Researchers warn about symptoms of paracholecystovirus central nervous system (CNS) infection based on a cluster of 23 young children admitted to a children’s hospital over a 6-week period.
From April 12 to May 24 this year, 23 healthy babies aged 5 days to 3 months, reported Dr. Romney Humphries of Vanderbilt University Medical Center in Nashville Admitted to Tennessee Children’s Hospital for human parabiliary virus meningoencephalitis. , and co-author in the Morbidity and Mortality Weekly Report .
Most infants developed fever, irritability and poor feeding without severe cerebrospinal fluid (CSF) inflammation, the researchers said.
Clinicians should consider testing in young infants when paraenterovirus is circulating, including those with normal cerebrospinal fluid parameters, Humphries and colleagues urge.
“Multiplex molecular panel rapid detection of paraenterovirus in cerebrospinal fluid could limit antibiotic ic management and improve patient management,” they wrote. “Parents with young infants, especially those with infants younger than 3 months, should be aware of these symptoms and see a pediatrician if symptoms persist.”
The report Follow the CDC health alert issued 2 weeks ago warning of paraenterovirus infection in newborns and young infants in multiple states.
Human paraenteroviruses belong to the family Picornaviridae and are divided into several genotypes. Parechovirus genotype 1 is the most prevalent and usually causes respiratory and gastrointestinal symptoms. Genotype 3 is the cause of the most severe cases, with a biennial cycle pattern that peaks in summer. These cases may include severe sepsis-like disease and central nervous system infections. Babies younger than 3 months are at increased risk of serious illness.
The median age of the 23 infants admitted was 24 days; 13 were girls and 10 were boys. Five patients were preterm, born at 28-36 weeks of gestation. The mean length of hospital stay was 4.5 days (range 1-26 days).
Nearly all children in the community were symptomatic; one premature infant was symptomatic in the Neonatal Intensive Care Unit (NICU). Most patients (70%) had siblings at home or had contact with other children.
Four infants had leukopenia. CSF cell counts were performed in 22 patients; seven samples showed elevated white blood cell counts, three of which may have been contaminated with blood during collection.
Four infants became seriously ill and required treatment in the neonatal intensive care unit. Brain MRI of these NICU patients showed white matter spread in all 4 infants consistent with typical paracholecystovirus meningoencephalitis.
Antibiotics were initially prescribed for 23 infants, but were discontinued in 13 patients within 24 hours of testing. Most infants (91.3%) recovered without complications. One patient was scheduled for follow-up evaluation for possible delayed hearing loss and hypercoagulability. Another person has persistent seizures and may experience severe developmental delay.
Humphries and co-authors note that the cause of this group of CNS infections is unknown. In 2018, the hospital detected 19 cases within 5 months. The researchers suggested that cases did not peak in 2020, possibly due to social distancing during the COVID-19 pandemic. So far, the hospital has found 29 cases in 2022, including 23 cases in this report.
Although paracholecystovirus infection is not a reportable disease, the Tennessee Department of Health has been notified.
Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s Articles on Haimer’s, Dementia, Multiple Sclerosis, Rare Diseases, Epilepsy, Autism, Headache, Stroke, Parkinson’s, ALS, Concussion, CTE, Sleep, Pain and more. Follow
Disclosure
Humphries reported on bioMerieux, Momentum BioSciences, Specific Diagnostics , Qiagen, Merck, Pattern Bioscience, Qpex Biopharma, Torus and Accelerate Diagnostics. Co-authors report on the relationship with the NIH.
