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Intracranial hemorrhage and other symptoms in infants associated with human parechovirus in Vienna, Austria

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Abstract

The human parechovirus (HPeV), mainly genotype 3, may cause severe illness in young infants and neonates, including sepsis-like illness and central nervous system (CNS) infection. We lack data concerning the impact and symptoms of HPeV infection in infants in Austria. The aim of the study is to evaluate the spectrum of symptoms and findings in infants with the parechovirus in Vienna and its environs. Patients younger than 3 months of age, with clinically suspected sepsis-like illness or CNS infection and a positive polymerase chain reaction (PCR) for HPeV, were included in the study. Medical records were analyzed retrospectively. Twenty patients were included in the study from 2009 to 2013. The most frequent manifestations were fever and neurological symptoms (89 and 80 %, respectively). Fifty percent of the infants had white blood cell counts out of range. The most notable aspect was cerebral hemorrhage in three neonates, which has not been reported earlier in association with HPeV infection.

Conclusion: In Austria, HPeV is a relevant pathogen in sepsis-like disease in infants. The clinical presentation is similar to that described in other studies; cerebral hemorrhage is a new aspect.

What is Known:

• Parechovirus infection can cause severe illness in infants.

• Symptoms have been described to involve all organs; sepsis-like signs, fever, and irritability are most frequent.

What is New:

• Also in Austria, HPeV plays an important role in severe illnesses in infants.

• Severe intracranial hemorrhage is described as a new finding.

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Abbreviations

ASAT:

Aspartate aminotransferase

ALAT:

Alanine aminotransferase

CCT:

Cranial computer tomography

CMV:

Cytomegalovirus

CNS:

Central nervous system

CRP:

C-reactive protein

CSF:

Cerebral spinal fluid

cUS:

Cranial ultrasound

EV:

Enterovirus

EVD:

External ventricular drainage

HPeV:

Human parechovirus

HSV:

Herpes simplex virus

IVH:

Intraventricular hemorrhage

MRI:

Magnetic resonance imaging

NICU:

Neonatal intensive care unit

PCR:

Polymerase chain reaction

QCMD:

Quality Control for Molecular Diagnostics

RNA:

Ribonucleic acid

RT:

Reverse transcription

SEH:

Subependymal hemorrhage

VZV:

Varicella zoster virus

WBC:

White blood cell count

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Conflict of interest statement

There was no sponsoring of this study. All authors declare no conflict of interest.

Author contributions

Authors 1 and 2 contributed to data analysis and manuscript writing; authors 3, 4, 5, 6, 9, and 10 evaluated and treated patients; and authors 7 and 8 did virologic testing and wrote the corresponding part of the methods section.

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Disclosure

The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Pediatrics, SMZ Ost, Danube Hospital Vienna, Langobardenstraße 122, A-1220, Vienna, Austria

    Herbert Kurz, Ruth Prammer & Wolfgang Bock

  2. Department of Pediatrics, Wilhelminenspital, Vienna, Austria

    Robert Ollerieth

  3. Preyer’s Children’s Hospital, Vienna, Austria

    Günther Bernert

  4. Department of Pediatrics, Landesklinikum St. Pölten, St. Pölten, Austria

    Karl Zwiauer

  5. Department of Virology, Medical University Vienna, Vienna, Austria

    Judith H. Aberle & Stephan W. Aberle

  6. St. Anna Children’s Hospital, Vienna, Austria

    Tamas Fazekas & Wolfgang Holter

Authors
  1. Herbert Kurz
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  2. Ruth Prammer
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  3. Wolfgang Bock
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  4. Robert Ollerieth
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  7. Judith H. Aberle
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  8. Stephan W. Aberle
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  10. Wolfgang Holter
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Corresponding author

Correspondence to Herbert Kurz.

Additional information

Communicated by David Nadal

Revisions received: 19 December 2014 / 17 April 2015 / 22 May 2015

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Kurz, H., Prammer, R., Bock, W. et al. Intracranial hemorrhage and other symptoms in infants associated with human parechovirus in Vienna, Austria. Eur J Pediatr 174, 1639–1647 (2015). https://doi.org/10.1007/s00431-015-2583-8

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  • DOI: https://doi.org/10.1007/s00431-015-2583-8

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