Mild-form human parechovirus encephalitis in the neonatal period

Abstract

  Many cases of human parechovirus (HPeV) infection have been reported to present with sepsis-like symptoms in neonates and infants and to progress to multiple organ damage and central nervous system symptoms, leading to severe illness. There are a cetrain number of cases in which brain magnetic resonance imaging (MRI) shows abnormal lesions mainly in the white matter, leading to the diagnosis of acute encephalitis. In the present study, we detail our experience with two cases of HPeV detected using Film Array^® Meningitis/Encephalitis (ME) Panel, in whom cerebrospinal fluid (CSF) analysis revealed no elevation in cell count or protein levels, visiting a medical facility for a fever in the neonatal period. In one case, HPeV type 3 was later proven in cerebrospinal fluid (CSF) by real-time polymerase chain reaction. In both cases, neopterin in CSF was elevated and brain MRI showed subtle lesions in the cerebral white matter and corpus callosum ; however, there were no central nervous system symptoms such as convulsions or disturbance of consciousness, and no neurological abnormalities were evident on physical examination. Both patients had no obvious permanent disability at the time of discharge from the hospital, and we considered these cases to be a mild form of HPeV encephalitis. It is considered necessary to study the epidemiology of HPeV encephalitis including the mild-form cases diagnosed by FilmArray, and the long-term developmental prognosis of these cases.