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Alonso-Cadenas JA, Velasco R, Clerigué Arrieta N, Amasorrain Urrutia J, Suarez-Bustamante Huélamo M, Mintegi S, Gomez B. Performance of blood enterovirus and parechovirus polymerase chain reaction testing in young febrile infants: a prospective multicentre observational study. Arch Dis Child 2024:archdischild-2024-327367. [PMID: 39097401 DOI: 10.1136/archdischild-2024-327367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/22/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVES To analyse the performance of blood enterovirus and parechovirus PCR testing (ev-PCR) for invasive bacterial infection (IBI) (isolation of a single bacterial pathogen in a blood or cerebrospinal fluid culture) when evaluating well-appearing infants ≤90 days of age with fever without a source (FWS). METHODS We describe the well-appearing infants ≤90 days of age with FWS and normal urine dipstick. We performed a prospective, observational multicentre study at five paediatric emergency departments between October 2020 and September 2023. RESULTS A total of 656 infants were included, 22 (3.4%) of whom were diagnosed with an IBI (bacteraemia in all of them and associated with meningitis in four). The blood ev-PCR test was positive in 145 (22.1%) infants. One patient with positive blood ev-PCR was diagnosed with an IBI, accounting for 0.7% (95% CI 0.02 to 3.8) compared with 4.1% (95% CI 2.6 to 6.2) in those with a negative test (p=0.04). All four patients with bacterial meningitis had a negative blood ev-PCR result. Infants with a positive blood ev-PCR had a shorter hospital stay (median 3 days, IQR 2-4) compared with 4 days (IQR 2-6) for those with negative blood ev-PCR (p=0.02), as well as shorter duration of antibiotic treatment (median 2 days, IQR 0-4 vs 2.5 days, IQR 0-7, p=0.01). CONCLUSIONS Young febrile infants with a positive blood ev-PCR are at a low risk of having an IBI. Incorporating the blood ev-PCR test into clinical decision-making may help to reduce the duration of antibiotic treatments and length of hospital stay.
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Affiliation(s)
- Jose Antonio Alonso-Cadenas
- Emergency Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
- Instituto de Investigacion del Hospital de La Princesa, Madrid, Spain
| | - Roberto Velasco
- Pediatric Emergency Department, Hospital Universitari Parc Tauli, Sabadell, Spain
| | | | | | | | - Santiago Mintegi
- Pediatric Emergency Department, Hospital Universitario Cruces, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- University of the Basque Country, Bilbao, Spain
| | - Borja Gomez
- Pediatric Emergency Department, Hospital Universitario Cruces, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
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Gutierrez L, Sáenz V, Franco D, Moreno B, Fuentes-Campos E, Capitan-Barrios Z, Rivera LF, Carrera JP, Castillo J, Castillo M, Pascale JM, López-Vergès S, Sosa N, Ábrego L. Detection of parechovirus A in respiratory, gastrointestinal, and neurological clinical samples of pediatric patients from Panama (2014-2015). Virol J 2023; 20:302. [PMID: 38115118 PMCID: PMC10731877 DOI: 10.1186/s12985-023-02268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Abstract
Parechovirus A (PeV-A, Parechovirus, Picornaviridae) are human pathogens associated with mild to severe gastrointestinal and respiratory diseases in young children. While several studies have investigated the association of PeV-A with human disease, little is known about its epidemiology or detection in Latin America. Between the years 2014 and 2015, a total of 200 samples were collected from Panamanian pediatric patients aged < 16 years old exhibiting symptoms associated with respiratory (n = 64), gastrointestinal (n = 68), or neurological (n = 68) diseases. These samples were gathered from patients who had previously received negative diagnoses for the main respiratory viruses, rotavirus, and neurological viruses like herpes virus, enterovirus, and cytomegalovirus. The presence of PeV-A was analyzed by real time RT-PCR.Eight positive PeV-A infections (4.0%, 95% CI: 1.7 to 7.7) were detected: two in respiratory samples (3.0%, 95% CI: 0.3 to 10.8), five in gastrointestinal samples (7.3%, 95% CI: 2.4 to 16.3), and one in cerebrospinal fluid (1.5%, 95% CI: 1.4 to 7.9). The study provides evidence of PeV-A circulation in Panama and the data collectively, remarked on the importance of considering PeV-A in the Panamanian pediatric diagnostic landscape, especially when conventional testing for more common viruses yields negative results.
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Affiliation(s)
- Lizette Gutierrez
- The University of Texas at El Paso (UTEP), El Paso, TX, 79968, US
- Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama
| | - Viridiana Sáenz
- The University of Texas at El Paso (UTEP), El Paso, TX, 79968, US
- Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama
| | - Danilo Franco
- Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama
| | - Brechla Moreno
- Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama
| | - Ediner Fuentes-Campos
- Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama
| | - Zeuz Capitan-Barrios
- Facultad de Ciencias Naturales, Exactas y Tecnología, Departamento de Microbiología y Parasitología, Universidad de Panamá, Panamá, Panama
- Carson Centre for Research in Environment and Emerging Infectious Diseases, La Peñita, Darien, Panama
| | - Luis Felipe Rivera
- Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama
- Carson Centre for Research in Environment and Emerging Infectious Diseases, La Peñita, Darien, Panama
| | - Jean-Paul Carrera
- Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama
- Carson Centre for Research in Environment and Emerging Infectious Diseases, La Peñita, Darien, Panama
| | - Juan Castillo
- Department Research in Genomic and Proteomic, Gorgas Memorial Institute of Health Studies, Panama City, Panama
| | - Marlene Castillo
- Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama
| | - Juan Miguel Pascale
- Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama
| | - Sandra López-Vergès
- Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama
| | - Néstor Sosa
- Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama
- Division of Infectious Diseases, University of New Mexico Hospital, Albuquerque, NM, US
| | - Leyda Ábrego
- Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama.
- Facultad de Ciencias Naturales, Exactas y Tecnología, Departamento de Microbiología y Parasitología, Universidad de Panamá, Panamá, Panama.
- Carson Centre for Research in Environment and Emerging Infectious Diseases, La Peñita, Darien, Panama.
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de Ceano-Vivas M, García ML, Velázquez A, Martín del Valle F, Menasalvas A, Cilla A, Epalza C, Romero MP, Cabrerizo M, Calvo C. Neurodevelopmental Outcomes of Infants Younger Than 90 Days Old Following Enterovirus and Parechovirus Infections of the Central Nervous System. Front Pediatr 2021; 9:719119. [PMID: 34650940 PMCID: PMC8505960 DOI: 10.3389/fped.2021.719119] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022] Open
Abstract
Enteroviruses (EVs) and human parechoviruses (HPeVs) are a major cause of central nervous system (CNS) infection in young infants. They have been implicated in neurodevelopmental delay, however limited data are available. The aim of this study is to describe the clinical outcome of young infants and to assess and compare the medium-term neurodevelopment following CNS infections caused by EV and HPeV. A multicentre observational ambispective study was conducted between May 2013 and March 2018. Children under 3 months of age with EV or HPeV CNS infection excluding encephalitis were included. Infants were contacted 1 year after the acute infection and their neurological development was evaluated using the Ages and Stages Questionnaire-3 (ASQ-3). If any area assessed was abnormal during the first round of tests, a second round was completed 6 to 12 months later. Forty-eight young infants with EV and HPeV CNS infection were identified: 33 (68.8%) were positive for EV and 15 (31.3%) for HPeV. At first assessment 14 out of 29 EV (48.3%) and 3 out of 15 HPeV (20%) positive cases presented some developmental concern in the ASQ-3 test. EV-positive infants showed mild and moderate alteration in all domains analyzed and HPeV-positive infants showed mild alterations only in gross and fine motor domains. Significant alterations in communication were observed in EV-positive but not in HPeV-positive infants (31 vs. 0%, p = 0.016). At second assessment 4 out of 13 EV-positive patients (30.8%) showed mild to moderate concerns in communication and gross motor function domains and 3 out of 13 (23.1%) showed significant concern in fine motor function. Although CNS infections without associated encephalitis are generally assumed to be benign our study shows that at a median age of 18 months almost half of the EV-infected infants (48.3%) and 20% of HPeV-positive infants presented some developmental concern in the ASQ-3 test. We recommend monitor the neurological development of infants during the first years of life after HPeV CNS infection and especially after EV CNS infection, even in mild cases, for an early intervention and stimulation of psychomotor development if necessary.
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Affiliation(s)
| | - M. Luz García
- Department of Pediatrics, Severo Ochoa University Hospital, Madrid, Spain
| | - Ana Velázquez
- Department of Pediatrics, La Paz University Hospital, Madrid, Spain
| | | | - Ana Menasalvas
- Department of Pediatrics, Virgen de la Arixaca University Hospital, Murcia, Spain
| | - Amaia Cilla
- Department of Pediatrics, Burgos University Hospital, Burgos, Spain
| | - Cristina Epalza
- Department of Pediatrics, 12 de Octubre University Hospital, Madrid, Spain
| | - M. Pilar Romero
- Department of Microbiology, La Paz University Hospital, Madrid, Spain
| | - María Cabrerizo
- National Centre for Microbiology, Instituto de Salud Carlos III, CIBER de Epidemiología y Salud Pública, Madrid, Spain
| | - Cristina Calvo
- Department of Pediatric Infectious Diseases, La Paz University Hospital and La Paz Research Institute (IdiPaz), Madrid, Spain
- Translational Research Network in Pediatric Infectious Diseases (Red de Investigación Traslacional en Infectología Pediátrica), Madrid, Spain
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Neurodevelopment medium-term outcome after parechovirus infection. Early Hum Dev 2019; 132:1-5. [PMID: 30908988 DOI: 10.1016/j.earlhumdev.2019.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 12/31/2022]
Abstract
AIM Human parechoviruses (HPeV) are responsible for fever without a source (FWS), sepsis-like illness and encephalitis in neonates and children under 3 months of age. Short-term outcome is generally good, but there is great concern about medium and long- term outcome of infants after HPeV infection. The aim of this study is to assess the medium-term outcome in infants following HPeV infection without encephalitis. METHODS Patients who suffered HPeV infection involving cerebrospinal fluid were evaluated twice using Ages and Stages Questionnaire-3 (ASQ-3). The first evaluation was conducted at least one year after the infection and the second one year later. RESULTS Sixteen patients were evaluated in the first assessment, and three of them presented mild alterations in motor function domains. Moreover, hypotonia was observed in the neurologic exam in one case, and hemiparesis in another case. In the second assessment fifteen patients were included, and only the patient with hemiparesis continued presenting gross motor disfunction, with complete recovery of the remaining patients. INTERPRETATION We have observed a good medium-term prognosis in infants after HPeV infections, with improvement of mild motor alterations after at-home intervention. Infants who suffer HPeV infection without encephalitis seem to have a better prognosis than those with encephalitis.
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Reina J, Dueñas J. [Detection of human Parechovirus in respiratory samples in the neonatal population with fever of unknown origin]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2019; 32:91-92. [PMID: 30569696 PMCID: PMC6372969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jordi Reina
- Unidad de Virología, Servicio de Microbiología, Hospital Universitario Son Espases, Palma de Mallorca
| | - Joaquín Dueñas
- Sección Infectología, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca
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High frequency and diversity of parechovirus A in a cohort of Malawian children. Arch Virol 2019; 164:799-806. [PMID: 30666460 PMCID: PMC6394728 DOI: 10.1007/s00705-018-04131-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/28/2018] [Indexed: 12/19/2022]
Abstract
Parechoviruses (PeVs) are highly prevalent viruses worldwide. Over the last decades, several studies have been published on PeV epidemiology in Europe, Asia and North America, while information on other continents is lacking. The aim of this study was to describe PeV circulation in a cohort of children in Malawi, Africa. A total of 749 stool samples obtained from Malawian children aged 6 to 60 months were tested for the presence of PeV by real-time PCR. We performed typing by phylogenetic and Basic Local Alignment Search Tool (BLAST) analysis. PeV was found in 57% of stool samples. Age was significantly associated with PeV positivity (p = 0.01). Typing by phylogenetic analysis resulted in 15 different types, while BLAST typing resulted in 14 different types and several indeterminate strains. In total, six strains showed inconsistencies in typing between the two methods. One strain, P02-4058, remained untypable by all methods, but appeared to belong to the recently reclassified PeV-A19 genotype. PeV-A1, -A2 and -A3 were the most prevalent types (26.8%, 13.8% and 9.8%, respectively). Both the prevalence and genetic diversity found in our study were remarkably high. Our data provide an important contribution to the scarce data available on PeV epidemiology in Africa.
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