G115(P) Parechovirus meningitis in infants – time for routine CSF viral screening?

Abstract

Human parechovirus (HPeV) is a virus belonging to the picornaviridae family; certain subtypes of which have been found to cause meningitis, particularly in infants. We describe a series of 7 infants who were diagnosed to have parechovirus meningitis by CSF PCR testing. Mean age at presentation was 2.4 months with a gender distribution of M:F 1.2:1. Clinical features included fever and severe irritability (100%), rash (60%) and diarrhoea (30%). All infants were clinically diagnosed to have sepsis of unknown aetiology and underwent a complete sepsis screen. CSF analysis was completely normal in all the infants, with normal CSF white cell count, CSF protein and glucose levels. Blood tests showed normal total white blood cell and neutrophil counts in all infants and a CRP less than 10 in 90% of the infants. CSF and blood cultures showed no growth in all infants. All infants received intravenous antibiotics (Cefotaxime and Amoxycillin) and 45% of infants received intravenous antiviral treatment (Aciclovir) at presentation. Positive identification of HPeV by PCR led to cessation of intravenous antibiotics and antiviral therapy in all infants and facilitated early discharge. HPeV is increasingly recognised to cause of meningitis in young infants, without accompanying CSF pleocytosis or CSF biochemical abnormalities. Standard criteria for CSF viral screening including CSF pleocytosis and/or CSF biochemical abnormalities would result in a failure to diagnose the majority of HPeV meningitis in infants. Undertaking routine viral screening of CSF samples in infants who present with clinical features of sepsis enables confirmation of a definitive diagnosis, avoidance of unnecessary antimicrobial therapy and a reduction in length of hospital stay.