2569. High Incidence of Enterovirus, HHV6, Parechovirus and Adenovirus Blood Viremia in Children 0 to 3 Years Old Presenting with Fever Without Source
Session: Oral Abstract Session: Pediatric Viral Infections
Saturday, October 6, 2018: 2:15 PM
Room: S 156
Background: Fever without source (FWS) is defined as a fever in which an extensive history and clinical examination fail to identify a cause. Although the vast majority of children with FWS have a self-limited viral infection, up to 10-25% have a serious bacterial infection (SBI). Therefore, many children require invasive diagnostic tests, hospital admission and empirical administration of broad spectrum antibiotics. The aim of this study was to assess the respective role of Human enterovirus (HEV), Human parechovirus (HPeV), Adenovirus (ADV) and Herpesvirus type 6 (HHV6) viremia in children < 3 years old (y.o.) presenting with FWS.

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.

Arnaud G. L'Huillier, MD1, Chiara Mardegan, MD2, Samuel Cordey, PhD3, Fanny Luterbacher, MD4, Sebastien Papis, MD2, Florence Hugon, RN4, Laurent Kaiser, MD3, Alain Gervaix, MD4, Klara Posfay-Barbe, MD, MS1 and Annick Galetto-Lacour, MD4, (1)Pediatric Infectious Diseases Division, University Hospitals of Geneva, Geneva, Switzerland, (2)Department of Paediatrics, University Hospitals of Geneva, Geneva, Switzerland, (3)Laboratory of Virology, University Hospitals of Geneva, Geneva, Switzerland, (4)Pediatric Emergency Medicine Division, University Hospitals of Geneva, Geneva, Switzerland

Disclosures:

A. G. L'Huillier, 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 .

C. Mardegan, None

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 .

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