Year-round, Routine Testing of Multiple Body Site Specimens for Human Parechovirus in Young Febrile Infants.

Abstract Objectives To test our hypothesis that routine year-round testing of specimens from multiple body sites and genotyping of detected virus would describe seasonal changes, increase diagnostic yield and provide a better definition of clinical manifestations of human parechovirus (PeV-A) infections in young febrile infants. Study design PeV-A reverse transcriptase-PCR was incorporated in routine evaluation of infants ≤60 days hospitalized at Nationwide Children’s Hospital for fever and/or suspected sepsis-like syndrome beginning in July 2013. We reviewed electronic medical records of infants who tested positive for PeV-A from July 2013 to September 2016. Genotyping was performed with specific type 3 RT-PCR and sequencing. Results Of 1475 infants evaluated, 130 (9%) tested positive for PeV-A in one or more sites: 100 (77%) in blood, 84 (65%) in a non-sterile site, and 53 (41%) in cerebrospinal fluid (CSF). Five (4%) infants had CSF only positive, 31 (24%) blood only, and 20 (15%) non-sterile site only positive. PeV-A3 was the most common type (85%) and the only type detected in CSF. Although the majority (79%) of infections were diagnosed between July and December, PeV-A was detected year-round. Median age was 29 days. Fever (96%), fussiness (75%) and lymphopenia (56%) were common. Among infants with PeV-A positive CSF, 77% had no CSF pleocytosis. Median duration of hospitalization was 41 hours. Four infants had bacterial coinfections diagnosed within 24 hours of admission; 40 infants had viral coinfections. Conclusions While most frequent in summer and fall, PeV-A infections were encountered in every calendar month within the 3-year period of study. More than one-half of patients had PeV-A detected at more than one body site. Coinfections were common. PeV-A3 was the most common type identified, and the only type detected in the CSF.