Evans Amanda S, Singh Sumit, Joshi Charuta, Filkins Laura, Akkoyun Esra, Custodio Haidee, Daniels Elizabeth A, Kao Carol M, Richardson Katherine, Carrillo-Marquez Maria, Borré Carla I, Oliveira Carlos R, Espinosa Claudia, Mandelia Yamini, Mazade Marc, Kimberlin David W
Department of Pediatrics, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Children's Health, Dallas, Texas, USA.
Clin Infect Dis. 2024 Dec 17;79(6):1479-1486. doi: 10.1093/cid/ciae400.
Human parechovirus (HPeV) infection can result in severe disease in infants, including sepsis, seizures, brain injury, and death. In 2022, a resurgence of HPeV was noted in young infants. The spectrum of illness and outcomes remain to be fully described.
A multistate retrospective cohort study was conducted to evaluate hospitalizations and outcomes of infants aged ≤6 months admitted in 2022 with laboratory-confirmed HPeV infection. Infants with severe disease were defined as having clinical seizures, or abnormalities on magnetic resonance imaging or electroencephalogram during admission. Infants with severe versus nonsevere disease were compared using descriptive statistics.
A total of 124 U.S. infants were identified with HPeV in 11 states. Cases of HPeV peaked in May and presented at a median of 25.8 days of life (0-194 d) with fever, fussiness, and poor feeding. Bacterial and other viral co-infections were rare. Thirty-three (27%) of infants had severe neurologic disease, were more likely to present at an earlier age (13.9 vs 30 days of life, P < .01), have preterm gestation (12% vs 1%, P = .02), and present with respiratory symptoms (26% vs 8%, P = .01) or apnea (41% vs 1%, P < .001). Subcortical white matter cytoxic cerebral edema was common in severe cases. Two infants with HPeV died during admission with severe neurologic HPeV disease; no infant with mild HPeV disease died.
This is the largest, geographically diverse U.S. study to describe the 2022 HPeV outbreak among infants. Longitudinal follow up of infants is needed to define predictors and outcomes of severe HPeV disease.
人细小病毒（HPeV）感染可导致婴儿出现严重疾病，包括败血症、癫痫、脑损伤和死亡。2022年，幼儿中出现了HPeV感染的再次流行。疾病谱和结局仍有待全面描述。
开展了一项多州回顾性队列研究，以评估2022年入院的年龄≤6个月且实验室确诊为HPeV感染的婴儿的住院情况和结局。患有严重疾病的婴儿定义为在入院期间出现临床癫痫发作，或磁共振成像或脑电图异常。使用描述性统计方法比较患有严重疾病和非严重疾病的婴儿。
在11个州共识别出124例美国感染HPeV的婴儿。HPeV病例在5月达到高峰，发病中位年龄为25.8天（0 - 194天），症状为发热、烦躁和喂养困难。细菌和其他病毒合并感染很少见。33例（27%）婴儿患有严重神经系统疾病，更可能在较小年龄发病（13.9天 vs 30天，P < 0.01），早产（12% vs 1%，P = 0.02），并出现呼吸道症状（26% vs 8%，P = 0.01）或呼吸暂停（41% vs 1%，P < 0.001）。严重病例中皮质下白质细胞毒性脑水肿很常见。2例感染HPeV的婴儿在入院期间因严重神经系统HPeV疾病死亡；轻度HPeV疾病的婴儿无死亡病例。
这是美国规模最大、地域分布广泛的一项描述2022年婴儿中HPeV疫情的研究。需要对婴儿进行纵向随访，以确定严重HPeV疾病的预测因素和结局。
