Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH.
J Pediatr. 2021 Feb;229:216-222.e2. doi: 10.1016/j.jpeds.2020.10.004. Epub 2020 Oct 9.
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.
PeV-A reverse-transcriptase polymerase chain reaction (RT-PCR) analysis was incorporated in routine evaluation of infants aged ≤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 between July 2013 and September 2016. Genotyping was performed with specific type 3 RT-PCR and sequencing.
Of 1475 infants evaluated, 130 (9%) tested positive for PeV-A in 1 or more sites: 100 (77%) in blood, 84 (65%) in a nonsterile site, and 53 (41%) in cerebrospinal fluid (CSF). Five infants (4%) were CSF-only positive, 31 (24%) were blood-only positive, and 20 (15%) were nonsterile 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. The median age at detection was 29 days. Fever (96%), fussiness (75%), and lymphopenia (56%) were common. Among infants with PeV-A-positive CSF, 77% had no CSF pleocytosis. The median duration of hospitalization was 41 hours. Four infants had bacterial coinfections diagnosed within 24 hours of admission; 40 infants had viral coinfections.
Although 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 1 body site. Coinfections were common. PeV-A3 was the most common type identified and the only type detected in the CSF.
验证我们的假设，即全年定期检测来自多个身体部位的标本并对检测到的病毒进行基因分型，将有助于描述季节变化、提高诊断率，并更好地定义人类肠道病毒 A 型（PeV-A）感染在发热婴儿中的临床表现。
自 2013 年 7 月起，我们将 PeV-A 逆转录聚合酶链反应（RT-PCR）分析纳入在全美儿童医院因发热和/或疑似脓毒症样综合征住院的≤60 日龄婴儿的常规评估中。我们回顾了 2013 年 7 月至 2016 年 9 月期间 PeV-A 检测呈阳性的婴儿的电子病历。采用特定的 3 型 RT-PCR 和测序进行基因分型。
在评估的 1475 名婴儿中，130 名（9%）在 1 个或多个部位检测到 PeV-A：100 名（77%）在血液中，84 名（65%）在非无菌部位，53 名（41%）在脑脊液（CSF）中。5 名婴儿（4%）仅 CSF 阳性，31 名（24%）仅血液阳性，20 名（15%）仅非无菌部位阳性。PeV-A3 是最常见的类型（85%），也是 CSF 中唯一检测到的类型。尽管大多数（79%）感染发生在 7 月至 12 月之间，但 PeV-A 全年都有检测到。中位检测年龄为 29 天。发热（96%）、烦躁（75%）和淋巴细胞减少（56%）是常见症状。在 PeV-A 阳性 CSF 的婴儿中，77%无 CSF 白细胞增多。中位住院时间为 41 小时。4 名婴儿在入院后 24 小时内被诊断为细菌合并感染；40 名婴儿存在病毒合并感染。
尽管 PeV-A 感染在夏季和秋季最常见，但在研究的 3 年期间，每个月都有 PeV-A 感染病例。超过一半的患者在一个以上的部位检测到 PeV-A。合并感染很常见。PeV-A3 是最常见的类型，也是 CSF 中唯一检测到的类型。
