Human Parechovirus Central Nervous System Infections in Southern California Children

Background: Human parechoviruses (hPeV) are increasingly recognized as significant etiological agents for meningoencephalitis especially in young children, but testing of cerebrospinal fluid (CSF) for hPeV by PCR is not routinely performed. Methods: We used real-time reverse transcriptase PCR for detection of serotypes 1-6 in CSF samples of 440 children who underwent a lumbar puncture to exclude an infectious etiology of their clinical presentation. We then compared the prevalence and clinical presentation of children with hPeV-positive CSF with that of children with enterovirus (EV)-positive CSF. Results: HPeV was detected in 2.7% and EV in 10.7% of CSF samples. Many hPeV-positive patients were < 3 months of age and usually had CSF parameters within the age-adjusted normal range. However, children with hPeV-positive CSF presented with neurologic symptoms more frequently than those with EV-positive CSF. Conclusions: HPeV infections of the central nervous system occurred mainly in young infants and were more commonly associated with neurologic symptoms at presentation, despite the fact that CSF findings were within the normal range in the vast majority of these cases. HPeV should be included in the differential diagnosis of young children with central nervous system symptoms and sepsis-like illness, even in the presence of normal CSF parameters.