Short communication
Enterovirus and Parechovirus viraemia in young children presenting to the emergency room: Unrecognised and frequent

https://doi.org/10.1016/j.jcv.2015.05.003Get rights and content

Highlights

  • Investigation of EV and HPeV viraemia in children admitted to the emergency room.

  • EV and HPeV viraemia in children <3 years old is largely underestimated.

  • Results reveal many cases of unnecessary antibiotic use.

  • A rapid EV diagnosis is essential in young children with a suspicion of infection.

Abstract

Background

Human Enterovirus (EV) and Parechovirus (HPeV) are well recognised as agents causing disease in neonates, but their importance is poorly described in the general paediatric population consulting with a suspicion of infection.

Objective

We investigated the prevalence of EV- or HPeV-associated infections in children presenting to a paediatric emergency department with a suspicion of infection.

Study design

Plasma specimens collected in our paediatric emergency room for clinical reasons were screened by specific real-time RT-PCR for the presence of EV and HPeV.

Results

Based on an analyses of 233 plasma specimens, up to 6.9% and 2.6% were positive for EV and HPeV, respectively. Amongst the population <3 y.o, prevalence of EV and HPeV viraemia was 11% and 3.7%, respectively. Importantly, 56.3% of positive EV specimens were detected in infants >3 months of age.

Conclusion

The prevalence of EV and HPeV viraemia in children <3 years old is largely underestimated. Our results confirm that EV should be suspected and included in the work-up in children >3 months of age and not restricted to neonates.

Section snippets

Background

Enterovirus (EV) and Parechovirus (HPeV) are human picornaviruses associated with serious illnesses in children, especially in neonates where EV can be detected in up to 24% of blood specimens from those with sepsis-like symptoms [1], [2], [3], [4], [5], [6]. Most studies have focused on EV and HPeV prevalence in neonates, but their prevalence in older children presenting with a suspicion of infection to an emergency room (ER) remains largely unknown. EV and/or HPeV can be considered in the

Objectives

The aim of the present pilot study was to investigate the prevalence of EV- and HPeV-associated infection in a cohort of unselected paediatric patients from all age groups admitted to our ER with a suspicion of infection and who had blood drawn for their standard care.

Study design

Between May and September 2014, all leftover plasma specimens (n = 233, collected from 233 independent patients, male-to-female ratio of 1.2:1) collected in our paediatric ER for clinical reasons in children presenting with a suspicion of infection were screened by quantitative and semi-quantitative specific real-time reverse transcription polymerase chain reaction (RT-PCR) for the presence of EV and HPeV, respectively. No blood specimens were collected specifically for the purpose of this study.

Results

Amongst the 233 plasma specimens analysed, 16 were positive for EV (16/233 = 6.9%; median viral load = 1.085 × 105 viral genome copies/mL, interquartile range (IQR) 1.15 × 104–1.47 × 106; median age for positive cases = 8 months) and 6 were HPeV-positive (6/233 = 2.6%; median age for positive cases = 2 months) (Fig. 1). No patient had both viruses. For patients <3 years old (y.o), the prevalence of EV and HPeV viraemia increased to 11% (15/136) and 3.7% (5/136), respectively. Importantly, 56.3% (9/16) of

Discussion

Our results show that the diagnosis of viral infection is frequently suspected, but not proven, and that the prevalence of EV and HPeV viraemia in children <3 years old is probably largely underestimated. Although it was previously documented that EV and HPeV are frequently detected in blood specimens in neonates with sepsis-like symptoms [1], [2], [3], [4], [5], [6], this study reports a high EV and HPeV prevalence in a cohort of unselected paediatric patients from all age groups with a

Funding

This study was supported by the Swiss National Science Foundation(grant32003B_146993 to L.K.).

Competing interests

None declared.

Ethical approval

Not required.

Acknowledgements

We would like to thank Dr. Olivier Golaz (University Hospitals of Geneva) for providing plasma specimens, Tom J. Petty and Rosemary Sudan for editorial assistance.

References (17)

There are more references available in the full text version of this article.

Cited by (19)

  • Likelihood of hospitalization for a chronic respiratory condition following pediatric infection with enterovirus and rhinovirus strains

    2022, Infectious Medicine
    Citation Excerpt :

    Despite their close relatedness in sequence, the clinical presentation and prognosis of rhinovirus and enterovirus infections in childhood are extremely diverse [1–9]. While rhinovirus is responsible for the majority of respiratory infections, enterovirus can cause a variety of different clinical presentations including nonspecific febrile illness, meningitis, and myocarditis in addition to respiratory illness [5,10–15]. Enterovirus strain D68 (EV-D68) has garnered increasing attention after it was found to be associated with severe respiratory illness in North American children in 2014 [16–19] and subsequently with flaccid paralysis observed in both North American and European children [20–22].

  • PCR detection rates for serum and cerebrospinal fluid from neonates and young infants infected with human parechovirus type 3 and enteroviruses

    2021, Journal of Clinical Virology
    Citation Excerpt :

    In contrast, serum and CSF viral RNA levels were not correlated in EV-infected patients, perhaps because EV infection comprises various genotypes, which differ in their clinical manifestations and detection rates in serum and CSF. In general, EV viral RNA levels was higher in CSF than in serum [40], and CSF viral RNA levels was higher for genotypes such as coxsackieviruses B4 and B5 than for echoviruses 6 and 11 [41]. Thus, it may be important to analyze the data in relation to the closely related genotypes among EV.

  • Assessment of blood enterovirus PCR testing in paediatric populations with fever without source, sepsis-like disease, or suspected meningitis: a prospective, multicentre, observational cohort study

    2018, The Lancet Infectious Diseases
    Citation Excerpt :

    Additional molecular tests are needed to speed up diagnosis of conditions associated with enterovirus infections.5 Several studies have evaluated testing blood specimens,7–12 but as yet no assessment has been done in a large cohort of paediatric patients. The aim of our multicentre study was to assess detection of enterovirus by PCR in blood specimens of newborn babies, infants, and children with fever without source, sepsis-like disease, or suspected meningitis.

  • Performance of a real-time PCR–based approach and droplet digital PCR in detecting human parechovirus type 3 RNA

    2016, Journal of Clinical Virology
    Citation Excerpt :

    Detection of HPeV3 in blood and/or cerebrospinal fluid (CSF) is important in diagnosis [7,8], and a serum sample collected at disease onset is more reliable than a CSF sample in the detection of HPeV3 RNA [7]. However, in previous studies on the diagnosis of HPeV3 infection, CSF samples [6,9–15] were used more often than blood samples [7,16–18]. We reported previously that real-time RT-PCR using CSF samples was unsuccessful in detecting HPeV3 RNA in some HPeV3-infected patients with positive serum samples, as determined by real-time RT-PCR [7].

  • Prospective assessment of clinical symptoms associated with enterovirus and parechovirus genotypes in a multicenter study in Dutch children

    2016, Journal of Clinical Virology
    Citation Excerpt :

    A possible explanation for this may be the younger age of the children in that study than in ours and the fact that 30 of the 32 included children in that study were admitted to a neonatal intensive care unit. Both the present study, and a previous one by Cordey et al. [3], did not support previous retrospective studies, including one from our group, which found an association between a younger age of presentation and lack of CSF pleocytosis in children with EV meningitis [27,28]. This may be related to the small of patients with EV meningitis with and without pleocytosis, in the present study population.

View all citing articles on Scopus
1

Both authors equally contributed to the study.

View full text