Paediatric Infectious Diseases Research Group, St George's University, London, UK.
Immunisation Department, Public Health England, London, UK.
Arch Dis Child. 2018 Nov;103(11):1061-1066. doi: 10.1136/archdischild-2017-314281. Epub 2018 Jun 5.
Human parechovirus (HPeV), like enteroviruses, usually causes mild self-limiting respiratory and gastrointestinal symptoms. In infants, HPeV can occasionally cause serious illnesses, including sepsis-like syndrome and encephalitis. In summer 2016, Public Health England (PHE) received increasing reports of severe HPeV infections nationally. We, therefore, reviewed all infants with confirmed HPeV across England during 2016.
HPeV cases in infants aged <12 months reported to PHE during 2016 were followed up using a clinical questionnaire. Additional cases identified by clinicians completing the questionnaire were also included.
We identified 106 infants with confirmed HPeV infection during 2016. The disease peaked during early summer. Most infants (98/106, 92%) were aged <90 days, and 43% (46/106) were neonates. Fever was the most commonly reported symptom (92%) and signs of circulatory shock were present in 53%. Eighteen infants (18%) required paediatric intensive care admission. Most infants had normal or low C reactive protein concentrations (<10 mg/dL in 75%, <50 mg/dL in 98%). A lumbar puncture was performed in 98% of cases; 92% (33/36) of neonates and 93% (53/57) of older infants had normal white cell count in the cerebrospinal fluid (CSF). Nearly all reported cases (98%) were confirmed by CSF PCR. All infants survived, but five had ongoing seizures after hospital discharge.
HPeV is an important cause of febrile illness in infants and can have severe clinical presentations. Early diagnosis may help reduce antimicrobial use, unnecessary investigations and prolonged hospitalisation. While prognosis remains favourable, some infants will develop long-term complications-paediatricians should ensure appropriate follow-up after discharge.
人类肠道病毒（HPeV）与肠病毒一样，通常引起轻微的自限性呼吸道和胃肠道症状。在婴儿中，HPeV 偶尔会引起严重疾病，包括类败血症综合征和脑炎。2016 年夏天，英国公共卫生署（PHE）收到越来越多的全国范围内严重 HPeV 感染报告。因此，我们回顾了 2016 年期间英格兰所有确诊的 HPeV 感染婴儿。
通过临床问卷对 2016 年期间向 PHE 报告的年龄<12 个月的 HPeV 病例进行随访。临床医生通过填写问卷确定的其他病例也包括在内。
我们确定了 2016 年期间确诊的 106 例 HPeV 感染婴儿。疾病在初夏达到高峰。大多数婴儿（98/106，92%）年龄<90 天，43%（46/106）为新生儿。发热是最常见的症状（92%），53%有循环休克的迹象。18 例（18%）婴儿需要儿科重症监护病房入院。大多数婴儿的 C 反应蛋白浓度正常或较低（75%<10mg/dL，98%<50mg/dL）。98%的病例进行了腰椎穿刺；92%（33/36）的新生儿和 93%（53/57）的较大婴儿脑脊液白细胞计数正常。几乎所有报告的病例（98%）均通过 CSF PCR 确诊。所有婴儿均存活，但 5 例出院后仍有持续癫痫发作。
HPeV 是婴儿发热疾病的重要病因，临床表现可能严重。早期诊断可能有助于减少抗菌药物的使用、不必要的检查和延长住院时间。虽然预后仍然良好，但一些婴儿会出现长期并发症-儿科医生应确保在出院后进行适当的随访。
