Elsevier

Journal of Clinical Virology

Volume 98, January 2018, Pages 28-32
Journal of Clinical Virology

Short communication
HPeV-3 predominated among Parechovirus A positive infants during an outbreak in 2013–2014 in Queensland, Australia

https://doi.org/10.1016/j.jcv.2017.12.003Get rights and content

Highlights

  • HPeV-3 was the only Parechovirus A genotype found in CNS of ill Queensland infants.

  • HPeV testing requests peaked between spring 2013 to autumn 2014.

  • HPeV testing should be routine for CSF from infants with acute CNS-related symptoms.

  • VP3/VP1 HPeV sequence analysis is rapid and can robustly identify most genotypes.

Abstract

Background

Parechoviruses (HPeV) are endemic seasonal pathogens detected from the respiratory tract, gut, blood and central nervous system (CNS) of children and adults, sometimes in conjunction with a range of acute illnesses. HPeV CNS infection may lead to neurodevelopmental sequelae, especially following infection by HPeV-3, hence screening and genotyping are important to inform epidemiology, aetiology and prognosis.

Objectives

To identify and characterise HPeVs circulating during an outbreak between November 2013 and April 2014 in Queensland, Australia.

Study design

To perform PCR-based screening and comparative nucleotide sequence analysis on samples from children with clinically suspected infections submitted to a research laboratory for HPeV investigations.

Results

HPeVs were detected among 25/62 samples, identified as HPeV-3 from 23 that could be genotyped. These variants closely matched those which have occurred worldwide and in other States of Australia.

Conclusions

The inclusion of PCR-based HPeV testing is not systematically applied but should be considered essential for children under 3 months of age with CNS symptoms as should long-term follow-up of severe sepsis-like cases.

Section snippets

Background

The species Parechovirus A include human parechovirus (HPeV) type 1 and 2, first identified in 1956 as echovirus 22 and 23 [1], [2]. There are now 19 HPeV genotypes within the genus Parechovirus, family Picornaviridae [1]. Infection has been associated with respiratory [3], [4] and gastrointestinal disease [4], [5]. Young children are more likely than adults to suffer aseptic meningitis [4], encephalitis, flaccid paralysis and severe neonatal sepsis [4], [6], [7], [8], [9], [10]. Long term

Objectives

During 2013–2014, reports described HPeV-3 cases in young children with acute CNS disease in the Australian east coast state of New South Wales (NSW) and southern state of Victoria [15], [26], [27], [28], [29]. These reports led us to offer research-based PCR testing to seek out and characterise the genotype of HPeV clinically suspected of causing similar cases in Queensland. We summarize this molecular epidemiology investigation.

Specimens

A range of samples were sent to the laboratory. Patients included those with suspected encephalitis because of fever, seizures and abnormal findings in CSF (e.g. pleocytosis) or upon neuroimaging [11]. Unlinked sex, date of birth and date of specimen collection data were examined. In response to a clinical request, RNA extracts were provided by Pathology Queensland Central laboratory and were screened for Parechovirus A at our research laboratory. RNA had been extracted from 200 μl of sample

HPeV detection

From 62 test requests submitted to our laboratory because of a clinically suspected acute HPeV infection between November 2013 and April 2014, 25 were identified as Parechovirus A positive by RT-rtPCR and 23 extracts from 22 patients could be genotyped. (Fig. 1) These originated from CSF (n = 14; 61% of all genotypes), faeces/stool (n = 6; 26%), throat swab (n = 2; 9%) and nasopharyngeal aspirate (NPA; n = 1; 4%) samples. Most samples were received during early summer 2013 (December; n = 22), which

Discussion

All Parechovirus A positive samples we received between spring 2013 and autumn 2014 in Queensland were variants of HPeV-3.

Samples were not systematically collected or tested for other pathogens; they were received and tested upon the request of a medical officer. No estimate could be made of the frequency of mild and asymptomatic HPeV infection in Queensland.

HPeV-3 is believed to cause infection and inflammation of the CNS but we also detected HPeV-3 from the gut and upper respiratory tract.

Author contributions

DM, CYTW and IMM conducted screening and genotyping. IMM designed the analysis and supervised DM and CYTW. IMM, KEA, AF and DM co-wrote the manuscript. All authors have read and accepted the manuscript.

Funding

This work was funded by Queensland Children’s Hospital Foundation Project Grant 50028.

Competing interests

None declared.

Acknowledgements.

We thank Pathology Queensland Central for the provision of specimen nucleic acid extracts, Dr Claire Heney for helpful discussions and Dr Sarah Tozer for provision of data. This work was carried out within the Qpid laboratory, CHRC.

References (42)

  • G. Boivin et al.

    Human parechovirus 3 and neonatal infections

    Emerg. Infect. Dis.

    (2005)
  • H. Harvala et al.

    Specific association of human parechovirus type 3 with sepsis and fever in young infants, as identified by direct typing of cerebrospinal fluid samples

    J. Infect. Dis.

    (2009)
  • H. Harvala et al.

    Comparison of human parechovirus and enterovirus detection frequencies in cerebrospinal fluid samples collected over a 5-year period in edinburgh: hPeV type 3 identified as the most common picornavirus type

    J. Med. Virol.

    (2011)
  • P.E. Obermeier et al.

    Acute disseminated encephalomyelitis after human parechovirus infection

    Pediatr. Infect. Dis. J.

    (2016)
  • P.N. Britton et al.

    Parechovirus encephalitis and neurodevelopmental outcomes

    Pediatrics

    (2016)
  • C.C. Yip et al.

    Epidemiology of human parechovirus, Aichi virus and salivirus in fecal samples from hospitalized children with gastroenteritis in Hong Kong

    Virol. J.

    (2014)
  • S. van der Sanden et al.

    Prevalence of human parechovirus in the Netherlands in 2000–2007

    J. Clin. Microbiol.

    (2008)
  • G. Cumming et al.

    Parechovirus genotype 3 outbreak among infants, new south wales, Australia, 2013–2014

    Emerg. Infect. Dis.

    (2015)
  • M. Ito et al.

    Isolation and identification of a novel human parechovirus

    J. Gen. Virol.

    (2004)
  • P. Joki-Korpela et al.

    Diagnosis and epidemiology of echovirus 22 infections

    Clin. Infect. Dis.

    (1998)
  • E. Karelehto et al.

    Strain-dependent neutralization reveals antigenic variation of human parechovirus 3

    Sci. Rep.

    (2017)
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