Human parechovius and enterovirus in neonates: Distinct infections with overlapping features

Abstract

Introduction: Human parechoviruses (HPeVs) have recently been added to the family Picornaviridae, where Enteroviruses (HEV) belong. The specific characteristics of HPeV infection in the neonate are not clear, and their involvement in neonatal infection is believed to be largely underestimated. HPeV type 3 has been recently linked to sepsis-like illness and neurological involvement in the newborn.

Objective: To assess the involvement of HPeV in central nervous system (CNS) infections throughout the neonatal period in term newborns, describe their clinical, analytical and cerebrospinal fluid (CSF) characteristics, and compare them to HEV infections.

Methods: Term newborns admitted for neurological symptoms or a suspected infection, aged 0-30 days were prospectively recruited (September 2012-August 2014). Bacterial cultures were performed in all patients. Viral tests were performed in CSF including: RT-PCR for cytomegalovirus, Herpes simplex type 1 and 2, Epstein-Barr virus, HEV and HPeV. HEV and HPeV positive samples were genotyped.

Results: Fifty-seven newborns were diagnosed of sepsis-like illness and/or CNS alteration. HEV (8.7%) and HPeV-3 (3.5%) were the two most common viral agents involved during the study period. The most frequent symptom at admission was fever. Irritability was present in 1/2 of HPeV and 1/5 of HEV cases. There were no other neurological symptoms. Blood and CSF analysis were unremarkable in HPeV infections. All cases resolved favorably.

Conclusions: HPeV infection was clinically very similar to that of HEV, while it featured normal blood and CSF analysis.

Practice implications: HPeV should be considered by clinicians in the differential diagnosis of neonatal infection, particularly when blood and CSF analysis are unremarkable.

Keywords: Encephalopathy; Human enterovirus; Human parechovirus; Neonatal sepsis; Newborn; Viral infection.