Abstract
Enteroviruses (EV) and human parechoviruses (HPeV) are known and emerging cause of sepsis-like illnesses in infants; however, testing is not yet routine. We retrospectively evaluated the number of diagnosed EV/HPeV infections in children under the age of 5 years who presented with sepsis-like illness or meningitis in Cornwall, UK, before and after routine implementation of viral screening of cerebrospinal fluid samples. During the 4-year period prior to routine testing, we identified 20 cases of EV meningitis and no cases of HPeV. In the year after introduction of routine screening, 27 cases of EV and 14 cases of HPeV were identified in 1 year. The majority of EV/HPeV infections occurred among children under 3 months old between May and August. Clinical and laboratory characteristics of EV and HPeV infections were mostly indistinguishable. We found that CSF pleocytosis and biochemistry-based testing strategy could miss 48.1 and 78.5% of EV and HPeV cases, respectively. With routine viral screening, the mean length of hospital stay (3.8 vs 5.9 days, P < 0.001) and antibiotic days (2.8 vs 4.7 days, P < 0.001) were significantly reduced in EV/HPeV-positive cases compared to a similar cohort without any detectable microbial aetiology.
Conclusion: Routine EV and HPeV testing of CSF samples in children has the potential to reduce length of stay and antibiotic use.
What is Known: • EV and HPeV are frequent cause of meningitis and sepsis-like illness among young children. • There is increasing evidence supporting routine EV and HPeV testing of paediatric CSF. | |
What is New: • Outcome of routine EV and HPeV testing in Cornwall, UK. • The value of testing all paediatric CSF without any screening criteria. • A rapid diagnosis of EV/HPeV can significantly reduce length of hospital stay and unnecessary antibiotics. |
Similar content being viewed by others
Abbreviations
- CSF:
-
Cerebrospinal fluid
- EV:
-
Enterovirus
- HPeV:
-
Human parechovirus
- PCR:
-
Polymerase chain reaction
- SLI:
-
Sepsis-like illness
References
Benschop KS, Schinkel J, Minnaar RP, Pajkrt D, Spanjerberg L, Kraakman HC, Berkhout B, Zaaijer HL, Beld MG, Wolthers KC (2006) Human parechovirus infections in Dutch children and the association between serotype and disease severity. Clin Infect Dis 42:204–210
Britton PH, Dale RC, Nissen MD, Crawford N, Elliot E, Macartney K, Khandaker G, Booy R, Jones CA (2016) Parechovirus encephalitis and neurodevelopmental outcomes. Pediatr 137(2):e2015848
Cumming G, Khatami A, McMullan BJ, Musto J, Leung K, Nguyen O, Ferson MJ, Papadakis G, Sheppeard V (2015) Parechovirus genotype 3 outbreak among infants, New South Wales, Australia, 2013-2014. Emerg Infect Dis 21(7):1144–1152
Esposito S, Rahamat-Langendoen J, Ascolese B, Senatore L, Castellazzi L, Niesters HG (2014) Pediatric parechovirus infections. J Clin Virol 60(2):84–89
Fischer TK, Midgley S, Dalgaaed NAY (2014) Human parechovirus infection, Denmark. Emerg Infect Dis 20(1):83–87
Harvala H, Robertson I, Chieochansin T, McWilliam Leitch EC, Templeton K, Simmonds P (2009) Specific association of human parechovirus type 3 with sepsis and fever in young infants, as identified by direct typing of cerebrospinal fluid samples. J Infect Dis 199(12):1753–1760
Harvala H, McLeish N, Kondracka J, McIntyre CL, McWilliam Leitch EC, Templeton K et al (2011) Comparison of human parechovirus and enterovirus detection frequencies in cerebrospinal fluid samples collected over a 5-year period in Edinburgh: HPeV type 3 identified as the most common picornavirus type. J Med Virol 83(5):889–896
Harvala H, Griffiths M, Solomon T, Simmonds P (2014) Distinct systemic and central nervous system disease patterns in enterovirus and parechovirus infected children. J Inf Secur 69:69–74
Janes VA, Minnaar R, Koen G, van Eijk H, Dijkman-de Haan K, Pajkrt D, Wolthers KC, Benschop KS (2014) Presence of human non-polio enterovirus and parechovirus genotypes in an Amsterdam hospital in 2007 to 2011 compared to national and international published surveillance data: a comprehensive review. Euro Surveill 19(46)
Kadambari S, Bukasa A, Okike IO, Pebody R, Brown D, Gallimore C, Xerry J, Sharland M, Ladhani SN (2014) Enterovirus infections in England and Wales, 2000-2011: the impact of increased molecular diagnostics. Clin Microbiol Infect 20(12):1289–1296
Khetsuriani N, Lamonte A, Oberste MS, Pallansch M (2006) Neonatal enterovirus infections reported to the national enterovirus surveillance system in the United States, 1983–2003. Pediatr Infect Dis J 25(10):889–893
Mulford WS, Buller RS, Arens MQ, Storch GA (2004) Correlation of cerebrospinal fluid (CSF) cell counts and elevated CSF protein levels with enterovirus reverse transcription-PCR results in pediatric and adult patients. J Clin Microbiol 42(9):4199–4203
National Institute for Health and Care Excellence (NICE). Fever in under 5s: assessment and initial treatment. Clinical Guideline [CG160]. May 2013. www.nice.org.uk/guidance/cg160
Piralla A, Mariani B, Stronati M, Maroni P, Baldante F (2014) Human enterovirus and parechovirus infections in newborns with sepsis-like illness and neurological disorders. Early Hum Dev 90(Suppl 1):S75–S77
Rotbart HA (1995) Enteroviral infections of the central nervous system. Clin Infect Dis 20(4):971–981
Sharp J, Bell J, Harrison C, Allan Nix W, Steven Oberste M, Selvarangan R (2012) Human parechovirus in respiratory specimens from children in Kansas City, Missouri. J Clin Microbiol 50(12):4111–4113
Tang JW, Holmes CW, Elsanousi FA, Patel A, Adam F, Speight R, Shenoy S, Bronnert D, Stiefel G, Sundaram P, Pande S, Sridhar A, Kairamkonda V, Bandi S (2016) Cluster of human parechovirus infections as the predominant cause of sepsis in neonates and infants, Leicester, United Kingdom, 8 May to 2 August 2016. Euro Surveill. 21(34)
Vergnano S, Kadambari S, Whalley K, Menson EN, Martinez-Alier N, Cooper M, Sanchez E, Heath PT, Lyall H (2015) Characteristics and outcomes of human parechovirus infection in infants (2008-2012). Eur J Pediatr 174(7):919–924
Wildenbeest JG, Benschop KS, Minnaar RP, Bouma-de Jongh S, Wolthers KC, Pajkrt D (2014) Clinical relevance of positive human parechovirus type 1 and 3 PCR in stool samples. Clin Microbiol Infect 20(10):O640–O647
Wolthers KC, Benschop KS, Schinkel J, Molenkamp R, Bergevoet RM, Spijkerman IJ, Kraakman HC, Pajkrt D (2008) Human parechoviruses as an important viral cause of sepsis-like illness and meningitis in young children. Clin Infect Dis 47(3):358–363
Acknowledgements
We would like to thank Public Health Reference Virology Lab in Bristol and London for confirming the identification and genotyping of EV and HPeV cases and Joanne Palmer (Research & Development, RCHT) for statistical support.
Funding
None.
Author information
Authors and Affiliations
Contributions
Prithwiraj Chakrabarti was responsible for the study design, test introduction, analysis and writing; Chris Warren for data collection and writing; Laura Vincent for data collection; and Yadlapalli Kumar for patient care, writing and review.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
Not required.
Informed consent
Not required.
Additional information
Communicated by Nicole Ritz
Rights and permissions
About this article
Cite this article
Chakrabarti, P., Warren, C., Vincent, L. et al. Outcome of routine cerebrospinal fluid screening for enterovirus and human parechovirus infection among infants with sepsis-like illness or meningitis in Cornwall, UK. Eur J Pediatr 177, 1523–1529 (2018). https://doi.org/10.1007/s00431-018-3209-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-018-3209-8