A Case of Neonatal Fever Diagnosed Using a Multiplex PCR Array Panel for Meningitis/Encephalitis

Abstract

A 17-day-old female infant presenting with fever and diarrhea was admitted to our hospital. We performed a sepsis work-up for neonatal fever. The blood test did not show any increase of inflammatory reaction and urinalysis revealed nothing in particular, either. The cerebrospinal fluid cell count was not raised and bacterial cultures of blood, cerebrospinal fluid and urine were all negative. Human parechovirus was finally detected with a multiplex PCR system (FilmArray Meningitis/Encephalitis Panel) in the cerebrospinal fluid. We diagnosed her as having human parechovirus infection and started maintenance intravenous fluid administration only. Five days later, her temperature became normal and she was discharged another three days later. The differential diagnosis of severe infections such as sepsis, meningitis or encephalitis is essential for neonatal fever. The early diagnosis of the pathogen results is of benefit in both severe central nervous infection cases and relatively mild cases. However, the spread of rapid diagnostic procedures in Japan is limited at present to some pathogens, and a definitive diagnosis is often delayed. The multiplex PCR system that we used in this case may be useful for early diagnosis and for prevention of unnecessary treatment such as antimicrobial agents and antiviral drugs. Convenience and cost are considered as future problems of the multiplex PCR test. The reduction of costs and the continuous review of an appropriate panel are needed. It is also important to select appropriate cases to examine.