Human Parechovirus Research Articles

Parechovirus neonatal sepsis and meningitis – a (still) poorly recognised agent

Human parechovirus (HPeV), a Picornaviridae virus, is a microorganism associated with respiratory and gastrointestinal infections, in most cases with a benign clinical course. However, some serotypes have been recently associated with a more serious clinical outcome in young children, namely sepsis-like disease and meningitis. In this report, we describe the case of a previously healthy, 11-day-old infant in our Paediatric Emergency Department who presented with high fever, irritability and poor feeding. No other accompanying symptoms, such as respiratory, gastrointestinal or urinary, were shown by the patient. Family history unveiled an 18-month-old sibling with an upper respiratory tract infection. Physical examination was unremarkable. Laboratory testing revealed a normal total white cell count with lymphopenia and a maximum C-reactive protein value of 21.4 mg/L. Cerebrospinal fluid (CSF) analysis showed pleocytosis with high proteinorrachia and normal glycorrhachia. With the clinical suspicion of sepsis, she was hospitalized for clinical surveillance, and empirical antibiotics were administered. Although the bacteriological exams of blood and CSF were negative, RNA of an HPeV was detected in the CSF. She had a favourable clinical course, the cerebral ultrasound was normal, and the clinical follow-up showed adequate psychomotor development until today (18 months old). Recent publications suggested HPeV as one of the major agents of neonatal sepsis and meningitis. Similarly, several other studies reported significant neurological impairments in infants with HPeV infection. In line with these recent findings, we believe this clinical case further supports the need for more extensive research in viral aetiology and in particular of this, not so uncommon, agent in order to avoid unnecessary and potentially harmful interventions in newborns presenting with a sepsis-like clinical picture.

Isolation of human parechovirus type 3 from an infant with sudden death.

Pediatrics InternationalVolume 64, Issue 1 e15305 Clinical Notes Isolation of human parechovirus type 3 from an infant with sudden death Yuko Hayashi, Yuko Hayashi Department of Pediatrics, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan Department of Pediatrics, School of Medicine, Iwate Medical University, Yahaba, Iwate, JapanSearch for more papers by this authorTakashi Odagiri, Takashi Odagiri Division of Infectious Diseases and Immunology, Department of Microbiology, School of Medicine, Iwate Medical University, Yahaba, Iwate, JapanSearch for more papers by this authorTaketora Echizenya, Taketora Echizenya Department of Pediatrics, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, JapanSearch for more papers by this authorKoji Dewa, Koji Dewa Department of Forensic Medicine, School of Medicine, Iwate Medical University, Yahaba, Iwate, JapanSearch for more papers by this authorYasushi Muraki, Corresponding Author Yasushi Muraki ymuraki@iwate-med.ac.jp orcid.org/0000-0001-8772-8018 Division of Infectious Diseases and Immunology, Department of Microbiology, School of Medicine, Iwate Medical University, Yahaba, Iwate, JapanCorrespondence: Yasushi Muraki, MD PhD, Division of Infectious Diseases and Immunology, Department of Microbiology, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate 028-3694, Japan. Email: ymuraki@iwate-med.ac.jpSearch for more papers by this author Yuko Hayashi, Yuko Hayashi Department of Pediatrics, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, Japan Department of Pediatrics, School of Medicine, Iwate Medical University, Yahaba, Iwate, JapanSearch for more papers by this authorTakashi Odagiri, Takashi Odagiri Division of Infectious Diseases and Immunology, Department of Microbiology, School of Medicine, Iwate Medical University, Yahaba, Iwate, JapanSearch for more papers by this authorTaketora Echizenya, Taketora Echizenya Department of Pediatrics, Iwate Prefectural Chubu Hospital, Kitakami, Iwate, JapanSearch for more papers by this authorKoji Dewa, Koji Dewa Department of Forensic Medicine, School of Medicine, Iwate Medical University, Yahaba, Iwate, JapanSearch for more papers by this authorYasushi Muraki, Corresponding Author Yasushi Muraki ymuraki@iwate-med.ac.jp orcid.org/0000-0001-8772-8018 Division of Infectious Diseases and Immunology, Department of Microbiology, School of Medicine, Iwate Medical University, Yahaba, Iwate, JapanCorrespondence: Yasushi Muraki, MD PhD, Division of Infectious Diseases and Immunology, Department of Microbiology, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Iwate 028-3694, Japan. Email: ymuraki@iwate-med.ac.jpSearch for more papers by this author First published: 18 October 2022 https://doi.org/10.1111/ped.15305 Yuko Hayashi and Takashi Odagiri contributed equally to this work. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume64, Issue1January/December 2022e15305 RelatedInformation

Türkiye'de Kentsel Bir Atıksu Arıtma Tesisinde SARS-CoV-2 ve Gastrointestinal Patojenlerin Araştırılması

In this study, SARS-CoV-2 and gastrointestinal pathogens in a municipal wastewater treatment plant (MWWTP) in Elazığ (Turkey) were investigated. The gastrointestinal pathogen analyzes were performed in influent and effluent of MWWTP, and SARS-CoV-2 analyzes were performed in different treatment units. According to obtained analysis results, gastrointestinal pathogens (bacterial, viral, EPA, and stool parasites) were detected in influent of the MWWTP. Enterohemorragic/verotoxin-producing Ecsherichia coli, all viral agents causing gastroenteritis (except sapoviruses (Sapo)), human parechovirus (HPeV) and adenoviruses from EPA, and Giardia lamblia from stool parasites were detected in effluents of the MWWTP. When bacterial agents causing gastroenteritis, viral agents, EPA, and stool parasites were investigated in the effluent of MWWTP, only 1 agent out of 7, 4 agents out of 6, 2 agents out of 3, and 1 agent out of 3 was detected as positive (+), respectively. SARS-CoV-2 could not be detected in the samples taken from each unit of the wastewater treatment plant. As a result, according to research findings, since pathogens are encountered in wastewater treatment plant effluents, it is necessary to have a disinfection system in the treatment plants and to monitor pathogens and SARS-CoV-2 continuously in order to protect environmental and human health.

Parechovirus infection in infants: Evidence-based parental counselling for paediatricians.

Human parechovirus (HPeV) is an increasingly recognised cause of severe illness and central nervous system infection in infants. Medium- to long-term neurodevelopmental outcomes post-HPeV infection remain unknown. This study aims to assess neurodevelopmental outcomes for children hospitalised as infants with HPeV infection in their second and third years of life. This prospective cohort study followed children hospitalised with HPeV in Brisbane, Queensland during the 2017/2018 outbreak. Serial application of Ages and Stages Questionnaire (ASQ) was used to assess developmental progress in the second and third years of life. Data from clinical follow-up, audiology and neuroradiology were included. In the second year of life, 63% (n= 29) of children showed some or significant concerns for developmental delay. This had largely been ameliorated by the third year of life when only 30% (n= 14) reported developmental concerns. Prematurity and apnoeas were associated with developmental concerns at 27-36 months of age. Communication was the most common domain of concern. The majority of infants hospitalised with HPeV infection in 2017-2018 showed normalisation of developmental progress by 27-36 months of age. Further investigation into more subtle neurological impairments in later childhood is required. These results can help guide clinicians in counselling parents during the acute illness and in planning appropriate follow-up.

Clinical profile of children with parechovirus meningitis in Singapore

Human parechovirus (HPeV) is one of the most common causes of aseptic meningitis in children worldwide. This study aims to review the epidemiology, clinical presentation, and cerebrospinal fluid (CSF) findings in HPeV meningitis and compare these with Enterovirus (EV) meningitis. This is a retrospective study of children aged ≤ 1year admitted for HPeV meningitis between November 2015 and July 2017, with positive CSF HPeV PCR and negative blood and CSF bacterial cultures. The clinical findings were compared with a historical cohort of children with EV meningitis admitted between July 2008 and July 2011. There were 71 children with HPeV meningitis, aged between 2 and 127days, with the majority (96%) being ≤ 90days old. The most common symptoms reported were poor feeding (42%), tachycardia out of proportion to fever (27%), and lethargy (20%). Only 2 patients (3%) had CSF pleocytosis. Cerebral spinal fluid white blood cell counts ranged from 0 to 28 cells/mm3, with a median of 3 cells/mm3 [interquartile range (IQR) 1-6 cells/mm3]. When compared to our historical cohort of EV meningitis ≤ 90days old, children with HPeV meningitis ≤ 90days old were less likely to have CSF pleocytosis (OR 0.008, 95% CI 0.001-0.057). HPeV and EV meningitis are known to cause sepsis-like illness in infants < 90days old. This study further supports this, with the requirement for fluid bolus therapy for tachycardia or poor perfusion noted to be higher in children with HPeV meningitis ≤ 90days old (OR 6.3, 95% CI 2.7-14.2).

Rapid molecular diagnosis of Parechovirus infection using the reverse transcription loop-mediated isothermal amplification technique.

Human parechovirus (HPeV), especially HPeV A3 (HPeV3), causes sepsis-like diseases and sudden infant death syndrome in neonates and young infants. Development of rapid and easier diagnostic laboratory tests for HPeVs is desired. Original inner primers, outer primers, and loop-primers were designed on the 5' untranslated region of HPeV3. HPeV3 ribonucleic acids (RNAs), other viral RNAs, and clinical stool samples were used to confirm whether the designed primers would allow the detection of HPeV3 with the reverse transcription loop-mediated isothermal amplification (RT-LAMP) technique. Three combinations of primers were created and it was confirmed that all primer sets allowed the detection of HPeV3 RNAs. The primer sets had cross-reactivity with HPeV type 1 (HPeV1), but all sets showed negative results when applied to coxsackievirus, echovirus, enterovirus, norovirus, and adenovirus genomes. Four of six stool samples, obtained from newborn and infant patients with sepsis-like symptoms, showed positive results with our RT-LAMP technique. This manuscript is the first description of an RT-LAMP for the diagnosis of HPeVs, allowing a faster, easier, and cheaper diagnosis. This technique is clinically useful for newborns and infants who have sepsis-like symptoms.

Characterization of Pathogenesis and Inflammatory Responses to Experimental Parechovirus Encephalitis.

Human parechovirus type 3 (PeV-A3) infection has been recognized as an emerging etiologic factor causing severe nerve disease or sepsis in infants and young children. But the neuropathogenic mechanisms of PeV-A3 remain unknown. To understand the pathogenesis of PeV-A3 infection in the neuronal system, PeV-A3-mediated cytopathic effects were analyzed in human glioblastoma cells and neuroblastoma cells. PeV-A3 induced interferons and inflammatory cytokine expression in these neuronal cells. The pronounced cytopathic effects accompanied with activation of death signaling pathways of apoptosis, autophagy, and pyroptosis were detected. A new experimental disease model of parechovirus encephalitis was established. In the disease model, intracranial inoculation with PeV-A3 in C57BL/6 neonatal mice showed body weight loss, hindlimb paralysis, and approximately 20% mortality. PeV-A3 infection in the hippocampus and cortex regions of the neonatal mouse brain was revealed. Mechanistic assay supported the in vitro results, indicating detection of PeV-A3 replication, inflammatory cytokine expression, and death signaling transduction in mouse brain tissues. These in vitro and in vivo studies revealed that the activation of death signaling and inflammation responses is involved in PeV-A3-mediated neurological disorders. The present results might account for some of the PeV-A3-associated clinical manifestations.

From a case-control survey to a diagnostic viral gastroenteritis panel for testing of general practitioners’ patients

ObjectiveTo evaluate the pathogenicity of a broad range of 11 possible gastroenteritis viruses, by means of statistical relationships with cases vs. controls, or Ct-values, in order to establish the most appropriate diagnostic panel for our general practitioner (GP) patients in the Netherlands (2010–2012).MethodsArchived stool samples from 1340 cases and 1100 controls were retested using internally controlled multiplex real-time PCRs for putative pathogenic gastroenteritis viruses: adenovirus, astrovirus, bocavirus, enterovirus, norovirus GI and GII, human parechovirus, rotavirus, salivirus, sapovirus, and torovirus.ResultsThe prevalence of any virus in symptomatic cases and asymptomatic controls was 16.6% (223/1340) and 10.2% (112/1100), respectively. Prevalence of astrovirus (adjusted odds ratio (aOR) 10.37; 95% confidence interval (CI) 1.34–80.06) and norovirus GII (aOR 3.10; CI 1.62–5.92) was significantly higher in cases versus controls. Rotavirus was encountered only in cases. We did not find torovirus and there was no statistically significant relationship with cases for salivirus (aOR 1,67; (CI) 0.43–6.54)), adenovirus non-group F (aOR 1.20; CI 0.75–1.91), bocavirus (aOR 0.85; CI 0.05–13.64), enterovirus (aOR 0.83; CI 0.50–1.37), human parechovirus (aOR 1.61; CI 0.54–4.77) and sapovirus (aOR 1.15; CI 0.67–1.98). Though adenovirus group F (aOR 6.37; CI 0.80–50.92) and norovirus GI (aOR 2.22, CI: 0.79–6.23) are known enteropathogenic viruses and were more prevalent in cases than in controls, this did not reach significance in this study. The Ct value did not discriminate between carriage and disease in PCR-positive subjects.ConclusionsIn our population, diagnostic gastroenteritis tests should screen for adenovirus group F, astrovirus, noroviruses GI and GII, and rotavirus. Case-control studies as ours are lacking and should also be carried out in populations from other epidemiological backgrounds.

Parechovirus A Infection of the Intestinal Epithelium: Differences Between Genotypes A1 and A3.

Human parechovirus (PeV-A), one of the species within the Picornaviridae family, is known to cause disease in humans. The most commonly detected genotypes are PeV-A1, associated with mild gastrointestinal disease in young children, and PeV-A3, linked to severe disease with neurological symptoms in neonates. As PeV-A are detectable in stool and nasopharyngeal samples, entry is speculated to occur via the respiratory and gastro-intestinal routes. In this study, we characterized PeV-A1 and PeV-A3 replication and tropism in the intestinal epithelium using a primary 2D model based on human fetal enteroids. This model was permissive to infection with lab-adapted strains and clinical isolates of PeV-A1, but for PeV-A3, infection could only be established with clinical isolates. Replication was highest with infection established from the basolateral side with apical shedding for both genotypes. Compared to PeV-A1, replication kinetics of PeV-A3 were slower. Interestingly, there was a difference in cell tropism with PeV-A1 infecting both Paneth cells and enterocytes, while PeV-A3 infected mainly goblet cells. This difference in cell tropism may explain the difference in replication kinetics and associated disease in humans.

Parechovirus Genotype 3 Outbreak Among Young Infants in Portugal.

Human parechovirus type 3 has been recognized as a cause of pediatric infection, occasionally associated with seriousillness, including sepsis and meningitis, particularly among young infants. The aim of this study is to report the first known humanparechovirus type 3 outbreak in Portugal. Descriptive study of an outbreak that occurred between the 8th June to the 12th August 2016. Laboratory diagnosiswas made by reverse transcription - polymerase chain reaction in the cerebrospinal fluid and/or in stools. Genotyping was madeby reverse transcription - polymerase chain reaction and sequencing in stool samples from infants and family members. Human parechovirus type 3 infection was detected in seven infants, of which six were male. Median age was 23 days (5 - 52).One had seizures, with a magnetic resonance imaging scan showing white matter diffusion restriction. The mean duration of admissionwas 5.6 days (3 - 11), with favourable outcome in all. In three cases there were symptomatic close family members. Human parechovirustype 3 was identified in the stools of three mothers. Even though human parechovirus type 3 infection has been well described in the presented age group, most Portuguesehospitals do not have this laboratory diagnosis. Our results are comparable to those obtained in other countries. Besides detection ofthe virus in the cerebrospinal fluid, there were no raised local or systemic inflammatory markers. This study reports the first known outbreak, in infants, of human parechovirus type 3 in Portugal. Although there is nospecific treatment, this diagnosis can avoid unnecessary empirical antibiotic treatment and prolonged admissions.

Neurodevelopmental Outcomes of Infants Younger Than 90 Days Old Following Enterovirus and Parechovirus Infections of the Central Nervous System.

Enteroviruses (EVs) and human parechoviruses (HPeVs) are a major cause of central nervous system (CNS) infection in young infants. They have been implicated in neurodevelopmental delay, however limited data are available. The aim of this study is to describe the clinical outcome of young infants and to assess and compare the medium-term neurodevelopment following CNS infections caused by EV and HPeV. A multicentre observational ambispective study was conducted between May 2013 and March 2018. Children under 3 months of age with EV or HPeV CNS infection excluding encephalitis were included. Infants were contacted 1 year after the acute infection and their neurological development was evaluated using the Ages and Stages Questionnaire-3 (ASQ-3). If any area assessed was abnormal during the first round of tests, a second round was completed 6 to 12 months later. Forty-eight young infants with EV and HPeV CNS infection were identified: 33 (68.8%) were positive for EV and 15 (31.3%) for HPeV. At first assessment 14 out of 29 EV (48.3%) and 3 out of 15 HPeV (20%) positive cases presented some developmental concern in the ASQ-3 test. EV-positive infants showed mild and moderate alteration in all domains analyzed and HPeV-positive infants showed mild alterations only in gross and fine motor domains. Significant alterations in communication were observed in EV-positive but not in HPeV-positive infants (31 vs. 0%, p = 0.016). At second assessment 4 out of 13 EV-positive patients (30.8%) showed mild to moderate concerns in communication and gross motor function domains and 3 out of 13 (23.1%) showed significant concern in fine motor function. Although CNS infections without associated encephalitis are generally assumed to be benign our study shows that at a median age of 18 months almost half of the EV-infected infants (48.3%) and 20% of HPeV-positive infants presented some developmental concern in the ASQ-3 test. We recommend monitor the neurological development of infants during the first years of life after HPeV CNS infection and especially after EV CNS infection, even in mild cases, for an early intervention and stimulation of psychomotor development if necessary.

The Identification and Genetic Characterization of Parechovirus Infection Among Pediatric Patients With Wide Clinical Spectrum in Chongqing, China.

Human parechoviruses (HPeVs) are important causes of infection in children. However, without a comprehensive and persistent surveillance, the epidemiology and clinical features of HPeV infection remain ambiguous. We performed a hospital-based surveillance study among three groups of pediatric patients with acute respiratory infection (Group 1), acute diarrhea (Group 2), and hand, foot and mouth disease (Group 3) in Chongqing, China, from 2009 to 2015. Among 10,212 tested patients, 707 (6.92%) were positive for HPeV, with the positive rates differing significantly among three groups (Group 1, 3.43%; Group 2, 14.94%; Group 3, 3.55%; P < 0.001). The co-infection with other pathogens was detected in 75.2% (531/707) of HPeV-positive patients. Significant negative interaction between HPeV and Parainfluenza virus (PIV) (P = 0.046, OR = 0.59, 95% CI = 0.34–0.98) and positive interactions between HPeV and Enterovirus (EV) (P = 0.015, OR = 2.28, 95% CI = 1.23–4.73) were identified. Among 707 HPeV-positive patients, 592 (83.73%) were successfully sequenced, and 10 genotypes were identified, with HPeV1 (n = 396), HPeV4 (n = 86), and HPeV3 (n = 46) as the most frequently seen. The proportion of genotypes differed among three groups (P < 0.001), with HPeV1 and HPeV4 overrepresented in Group 2 and HPeV6 overrepresented in Group 3. The spatial patterns of HPeV genotypes disclosed more close clustering of the currently sequenced strains than those from other countries/regions, although they were indeed mixed. Three main genotypes (HPeV1, HPeV3, and HPeV4) had shown distinct seasonal peaks, highlighting a bi-annual cycle of all HpeV and two genotypes (HPeV 1 and HPeV 4) with peaks in odd-numbered years and with peaks in even-numbered years HPeV3. Significantly higher HPeV1 viral loads were associated with severe diarrhea in Group 2 (P = 0.044), while associated with HPeV single infection than HPeV-EV coinfection among HFMD patients (P = 0.001). It’s concluded that HPeV infection was correlated with wide clinical spectrum in pediatric patients with a high variety of genotypes determined. Still no clinical significance can be confirmed, which warranted more molecular surveillance in the future.

European Non-Polio Enterovirus Network: Introduction of Hospital-Based Surveillance Network to Understand the True Disease Burden of Non-Polio Enterovirus and Parechovirus Infections in Europe.

Background. Non-polio enteroviruses (EVs) and human parechoviruses (PeVs) cause a wide range of human infections. Limited data on their true disease burden exist as standardized European-wide surveillance is lacking. Aims. Our aim is to estimate the disease burden of EV and PeV infections in Europe via establishment of standardized surveillance for hand, foot and mouth disease (HFMD) and respiratory and neurological infections caused by these viruses. We will also assess the sensitivity of assays implemented in the network of participating laboratories so that all EV and PeV types are adequately detected. Plan. The European Non-Polio Enterovirus Network (ENPEN) has developed standardized protocols for a prospective, multi-center and cross-sectional hospital-based pilot study. Protocols include guidance for diagnosis, case definition, detection, characterization and reporting of EV and PeV infections associated with HFMD and respiratory and neurological diseases. Over 30 sites from 17 European countries have already registered to this one pilot study, likely to be commenced in 2022. Benefits. This surveillance will allow European-wide comparison of data on EV and PeV infection. These data will also be used to determine the burden of EV and PeV infections, which is needed to guide the further prevention measures and policies.

Virome in adult Aedes albopictus captured during different seasons in Guangzhou City, China.

BackgroundThe mosquito Aedes albopictus is an important vector for many pathogens. Understanding the virome in Ae. albopictus is critical for assessing the risk of disease transmission, implementation of vector control measures, and health system strengthening.MethodsIn this study, viral metagenomic and PCR methods were used to reveal the virome in adult Ae. albopictus captured in different areas and during different seasons in Guangzhou, China.ResultsThe viral composition of adult Ae. albopictus varied mainly between seasons. Over 50 viral families were found, which were specific to vertebrates, invertebrates, plants, fungi, bacteria, and protozoa. In rural areas, Siphoviridae (6.5%) was the most common viral family harbored by mosquitoes captured during winter and spring, while Luteoviridae (1.1%) was the most common viral family harbored by mosquitoes captured during summer and autumn. Myoviridae (7.0% and 1.3%) was the most common viral family in mosquitoes captured in urban areas during all seasons. Hepatitis B virus (HBV) was detected by PCR in a female mosquito pool. The first near full-length HBV genome from Ae. albopictus was amplified, which showed a high level of similarity with human HBV genotype B sequences. Human parechovirus (HPeV) was detected in male and female mosquito pools, and the sequences were clustered with HPeV 1 and 3 sequences.ConclusionsLarge numbers of viral species were found in adult Ae. albopictus, including viruses from vertebrates, insects, and plants. The viral composition in Ae. albopictus mainly varied between seasons. Herein, we are the first to report the detection of HPeV and HBV in mosquitoes. This study not only provides valuable information for the control and prevention of mosquito-borne diseases, but it also demonstrates the feasibility of xenosurveillance.Graphical

Menenjitli Bir Bebekte İnsan Parekovirüs Enfeksiyonu Olgusu

Menenjitli Bir Bebekte İnsan Parekovirüs Enfeksiyonu Olgusu

Menenjitli Bir Bebekte İnsan Parekovirüs Enfeksiyonu Olgusu

Menenjitli Bir Bebekte İnsan Parekovirüs Enfeksiyonu Olgusu

A case series of neonatal human parecho-virus encephalitis with a seasonality and endemicity

Human parecho viruses are small, non-enveloped, single stranded RNA viruses within parechovirus genus of the large picornaviridae family. In new-born it can cause gastroenteritis, sepsis and encephalitis. We report case series of parecho-virus encephalitis admitted to a tertiary care centre, Perinthalmanna. Parechoviral encephalitis is an endemic disease seasonally present (May-July) in certain regions of Northern part of Kerala. HPeV are viruses that cause CNS infection in the neonatal period, resulting in white matter lesions that can be visualised with MRI. In a retrospective study, 4 newborn babies of neonatal HPeV encephalitis diagnosed on the basis of clinical and radiological findings with a seasonality were assessed. HPeV encephalitis needs to be in differential diagnosis when neonates and young infants present with seizure and sepsis. HPeV infection must be considered in infants with specific pattern of white matter change but no convincing history of a perinatal hypoxic-ischaemic insult.

Akut Alt Solunum Yolu Enfeksiyonu Nedeni ile Yatırılarak İzlenen Yenidoğanların Klinik ve Virolojik Özellikleri

Aim: Viruses including respiratory syncytial virus, parainfluenza virus, rhinovirus are the primary etiologic agents in acute lower tract infections in neonates. We aimed to evaluate the clinical and demographic characteristics of newborns with acute lower tract infections. Material and Method: Data was recorded from patients' medical records admitted between January 2013 and April 2016. Results: The study population consisted of 43 neonates (19 girls, 24 boys). Mean gestational age and birthweight were 32 ± 4.4 weeks and 1735 ± 820 g, respectively. On admission, mean postnatal day and postmenstrual ages were 61 ± 48 days and 41 ± 4.3 weeks. Respiratory syncytial virus (n:8), rhinovirus (n:3), parainfluenza-3 virus (n:3) and adenovirus (n:3), respiratory syncytial virus and parechovirus (n:1), respiratory syncytial virus and adenovirus (n:1), rhinovirus and human bocavirus (n:1) were detected by polymerase chain reaction 20 patients in total. Siblings in the house (n:31), viral infection in the family (n:23), insufficient breastfeeding (n:15), bronchopulmonary dysplasia (n:13), siblings attending school (n:10) and being twin or triplet (n:7) were leading risk factors. Median hospital stay was 9 (1-60) days. Prematurity, fever, rales, respiratory support and feeding difficulty were statistically more common in polymerase chain reaction positive patients. Patients with the respiratory syncytial virus had higher gestational age, birth weight, less respiratory distress syndrome, surfactant use and patent ductus arteriosus, and lower postnatal day on admission than patients with other viruses (p&amp;lt;0.05). Conclusion: Respiratory syncytial virus is the commonest cause of acute lower tract infections in newborns, but the clinical importance of co-infection and rare agents such as human bocavirus and parechovirus should be kept in mind. Supportive management is the mainstay of the therapy.

Parechovirus and enteroviruses among young infants with sepsis in Iran.

Background and Objectives:Human parechoviruses (HPeV) and Human enteroviruses (EV) frequently cause a sepsis-like illness in young infants (younger than three months). Therefore, this study was conducted to determine the frequency of HPeV and EV among the young infants with clinical signs and symptoms of sepsis in Ahvaz city, Iran.Materials and Methods:The blood specimens were collected from 100 (younger than 90 days hospitalized infants) including 54 (56.25%) males and 46 (43.75%) females with clinical signs and symptoms of sepsis-like disease. The RNA was extracted and tested for detection of VP1 region of HPeV and 5 UTR (Untranslated Region) of EV by RT-PCR. The sequences of positive of HPeV were further analyzed to determine HPeV genotyping.Results:5/100 (5%) of patients including 2/46 (2%) females and 3/54 (3%) males tested positive for HPeV (P=0.85). The analysis of 5 positive VP1 region of HPeV revealed the genotype 1. The analysis of sequencing and phylogenetic tree revealed that the isolated HPeVs were genotype 1. While 38/100 (38%) specimens including 16 (16%) females and 22 (22%) males were tested positive for EV (P=0.68).Conclusion:The frequency of HPeV genotype 1 was 5% among the young infants with sepsis. While frequency of EV was 38% among the young infants with sepsis. This study showed HPeV genotype 1 and EV are dominant in this region.

Zakażenie OUN wywołane przez parechowirusy u dzieci poniżej 3. miesiąca życia – charakterystyka i przebieg zakażenia omówione na przypadkach

Human parechoviruses are an important cause of meningo-encephalitis in infants younger than 3 months. Clinical presentation include fever, rash, irritability, lethargy, seizures, diarrhea and feeding difficulties. The outcome can be variable and some patients may require intensive care. Usually there are no important alterations in blood test results. The absence of CSF pleocytosis is common in HPeV infections and the diagnosis is confirmed by molecular tests. Genotype 3 of HPeV is known to have particular neurotropism. Some infants develop serious neurodevelopmental sequelae. In our case series there were no severe cases of HPeV and the MRI imaging as well as short-term neurological assessment showed no abnormalities.