Epidemic Myalgia in Adults Associated with Human Parechovirus Type 3 Infection, Yamagata, Japan, 2008

Katsumi Mizuta,Tetsuya Mizutani,Takeo Kato,Yoko Aoki,Toru Kawanami,Hirokazu Kimura,Tatsuya Ikeda,Masahiro Noda,Tadayuki Ahiko,Yoshikazu Yahata,Masayuki Kurimura,Tsuyoshi Sekizuka,Makoto Kuroda,Chieko Abiko

doi:10.3201/eid1811.111570

Abstract

Human parechovirus has rarely been shown to cause clinical disease in adults. During June-August 2008, a total of 22 adults sought treatment at Yonezawa City Hospital in Yamagata, Japan, for muscle pain and weakness of all limbs; most also had fever and sore throat. All patients received a clinical diagnosis of epidemic myalgia; clinical laboratory findings suggested an acute inflammatory process. Laboratory confirmation of infection with human parechovirus type 3 (HPeV3) was made for 14 patients; we isolated HPeV3 from 7 patients, detected HPeV3 genome in 11, and observed serologic confirmation of infection in 11. Although HPeV3 is typically associated with disease in young children, our results suggest that this outbreak of myalgia among adults was associated with HPeV3 infection. Clinical consideration should be given to HPeV3 not only in young children but also in adults when an outbreak occurs in the community.

Highlights

Human parechovirus has rarely been shown to cause clinical disease in adults
By conducting virus isolation, RT-PCR, and serologic examination, we confirmed an outbreak of epidemic myalgia among adults in Yonezawa, Yamagata, Japan, during June–August 2008 was associated with human parechovirus type 3 (HPeV3) infection
We did not detect any virus in our first screening, direct sequencing analysis suggested that these patients were infected with HPeV3

Summary

Introduction

Human parechovirus has rarely been shown to cause clinical disease in adults. HPeV3 is typically associated with disease in young children, our results suggest that this outbreak of myalgia among adults was associated with HPeV3 infection. Clinical consideration should be given to HPeV3 in young children and in adults when an outbreak occurs in the community. HPeV1 and HPeV2 mainly cause mild gastrointestinal or respiratory illness, but more serious diseases have been occasionally reported, including myocarditis, encephalitis, pneumonia, meningitis, flaccid paralysis, Reye syndrome, and fatal neonatal infection [2,5,6]. Japan, and epidemiologic investigation found that it was associated with HPeV3 infection. We describe this outbreak and provide expanded information about the clinical spectrum of HPeV3 infection

Methods

Results

Conclusion