Emergence of parechovirus A4 central nervous system infections among infants in Kansas City, Missouri, USA

Creator(s)

Anjana Sasidharan, Children's Mercy HospitalFollow
Christopher J. Harrison, Children's Mercy HospitalFollow
Dithi Banerjee, Children's Mercy HospitalFollow
Rangaraj Selvarangan, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

5-2019

Identifier

DOI: 10.1128/JCM.01698-18; PMCID: PMC6498030

Abstract

Among known parechovirus (PeV) types infecting humans, PeV-A3 (formerly HPeV3) and PeV-A1 (formerly HPeV1) are associated with pediatric central nervous system (CNS) infections. The prevalence of PeV-A3 among hospitalized infants with sepsis-like illness and viral CNS infection is well described; however, the contribution of PeV-A4 to infant CNS infection is relatively unexplored. We report the first 11 U.S. cases of PeV-A4 CNS infections occurring in Kansas City infants during 2010 to 2016 and compare the clinical presentation with that of PeV-A3. PeV-positive cerebrospinal fluid (CSF) specimens from 2010 to 2016 underwent sequencing for genotyping. Among all PeV-CSF positives, PeV-A4 was detected in 11 CSF samples from 2010 to 2016. PeV-A4 was first detected in 2010 (n 1/4), followed by detections in 2014 (n 1/39), 2015 (n 6/9), and 2016 (n 3/33). The median age of PeV-A4-infected infants in weeks (median, 4; range, 1 to 8) was similar to that of infants infected with PeV-A3 (median, 4; range, 0.25 to 8). Clinical characteristics of PeV-A4 (n 11) were compared with those of select PeV-A3-infected children (n 34) with CNS infections and found to be mostly similar, although maximum temperature was higher (P 0.017) and fever duration was shorter (P 0.03) for PeV-A4 than for PeV-A3. Laboratory test results were also similar between genotypes, although they showed significantly lower peripheral white blood cell (P 0.014) and absolute lymphocyte (P 0.04) counts for PeV-A4 infants. Like PeV-A3, PeV-A4 caused summer-fall seasonal clusters of CNS infections in infants, with mostly similar presentations. Further surveillance is necessary to confirm potential differences in laboratory findings and in fever intensity/duration.

Journal Title

Journal of Clinical Microbiology

Volume

57

Issue

5

Keywords

Central nervous system infections, Children, Parechovirus

Recommended Citation

Sasidharan A, Harrison CJ, Banerjee D, Selvarangan R. Emergence of Parechovirus A4 Central Nervous System Infections among Infants in Kansas City, Missouri, USA. J Clin Microbiol. 2019;57(5):e01698-18. Published 2019 Apr 26. doi:10.1128/JCM.01698-18