Methods: Cerebrospinal fluid (CSF) specimens were obtained from infants < 90 days old, who were hospitalized with sepsis-like illness or meningitis. After testing for HPeV by real-time RT-PCR at CMH, specimens from HPeV-positive infants were sent to CDC for typing by molecular sequencing. Clinical data were abstracted from the medical records of hospitalized infants.
Results: During June – October, 2014, 40 infants were identified with HPeV meningitis at CMH; 32 were confirmed as HPeV type 3 (HPeV3) by CDC, 4 failed sequencing and four were not typed. Among the 32 HPeV3-confirmed infants, 53% were male and the median age was 24.5 days (range: 5 to 56 days). Symptoms included fever (> 38°C, 94%), tachycardia (78%), poor feeding (75%), irritability (72%), mottled skin (34%) and rash (22%). The median length of stay (LOS) was 3 days (range: 1 to 18 days). Six infants required intensive care and all were < 3 weeks of age (age range: 5 – 18 days); these six (mean age = 10.2 days, 95% confidence interval (CI95): 4.8, 15.5 days) were significantly younger than infants who did not require intensive care (mean age = 27.7 days, CI95: 21.7, 33.6 days). Median LOS for those requiring intensive care was 6.5 days (range: 2 to 18 days); all six were treated with acyclovir, and all subsequently tested negative for herpes simplex virus (HSV). Five of the six who required intensive care had neurologic manifestations consistent with seizures, including eye deviation and limb stiffening. MRIs were performed for two infants and both were abnormal with white matter changes noted. No deaths were reported.
Conclusion: HPeV3 can cause severe neurologic illness requiring intensive care management in the first three weeks of life, and should be considered alongside HSV and other pathogens in cases of sepsis-like illness or meningitis. More widespread testing for HPeVs is recommended to better understand clinical scope and virus circulation.
J. Watson, None
S. Oberste, None
W. A. Nix, None
C. Harrison, None
S. Gerber, None
R. Selvarangan, None