ABSTRACT
Among known parechovirus (PeV) types infecting humans, PeV-A3 (formerly HPeV3) and PeV-A1 (formerly HPeV1) are associated with pediatric central nervous system (CNS) infections. The prevalence of PeV-A3 among hospitalized infants with sepsis-like illness and viral CNS infection is well described; however, the contribution of PeV-A4 to infant CNS infection is relatively unexplored. We report the first 11 U.S. cases of PeV-A4 CNS infections occurring in Kansas City infants during 2010-2016 and compare the clinical presentation with that of PeV-A3. PeV-positive cerebrospinal fluid (CSF) specimens from 2010 to 2016 underwent sequencing for genotyping. Among all PeV-CSF positives, PeV-A4 was detected in 11 CSF samples from 2010 to 2016. PeV-A4 was first detected in 2010 (n=1/4), followed by detections in 2014 (n=1/39), 2015 (n=6/9), and 2016 (n=3/33). The median age of PeV-A4 infected infants in weeks (median: 4; range: 1-8) were similar to that of infants infected with PeV-A3 (median: 4; range: 0.25-8). Clinical characteristics of the PeV-A4 (n=11) were compared with select PeV-A3 (n=34) children with CNS infections and found to be mostly similar, although maximum temperature was higher (P=0.017) and fever duration was shorter (P=0.03) for PeV-A4 vs. PeV-A3. Laboratory test results were also similar between genotypes, although showed significantly lower peripheral white blood cell (P=0.014) and absolute lymphocyte counts (P =0.04) for PeV-A4 infants. Like PeV-A3, PeV-A4 caused summer-fall seasonal clusters of CNS infections in infants, with mostly similar presentations. Further surveillance is necessary to confirm potential differences in laboratory findings and in fever intensity/duration.
- Copyright © 2019 American Society for Microbiology.
