Parechovirus and Human Herpes Virus-6 in the Cerebrospinal Fluid of Infants Clinically Tested for Enterovirus or Herpes Simplex Virus
Methods: All stored CSF samples from EV or HSV testing in infants less than six months of age at Children’s Hospital Colorado between January 1, 2010 and December 31, 2011 were tested for HPeV, HHV-6, EV, and HSV by PCR. Cases were categorized according to primary microbiologic diagnosis. Clinical characteristics and epidemiological data were collected using blinded, retrospective electronic chart review.
Results: Of the 239 infants tested, 106 (44.3%) had a microbiologic diagnosis made in the clinical setting with an additional 15 (6.3%) diagnosed following standardized testing for HPeV, HHV-6, EV, and HSV. There were 29 cases of EV (12.1%), 7 cases of HPeV (2.9%), 5 cases of HHV-6 (2.1%), and 5 cases of HSV (2.1%) identified. Twenty four infants (10%) had serious bacterial infections, though no bacterial co-infections occurred within the HPeV, HHV-6, EV, or HSV groups. All HPeV cases occurred in infants less than 2 months of age between July and October. Infants with HPeV had a median maximum temperature of 39°C (Interquartile range (IQR): 38.9-39), median fever duration of 3 days (IQR: 2-3) and median peripheral white blood cell count of 5.2 x 103/µL (IQR:3.6-6.3). HHV-6 cases occurred in infants with median age of 50 days (IQR: 20-136) without seasonality. The typical sepsis evaluation involved four days of hospitalization, three days of intravenous antibiotics, and one to two days of intravenous acyclovir.
Conclusion: Five percent of infants less than six months of age undergoing testing for EV or HSV have HPeV or HHV-6 in their CSF, increasing the diagnostic yield by 15%. Targeting testing of HPeV towards febrile infants less than 2 months of age with leukopenia in the late summer to early fall, and HHV-6 towards older infants may increase this yield. Further research is needed to determine the impact that a standardized approach to testing for these four viruses will have on rates of hospitalization, exposure to antimicrobials, and health care costs in infants with suspected sepsis.
Q. Wei, None
C. C. Robinson, None
S. R. Dominguez, None