(1494) Severe Parechovirus Meningoencephalitis in Neonates and Infants: Case Series and Literature Review

Introduction: Human parechovirus (HPeV) is a rare cause of severe meningoencephalitis in neonates and infants. Although most of the cases include mild illness with fever and poor feeding in this population, severe illness does cause multiorgan failure with shock and seizures. In this report, we discuss the presentation, clinical course, and management of four neonates who were admitted to the PICU in Kansas and West Virginia during the July 2022 outbreak. We review the pathogenesis of HPeV, treatment strategies, and the importance of long-term neurologic follow-up in these patients.

Description: In our four cases, the mean age at presentation was 18.2 days (ranging from 6 to 42 days). All four patients were Caucasian with 2 female patients. The common presenting symptoms included fever, irritability, hypothermia, poor feeding, high-pitched crying, apnea, and poor muscle tone. All cases were positive for HPeV PCR in their spinal fluid and MRI brain showed extensive diffusion restriction involving white matter. All experienced refractory status epilepticus requiring midazolam and pentobarbital infusions. Multiple complications were observed, including shock, multiorgan failure, disseminated intravascular coagulation, and motor deficits. Cardiac involvement was seen in 3 patients with elevated BNP, troponin, and hypotension. All 4 patients were in septic shock and required mechanical ventilation and vasopressors. Patients required on average 15.5 days of ventilation (ranging from 7 to 33 days) and were treated with IVIG, and either methylprednisolone or hydrocortisone. The average length of stay in the PICU was 21.2 days (ranging from 11 to 46 days). The average overall hospital length of stay was 26.2 days (ranging from 11 to 56 days). At discharge, 2 infants exhibited mild- moderate feeding deficits and motor delays, while one had no deficits and one had significant motor delays.

Discussion: HPeV presents a wide clinical spectrum with more severe presentations being noted across the United States in 2022. In addition to typical supportive measures, IVIG and corticosteroids can be used as adjunctive therapy in severe HPeV illness. Seizures can be refractory requiring barbiturate infusion. Patients are at risk for short and long-term neurologic sequelae and need close post-discharge follow-up.