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In children with clinical signs of sepsis, inflammatory parameters in blood, bacterial cultures of blood, urine and cerebrospinal fluid (CSF), and viral diagnostics (herpes simplex virus) and enteroviruses (EV) in CSF and EV in faeces) are often examined, mostly followed by hospital admission and empiric antibiotic treatment.
Human parechovirus (HPeV) has been identified and described as cause of sepsis-like illness, meningitis and occasionally encephalitis in children.1 Timely diagnosis of HPeV infection can influence the decision to discontinue antibiotic treatment.
To establish the incidence of HPeV and EV infection, we retrospectively performed PCR analysis on CSF and faecal samples from children (birth to 18 years) with clinically suspected sepsis-like illness (fever and/or general illness for which blood culture and CSF puncture were performed) and negative bacterial cultures during an 18-month period (January 2008–June 2009). We added a degenerative probe (5'-NED-YAGTGTCTCTTGTTACC TRCRGGTACCTYCT-BQ1-3') in addition to custom probe sequences2 to ensure detection of all currently described HPeV sequences. We compared the clinical and laboratory characteristics of patients with proven HPeV and EV infections. The Mann–Whitney U test was used for statistic analysis.
In all, 89 patients were included (median age 0.4 years, range 0.1–13.2 years), of whom 86 had a sufficient CSF sample volume to test for HPeV and 45 had available stool samples for faecal PCR testing. HPeV infections were as common as EV infections (figure 1). HPeV infections all occurred in 2008 (spring n=2, summer n=5, autumn n=3), whereas EV infections occurred in 2008–2009 (2008: winter n=1, spring n=1, summer n=1, autumn n=6, 2009: spring n=3). A comparison between patients who were EV and HPeV positive is presented in table 1.
All patients with EV and HPeV fully recovered with supportive therapy, without intensive care unit admission, intubation or inotropic agents.
HPeV infections in infants may be clinically undistinguishable from bacterial sepsis or EV infections.3 In our series, HPeV infection was as common as EV infection. Although blood leucocyte counts were statistically higher in EV than in HPeV infection, this finding is not useful given the average low value and outliers in both groups. Furthermore, C-reactive protein and CSF leucocyte counts did not differentiate between EV and HPeV infections.
Despite the overlap in clinical presentation, HPeV and EV infections are caused by distinct viral agents and diagnosed with distinct PCR tests.1 3 Our data show that the yield of microbial diagnostics may be considerably increased when HPeV is tested for routinely in children with sepsis-like illness. Previous studies have demonstrated the association between HPeV3 serotype and sepsis-like illness in the young.1 4 In the current retrospective study, serotyping was not performed since our main objectives were to assess the overall incidence of HPeV infections in children and to increase the diagnostic yield of our sepsis investigation.
We advocate routine PCR testing for HPeV besides EV PCR testing in children with sepsis-like illness. Clinically, there is much overlap between EV and HPeV infections in the young.
Provenance and peer review Not commissioned; externally peer reviewed.
Competing interests None.
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