:Serum / Q000821:virology
keywords: Human parechovirus type 3; Infants; Sepsis; Serum; Viral load