Background: Human parechovirus type 3 (HPeV3) and enteroviruses (EVs) are the major viral pathogens causing severe diseases in neonates and young infants. Although two infections typically occur in summer, and initial clinical presentations are similar, differences in clinical and laboratory characteristics of HPeV3- and EV- infections are not well described.
Methods: From January 2014 to December 2016, we prospectively obtained serum and/or cerebrospinal fluid (CSF) samples from febrile neonates and young infants < 4 months suspecting sepsis and meningoencephalitis in Niigata, Japan. RNA/DNA were extracted from the samples and viral etiologies including HPeV3, EVs, and/or herpes simplex virus were tested using the real-time PCR, followed by genetic sequencing and typing. The comparison was made between HPeV3- and EVs-infected patients based on their medical records and subsequent questionnaires using appropriate statistical analyses.
Results: In total, we obtained 212 serum and 170 CSF samples from 222 patients. HPeV3 and EVs were detected for 56 (25%) and 43 patients (19%) (Figure), and their median ages were 29 and 24 days (P = 0.58), respectively. HPeV3-infected patients presented with higher median body temperature (38.9 ̊C vs 38.5 ̊C, P < 0.001), heart rates (184/min vs. 161/min, P = 0.002), peripheral coldness (72% vs. 34%, P < 0.001), skin mottling (65% vs. 23%, P < 0.001), and grunting (22% vs. 5%, P = 0.014) than EVs-infected patients. Additionally, systemic inflammatory response syndrome (SIRS) was more frequently observed in HPeV3-infected patients than in EVs-infected patients (82% vs. 58%, P = 0.009). In the laboratory data, median white blood cell count was lower in HPeV3-infected patients than those in EVs-infected patients (5,200/µL vs. 8,900/µL, P < 0.001). The pleocytosis was observed 58% of EVs-infected patients, but none of the HPeV3-infected patients (P < 0.001); however, HPeV3 RNA was frequently detected than EVs in CSF (90% vs 66%, P = 0.012).
Conclusion: This study showed that HPeV3-infected neonates and young infants presented more severe clinical manifestations than those infected with EVs. Significant tachycardia, poor peripheral circulation, and fulfilling SIRS criteria at the presentation may be the clues considering HPeV3 infection rather than EVs infection.
R. Habuka, None
K. Watanabe, None
T. Otsuka, None
A. Saitoh, None