G320(P) Septic baby; have you considered parechovirus meningitis?

Abstract

Introduction “Febrile baby” is a common presentation to paediatric departments. In young babies paediatricians are likely to perform a full septic screen to ascertain the source of the temperature. Part of this process involves requesting the correct tests for the best chance of achieving a diagnosis. We discuss three cases with a diagnosis that is perhaps not often considered yet may have potential consequences for development. Case presentation Three babies presented in the neonatal period with symptoms including temperature, poor perfusion, rash, shortness of breath and apnoea. All three were judged to be cardiovascularly unstable and received fluid boluses. They all had unremarkable CRP results (maximum 14mg/L). CSF demonstrated raised protein in all three but low white cell count (maximum 3 × 1000000/L). One of the babies required intubation and ventilation for three days for apnoeas. All of the babies improved clinically as soon as they became afebrile (around 3 days after admission). All babies were PCR positive for parechovirus on CSF. Discussion There are over ten types of parechovirus identified with type 3 most commonly associated with neonatal sepsis. Over 90% of five year olds have experienced parechovirus as a mild gastrointestinal or respiratory illness. In babies under 3 months of age it is more likely to present more dramatically. It is spread in respiratory droplets, saliva and faeces. Low CSF WCC and raised protein are typical findings. Management is supportive and there is no vaccine. Neurodevelopmental delay has been reported following the illness and animal data suggests persistent presence in CNS causing ongoing inflammation. Conclusion When assessing and investigating a febrile baby sending a CSF PCR for parechovirus may yield a result in a patient with otherwise unremarkable laboratory investigations. This diagnosis is important as it has the potential to cause neurodevelopmental problems and as such these patients may warrant follow up.