Methods: Prospective monocentric diagnostic study. Between 11.2015 to 12.2017, children < 3 y.o. with FWS had, in addition to the standardized institutional work-up for FWS, plasma tested by real-time (reverse-transcription-) Polymerase Chain Reaction (PCR) for ADV, HHV6, HEV and HPeV. Specimens with cycle threshold values <40 were considered positive. Quantification was performed on positive specimens for HEV, ADV and HHV6 specimens when volume permitted.
Results: One hundred and thirty-five patients had plasma PCR for ADV, HHV6, HEV and HPeV. Male:Female ratio was 1.45:1 and median age was 2.4 months (interquartile range 1.3-9.7). Among those, 47/135 (34.8%) had at least one virus detected in the plasma. More specifically, HEV was detected in 19 patients (14.1%), HHV6 in 15 (11.1%), HPeV in 8 (5.9%)and ADV in 7 (5.2%). Co-infection with two viruses was detected in two patients (ADV/HEV and ADV/HPeV). No patient with positive plasma PCR had a positive blood or CSF culture. Two patients with positive plasma PCR fulfilled American Academy of Pediatrics criteria for urinary tract infection. The first was HEV+ in plasma and CSF, midstream urine was positive for leucocytes and grew E. coli 10e6 CFU/ml, whereas the second was HHV6+ in plasma and catheter urine was positive leucocytes/nitrites and grew P. mirabilis 10e5 CFU/ml.
Conclusion: This epidemiological study highlights the frequent detection of active enteroviral, adenoviral and HHV6 infections in plasma of children with FWS. Virus-virus and virus-bacteria co-infections are rare. Further studies are needed to establish causality between FWS and viremia.
A. G. L'Huillier,
Gertrude Von Meissner foundation:
Ernst and Lucie Schmidheiny foundation:
Research and Development Grant, Geneva University Hospitals:
S. Cordey, None
F. Luterbacher, None
S. Papis, None
F. Hugon, None
L. Kaiser, Swiss National Funds: Investigator , Research grant .
A. Gervaix, None
K. Posfay-Barbe, None
A. Galetto-Lacour, Gertrude Von Meissner foundation: Investigator , Research grant . Ernst and Lucie Schmidheiny foundation: Investigator , Research grant . Research and Development Grant, Geneva University Hospitals: Investigator , Research grant .