Rapid syndromic molecular testing and human parechovirus infection in children: A report of three cases in Argentina / Diagnóstico molecular sindrómico rápido e infección por parechovirus humano en ninos: reporte de 3 casos en Argentina

Abstract Human parechovirus (HPeV) is one of the members of the family Picornaviridae that has been associated with fever of unknown origin, gastroenteritis, clinical sepsis, meningitis, orencephalitis in very young infants. HPeV detection is not routinely performed in most clinical microbiology laboratories in Argentina and, therefore, its real prevalence is unknown. We here report three cases of HPeV CNS infection that presented to our hospital with different clinical features after the implementation of a multiplex PCR meningitis/encephalitis panel. Molecular diagnostic techniques could help improve patient care and understand the real prevalence of this infection in Argentina.

Resumen Los parechovirus humanos (HPeV) son virus de la familia Picornaviridae, que se han asociado a diferentes cuadros clínicos, como fiebre de origen desconocido, gastroenteritis, sepsis, meningitis o encefalitis en ninos pequeños. Su detección no está disponible de rutina en la mayoría de los laboratorios de nuestro país, por lo que su prevalencia es desconocida. Reportamos 3 casos de infección del sistema nervioso central por HPeV con diferentes características clínicas, que se presentaron luego de la implementación de un panel molecular para el diagnóstico sindrómico de meningitis/encefalitis. Las técnicas de diagnóstico molecular podrían ayudar a mejorar el abordaje y el cuidado de estos pacientes, así como también a conocer la prevalencia de esta infección en Argentina.

Rapid syndromic molecular testing and human parechovirus infection in children: A report of three cases in Argentina.

Human parechovirus (HPeV) is one of the members of the family Picornaviridae that has been associated with fever of unknown origin, gastroenteritis, clinical sepsis, meningitis, or encephalitis in very young infants. HPeV detection is not routinely performed in most clinical microbiology laboratories in Argentina and, therefore, its real prevalence is unknown. We here report three cases of HPeV CNS infection that presented to our hospital with different clinical features after the implementation of a multiplex PCR meningitis/encephalitis panel. Molecular diagnostic techniques could help improve patient care and understand the real prevalence of this infection in Argentina.

Parechovirus como agente etiológico de meningitis y/o sepsis viral en lactantes / Parechovirus as etiologic agent of meningitis and/or sepsis like illness in infants

Introduction: Human parechovirus (HPeV) belongs to the Picornaviridae family and has been described in viral meningoencephalitis and sepsis like illness in infants. Until now, 16 genotypes have been recognized, the most common are HPEV 1, 2 and 3; type 3 is most severe. Aims: To estimate the frequency of HPEV etiology in viral meningoencephalitis and sepsis in infants and characterize clinical and molecular aspects of infection. Methods: Between October 2013 and March 2015 we collected CSF samples, plasma, nasopharyngeal swabs and/or stools of patients younger than two years with suspected sepsis and/or viral meningitis. Samples were obtained from laboratory storage sites and from hospitalized patients. HPeV was diagnosed by real-time polymerase chain reaction (PCR) assay against the 5'UTR region. Positive samples were genotyped by sequencing a 304pb segment in VP3/VP1 overlapping region obtained with a nested PCR. Results: Overall HPeV detection rate was 18,6% (11/59 patients), distributed in 8.7% (4/46) laboratory's samples and 53.8% (7/13) of samples from hospitalized patients; mean age was 49 days (SD?). Most common clinical signs were irritability (%), inappetance and fever (algo mas? Magnitude? %). All six samples genotyped were HPeV 3. Conclusions: HPeV should be considered as a relatively significant etiologic agent of viral meningoencephalitis and sepsis in infants.

Introducción: Parechovirus humano (HPeV) pertenece a la familia Picornaviridae; ha sido descrito en sepsis viral y meningoencefalitis en niños de dos años o menos (lactantes). Se conocen 16 genotipos, siendo los más frecuentes HPeV 1, 2 y 3; el más grave es el tipo 3. Objetivos: Estimar la frecuencia de HPeV como agente causal de meningoencefalitis o sepsis viral en lactantes; caracterizar clínica y molecularmente los HPeV encontrados. Material y Métodos: Estudio descriptivo. Se utilizaron muestras de LCR, plasma, hisopado nasofaríngeo y/o deposiciones de lactantes con sospecha de sepsis y/o meningoencefalitis viral entre octubre 2013 y marzo 2015. Se estudiaron muestras almacenadas en laboratorio y de pacientes hospitalizados. Como diagnóstico, se realizó RPC-TR en tiempo real para HPeV dirigido a sector 5'UTR. Para la caracterización molecular, se secuenció un sector de 304 pb en unión VP3/VP1 mediante una RPC-TR anidada. Resultados: Se reclutó un total de 59 pacientes con frecuencia de HPeV de 18,6% (11/59), correspondientes a 8,7% (4/46) en muestras de colección y 53,8% (7/13) en hospitalizados, edad promedio 49 días. En la presentación clínica destacó la irritabilidad, el rechazo alimentario y la fiebre. Seis casos fueron genotipificados, todos correspondieron al tipo HPeV 3. Conclusiones: HPeV debe ser considerado como agente causal en sepsis y/o meningoencefalitis en lactantes.

Emerging Infections of CNS: Avian Influenza A Virus, Rift Valley Fever Virus and Human Parechovirus.

History is replete with emergent pandemic infections that have decimated the human population. Given the shear mass of humans that now crowd the earth, there is every reason to suspect history will repeat itself. We describe three RNA viruses that have recently emerged in the human population to mediate severe neurological disease. These new diseases are results of new mutations in the infectious agents or new exposure pathways to the agents or both. To appreciate their pathogenesis, we summarize the essential virology and immune response to each agent. Infection is described in the context of known host defenses. Once the viruses evade immune defenses and enter central nervous system (CNS) cells, they rapidly co-opt host RNA processing to a cataclysmic extent. It is not clear why the brain is particularly susceptible to RNA viruses; but perhaps because of its tremendous dependence on RNA processing for physiological functioning, classical mechanisms of host defense (eg, interferon disruption of viral replication) are diminished or not available. Effectiveness of immunity, immunization and pharmacological therapies is reviewed to contextualize the scope of the public health challenge. Unfortunately, vaccines that confer protection from systemic disease do not necessarily confer protection for the brain after exposure through unconventional routes.