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