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Emergency: requires immediate attention
Human parechovirus infection
Other Resources UpToDate PubMed
Emergency: requires immediate attention

Human parechovirus infection

Contributors: Neil Mendoza MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

The human parechoviruses are members of the genus Parechovirus, of the Picornaviridae family. They are genetically similar to the enteroviruses. Infection may cause an undifferentiated febrile illness, and many cases have been reported in infants. They present with fever, irritability, and poor feeding. The illness may be associated with a rash (reported as macular, maculopapular, or erythematous). Infection may be severe and lead to shock. Neurologic manifestations may include meningitis, encephalitis, and acute flaccid paralysis. Gastrointestinal (GI) manifestations include the hemorrhage-hepatitis syndrome (hepatitis, thrombocytopenia, coagulopathy) in infants, necrotizing enterocolitis, and gastroenteritis. Human parechovirus infection has also been associated with myocarditis. There are 4 species of Parechovirus (PeV), of which only PeV-A causes disease in humans, with PeV-A3 most often associated with the most severe disease.

In July of 2022, the US Centers for Disease Control and Prevention (CDC) announced a health advisory relating to multiple reports of PeV circulating in multiple US states. Reported cases present with fever, sepsis-like syndrome, or neurologic illness (eg, seizures, meningitis) in neonates and young infants. All specimens tested by the CDC for these recent cases have been type PeV-A3.

Symptoms of upper respiratory tract infection, fever, and rash are common in those aged between 6 months and 5 years. However, in infants younger than 3 months, severe illness can occur, including a sepsis-like presentation, seizures, meningitis, and/or meningoencephalitis. Fulminant hepatitis has also been described. Intriguingly, the spinal fluid in infants with PeV is often pauci-cellular (few to no white blood cells).

Transmission can occur from both symptomatic and asymptomatic infected individuals via fecal-oral and respiratory routes. Shedding can occur for 1-3 weeks to 6 months from the GI tract following infection. The incubation period is unknown.

PeV-A3 demonstrates a cyclical pattern of infection with peaks occurring biennially.

Diagnosis is generally made by isolating viral RNA by nucleic acid testing, although few laboratories can also culture the virus. Commercial laboratory assays, multiplex platforms for meningitis and encephalitis, and testing through state public health laboratories are available to test cerebrospinal fluid (CSF) for PeV. CDC laboratory support is also available.

No specific antiviral therapy is available.

Codes

ICD10CM:
B34.9 – Viral infection, unspecified

SNOMEDCT:
105633007 – Disease caused by Picornaviridae

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Neonates and infants:
Older children:

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:07/13/2022
Last Updated:07/14/2022
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Emergency: requires immediate attention
Human parechovirus infection
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A medical illustration showing key findings of Human parechovirus infection : Diarrhea, Fever, Erythema, Irritability, Transient paralysis, Maculopapular rash
Copyright © 2022 VisualDx®. All rights reserved.