Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; University of Missouri - Kansas City School of Medicine, Kansas City, MO, United States.
Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; University of Missouri - Kansas City School of Medicine, Kansas City, MO, United States.
J Clin Virol. 2021 Sep;142:104939. doi: 10.1016/j.jcv.2021.104939. Epub 2021 Aug 2.
Parechovirus A (PeV-A) has emerged as a leading cause of infant central nervous system (CNS) infections. Risk factors associated with infant acquisition of PeV-A are not well understood.
We conducted prospective PeV-A/enterovirus (EV) CNS infection surveillance, enrolling 461 hospitalized infants <90 days old who underwent sepsis evaluations and lumbar puncture during 2011-2012. Infants were grouped by RT-PCR detection of PeV-A, EV, or neither virus (Neg) in CSF. We collected demographic/clinical data and tested specimens from all infants. For 427 mothers, we collected demographic/clinical data and evaluated PeV-A3 and EV shedding, and PeV-A3 neutralizing antibody for 147 mothers.
PeV-A was detected in 40 infants (8.7%), 4 in 2011 and 36 in 2012. EV was detected in 35 infants (7.6%), 16 in 2011, and 19 in 2012. PeV-A infected infants presented with irritability, abdominal discomfort, fever, and tachycardia, plus both lymphopenia and absence of CSF pleocytosis which help differentiate PeV-A from EV CNS infection. PeV-A was detected in 9/427 maternal throat swabs; eight of their infants also had PeV-A CNS infection. Infants whose mothers had PeV-A3-positive throat swabs were more likely to be PeV-A3-positive than infants whose mothers had negative throat swabs (relative risk [RR], 13.4 [95% CI, 8.6 - 20.7]). Maternal PeV-A3 seropositivity decreased with increasing maternal age. Mothers of PeV-A-positive infants had lower median PeV-A3 neutralizing titers and were more likely seronegative.
Maternal viral shedding, serostatus and neutralization titers appear to be important factors in infant PeV-A3 CNS infections.
细小病毒 A（PeV-A）已成为婴儿中枢神经系统（CNS）感染的主要原因。然而，与婴儿 PeV-A 感染相关的危险因素尚不清楚。
我们进行了前瞻性 PeV-A/肠病毒（EV）CNS 感染监测，纳入了 2011 年至 2012 年期间因败血症评估而行腰椎穿刺的 461 名 <90 天的住院婴儿。根据 PeV-A、EV 或两者均未在 CSF 中检测到（Neg），将婴儿分为 RT-PCR 检测组。我们收集了所有婴儿的人口统计学/临床数据并进行了检测。对于 427 位母亲，我们收集了人口统计学/临床数据，并评估了 PeV-A3 和 EV 脱落情况，以及 147 位母亲的 PeV-A3 中和抗体。
40 名婴儿（8.7%）检测到 PeV-A，其中 2011 年 4 名，2012 年 36 名。35 名婴儿（7.6%）检测到 EV，其中 2011 年 16 名，2012 年 19 名。PeV-A 感染的婴儿表现为易激惹、腹部不适、发热和心动过速，以及淋巴细胞减少和缺乏 CSF 白细胞增多，这有助于将 PeV-A 与 EV CNS 感染区分开来。427 位母亲的咽喉拭子中检测到 9 例 PeV-A，其 8 名婴儿也有 PeV-A CNS 感染。母亲咽喉拭子 PeV-A3 阳性的婴儿比母亲咽喉拭子阴性的婴儿更有可能 PeV-A3 阳性（相对风险 [RR]，13.4 [95% CI，8.6-20.7]）。母亲 PeV-A3 血清阳性率随母亲年龄的增加而降低。PeV-A 阳性婴儿的母亲的 PeV-A3 中和滴度中位数较低，且更有可能为血清阴性。
母体病毒脱落、血清状态和中和滴度似乎是婴儿 PeV-A3 CNS 感染的重要因素。
