Parechovirus Sepsis and Meningitis in a Neonatal Intensive Care Unit

The majority of febrile neonates have negative bacterial cultures and presumed viral infections. During November 2014, four febrile neonates in southeastern Wisconsin required intensive care admission for human parechovirus (HPeV) infection in the blood and/or cerebral spinal fluid (CSF). Both vertical and horizontal transmission led to disease, and a variety of signs and symptoms, including tachycardia, hypotension, neutropenia, rash and irritability accompanied fever. All neonates recovered clinically, although concern for neurodevelopmental delay remains for those with meningoencephalitis. This case series describes the presentation and short-term outcomes of neonates requiring intensive care for HPeV infections. status with normal enteral intake and was discharged home after three days. Patient 3 is a male who was born at 39 weeks gestation by repeat C-section and was discharged home on day of life 3. He presented to the emergency department on day of life 25 with fever, tachycardia, poor feeding and irritability. His initial complete blood count revealed leukopenia of 5,500 cell per μL with a left shift with normal hemoglobin and platelet count. His CSF did not contain any nucleated cells or red blood cells, and protein and glucose levels in the CSF were within normal limits. Fevers persisted for three days, during which time he continued to be intermittently irritable and tachycardic. PCR of the blood and nasopharynx was positive for HPeV; there was not sufficient CSF available for viral studies. He received five days of broad spectrum antibiotics for persistent fevers. Repeat blood cultures revealed pancytopenia with platelet count of 24,000 per μL and hematocrit of 29%, and he became neutropenic with an absolute neutrophil count of 532 cells per μL. He required two platelet transfusions and one packed red blood cell transfusion during his first week of illness. Transaminases were elevated, as was his ferritin level to greater than 20,000 ng/μL, prompting a workup for hemophagocytic lymphohistiocytosis (HLH). Though he met clinical criteria, his natural killer cell activity was normal, excluding the diagnosis. His cell counts improved throughout his ten day hospitalization, and he was discharged home. He was followed closely with pancytopenia and elevated liver enzymes normalizing within two weeks of discharge. Patient 4 is a male born at 41 weeks gestation by induced vaginal delivery. He was well until day of life 25, when he presented to the emergency department with fever, poor feeding and apparent abdominal pain. Parents noted that his older sister had a two day history of cold symptoms. His initial blood count was significant for a white blood Citation: Fritz K, Karody V, Cohen S (2015) Parechovirus Sepsis and Meningitis in a Neonatal Intensive Care Unit. J Neuroinfect Dis 6: 187. doi:10.4172/2314-7326.1000187