P128 – 2769: Human Parechovirus CNS infection: A rare cause of neonatal encephalitis

Abstract

Objective Human Parechoviruses (HPeV) belong to the family of Picornaviridae and can cause a variety of symptoms ranging from mild diarrhoea to sepsis, meningitis and encephalitis, particularly among young children and infants. We describe the clinical spectrum, laboratory and radiological findings of two neonates with HPeV CNS infection. Method Case reports. Results Case 1: A nine day old neonate with no preceding risk factors for infection presented with a one day history of irritability and poor feeding. He was apyrexial on presentation but deteriorated with apnoeas and encephalopathy needing intensive care support. He had normal inflammatory markers and TORCH screen. CSF examination revealed 0 WCC, normal protein, glucose with no growth on culture. MRI Brain multiple small lesions in bifrontal subcortical, deep periventricular white matter, corpus callosum with marked restricted diffusion. CSF PCR was positive for HPeV. He received I/V antibiotics/antivirals (1 week) and showed spontaneous clinical improvement with normal neurodevelopment at 6 months. Case 2: A twelve day old neonate with no preceding history of note presented with a one-day history of intermittent facial twitch and clonic jerking of upper or lower limbs. He was commenced on antibiotics and antiviral following infection screen and treated with IV phenobarbitone for focal seizures. CSF was acellular, with normal protein and glucose with no growth on culture. MRI scan showed multifocal parenchymal lesions with marked restricted diffusion in the white matter along with corpus callosum. A CSF PCR was positive for HPeV. Baby was discharged after clinical improvement. Conclusion HPeV CNS infection is a rare but emerging cause of neonatal encephalitis. Paediatricians must be aware of this disease and consider it as a part of neurotropic virus screen in neonatal sepsis. Neuroimaging may be helpful with its characteristic MRI findings.