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Rapid syndromic molecular testing and human parechovirus infection in children: A report of three cases in Argentina
Diagnóstico molecular sindrómico rápido e infección por parechovirus humano en niños: reporte de 3 casos en Argentina
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Phylogenetic analysis of hantaviruses based on 853<span class="elsevierStyleHsp" style=""></span>bp of S-segment genome of Andes virus, and other orthohantaviruses characterized previously. Taxa in the branches of the tree indicate virus name and province of origin. GenBank accession numbers and reservoir rodent specie were: <span class="elsevierStyleInterRef" id="intr0005" href="ncbi-n:AF482717">AF482717</span>, Pergamino (<span class="elsevierStyleItalic">Akodon azarae</span>); <span class="elsevierStyleInterRef" id="intr0010" href="ncbi-n:AF482716">AF482716</span>, Maciel (<span class="elsevierStyleItalic">Necromys benefactus</span>); <span class="elsevierStyleInterRef" id="intr0015" href="ncbi-n:AF482715">AF482715</span>, Orán (<span class="elsevierStyleItalic">Oligoryzomys chacoensis</span>); <span class="elsevierStyleInterRef" id="intr0020" href="ncbi-n:AF482713">AF482713</span>, Bermejo (<span class="elsevierStyleItalic">Oligoryzomys occidentalis</span>); <span class="elsevierStyleInterRef" id="intr0025" href="ncbi-n:AF482714">AF482714</span>, Lechiguanas (<span class="elsevierStyleItalic">Oligoryzomys</span><span class="elsevierStyleItalic">flavesc</span>ens and <span class="elsevierStyleItalic">O. nigripes</span>); <span class="elsevierStyleInterRef" id="intr0030" href="ncbi-n:AF482711">AF482711</span>, Buenos Aires (undescribed); <span class="elsevierStyleInterRef" id="intr0035" href="ncbi-n:AY740624">AY740624</span>, Araucaria (<span class="elsevierStyleItalic">O. nigripes</span>); <span class="elsevierStyleInterRef" id="intr0040" href="ncbi-n:KC422346">KC422346</span>, Juquitiba (<span class="elsevierStyleItalic">O. nigripes</span>); <span class="elsevierStyleInterRef" id="intr0045" href="ncbi-n:AF291702">AF291702</span>, <span class="elsevierStyleInterRef" id="intr0050" href="ncbi-n:AF004660">AF004660</span> and <span class="elsevierStyleInterRef" id="intr0055" href="ncbi-n:AF324902">AF324902</span> Andes (<span class="elsevierStyleItalic">Oligoryzomys longicaudatus</span>; <span class="elsevierStyleInterRef" id="intr0060" href="ncbi-n:HM582091">HM582091</span>, Jaborá (<span class="elsevierStyleItalic">Akodon montensis</span>) and NC038505 Laguna Negra (<span class="elsevierStyleItalic">Calomys laucha</span>). The model selection retained GTR+G+I as the best model that shows the lowest Akaike (6384.96) and BIC (6645.48) values.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Isabel E. Gómez Villafañe, Eliana F. Burgos, Rocio M. Coelho, Carla M. Bellomo, Jerónimo Garcilazo Amatti, Valeria P. Martinez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Isabel E." "apellidos" => "Gómez Villafañe" ] 1 => array:2 [ "nombre" => "Eliana F." "apellidos" => "Burgos" ] 2 => array:2 [ "nombre" => "Rocio M." "apellidos" => "Coelho" ] 3 => array:2 [ "nombre" => "Carla M." "apellidos" => "Bellomo" ] 4 => array:2 [ "nombre" => "Jerónimo" "apellidos" => "Garcilazo Amatti" ] 5 => array:2 [ "nombre" => "Valeria P." "apellidos" => "Martinez" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754121000444?idApp=UINPBA00004N" "url" => "/03257541/0000005400000001/v1_202204020607/S0325754121000444/v1_202204020607/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0325754121000389" "issn" => "03257541" "doi" => "10.1016/j.ram.2021.02.005" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "448" "copyright" => "Asociación Argentina de Microbiología" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Argent Microbiol. 2022;54:25-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Placentitis and abortion caused by a multidrug resistant strain of <span class="elsevierStyleItalic">Campylobacter fetus</span> subspecies <span class="elsevierStyleItalic">fetus</span> in a sheep in Uruguay" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:3 [ 0 => "en" 1 => "en" 2 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "25" "paginaFinal" => "30" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Placentitis y aborto causado por una cepa de <span class="elsevierStyleItalic">Campylobacter fetus</span> subespecie <span class="elsevierStyleItalic">fetus</span> multirresistente a antibióticos en una oveja en Uruguay" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3017 "Ancho" => 1508 "Tamanyo" => 1288853 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">(A) Histologic section of the cotyledonary region of the placenta showing severe extensive inflammatory infiltrate. (B) Higher magnification of <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A. Note abundant degenerate neutrophils admixed with fibrin exudate and karyorrhectic (necrotic) cellular debris (severe extensive fibrinonecrotizing and neutrophilic cotyledonary placentitis. (C) Cross section of a chorionic arteriole (center) depicting concentric necrosis of the tunica media and mural neutrophilic infiltrate (arteriolitis), with abundant fibrin and necrotic debris in the surrounding stroma (hematoxylin and eosin stain, A: 200×, B: 400×, C: 630×).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Matías A. Dorsch, María L. Casaux, Lucía Calleros, Virginia Aráoz, Rubén D. Caffarena, Cecilia Monesiglio, Maila Barcellos, Caroline da Silva Silveira, Yisell Perdomo, Georgget Banchero, Francisco A. Uzal, Martín Fraga, Federico Giannitti" "autores" => array:13 [ 0 => array:2 [ "nombre" => "Matías A." "apellidos" => "Dorsch" ] 1 => array:2 [ "nombre" => "María L." "apellidos" => "Casaux" ] 2 => array:2 [ "nombre" => "Lucía" "apellidos" => "Calleros" ] 3 => array:2 [ "nombre" => "Virginia" "apellidos" => "Aráoz" ] 4 => array:2 [ "nombre" => "Rubén D." "apellidos" => "Caffarena" ] 5 => array:2 [ "nombre" => "Cecilia" "apellidos" => "Monesiglio" ] 6 => array:2 [ "nombre" => "Maila" "apellidos" => "Barcellos" ] 7 => array:2 [ "nombre" => "Caroline" "apellidos" => "da Silva Silveira" ] 8 => array:2 [ "nombre" => "Yisell" "apellidos" => "Perdomo" ] 9 => array:2 [ "nombre" => "Georgget" "apellidos" => "Banchero" ] 10 => array:2 [ "nombre" => "Francisco A." "apellidos" => "Uzal" ] 11 => array:2 [ "nombre" => "Martín" "apellidos" => "Fraga" ] 12 => array:2 [ "nombre" => "Federico" "apellidos" => "Giannitti" ] ] ] ] "resumen" => array:1 [ 0 => array:3 [ "titulo" => "Highlights" "clase" => "author-highlights" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0005" class="elsevierStylePara elsevierViewall">We describe for the first time a case of <span class="elsevierStyleItalic">Campylobacter fetus fetus</span> abortion in sheep in Uruguay.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0010" class="elsevierStylePara elsevierViewall">Neutrophilic and fibrinonecrotizing placentitis with arteriolitis was diagnosed.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Campylobacter fetus fetus</span> was isolated and confirmed by PCR and DNA sequencing.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0020" class="elsevierStylePara elsevierViewall">The strain was resistant to four antimicrobial classes (multidrug resistance).</p></li></ul></p></span>" ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754121000389?idApp=UINPBA00004N" "url" => "/03257541/0000005400000001/v1_202204020607/S0325754121000389/v1_202204020607/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Rapid syndromic molecular testing and human parechovirus infection in children: A report of three cases in Argentina" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "31" "paginaFinal" => "34" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Barbara Fox, Veronica Sabio Paz, María Agustina Incardona, María Elisa Elisiri, Sol Gonzalez Fraga, Claudio Luis Solana, Liliana Fernández-Canigia" "autores" => array:7 [ 0 => array:4 [ "nombre" => "Barbara" "apellidos" => "Fox" "email" => array:1 [ 0 => "fox.bar89@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Veronica" "apellidos" => "Sabio Paz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "María Agustina" "apellidos" => "Incardona" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "María Elisa" "apellidos" => "Elisiri" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Sol" "apellidos" => "Gonzalez Fraga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Claudio Luis" "apellidos" => "Solana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "Liliana" "apellidos" => "Fernández-Canigia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Laboratorio Central, Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Pediatría, Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Diagnóstico molecular sindrómico rápido e infección por parechovirus humano en niños: reporte de 3 casos en Argentina" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 538 "Ancho" => 1255 "Tamanyo" => 57172 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Case 1 – axial magnetic resonance imaging. Diffusion sequence (a) and apparent diffusion coefficient (ADC) map (b) where extensive restrictive areas of diffuse and symmetric distribution are observed, compromising the supratentorial bihemispheric white matter, dorso-lateral nuclei of both thalamus and corpus callosum. T2 * Sequence (c) showing the bleeding area (red arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Human parechovirus (HPeV) is a small non-enveloped RNA virus that belongs to the family <span class="elsevierStyleItalic">Picornaviridae</span>. It was first isolated in 1956 and the first two viruses were classified as echoviruses 22 and 23 of the genus <span class="elsevierStyleItalic">Enterovirus</span> (EV). In 1999 they were reclassified into the genus <span class="elsevierStyleItalic">Parechovirus</span>, as HPeV-1 and HPeV-2 respectively. Currently, 19 genotypes have been identified, being HPeV-3 particularly neurotropic and associated with more severe disease<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Infection is prevalent among young children. It is often asymptomatic or associated with mild disease of the gastrointestinal and respiratory tracts. However, HPeV can also cause severe diseases such as sepsis, encephalitis, and meningitis<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">4,10</span></a> with long term neurological sequelae in young infants, including cerebral palsy, central visual impairment, and gross motor impairment<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">3,11,13</span></a>. Therefore, it represents a diagnostic and therapeutic challenge for the treating physician.</p><p id="par0015" class="elsevierStylePara elsevierViewall">HPeV detection is not routinely performed in most clinical microbiology laboratories and, therefore, its real prevalence is unknown. Recent studies have shown that HPeV-3 might be one of the main agents involved in neonatal neurological infections worldwide<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">1,7,14</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We report three cases that presented with different clinical features in our hospital after the implementation of a multiplex PCR meningitis/encephalitis panel (ME) (<span class="elsevierStyleItalic">Filmarray</span>) between December 2018 and December 2019. The panel includes the detection of 7 viruses (HPeV, EV, herpes simplex virus 1 and 2, human herpesvirus 6, varicella-zoster virus), 6 bacteria (<span class="elsevierStyleItalic">Escherichia coli K1, Haemophilus influenzae, Listeria monocytogenes, Neisseria meningitidis, Streptococcus agalactiae, Streptococcus pneumoniae</span>) and one yeast (<span class="elsevierStyleItalic">Cryptococcus neoformans/gattii)</span>.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A 6-day-old boy was brought to the Department of Pediatrics for a neonatal jaundice follow-up examination. His mother reported decreased oral intake and a febrile episode of 37.9<span class="elsevierStyleHsp" style=""></span>°C without gastrointestinal or respiratory symptoms. He was cesarean-born and his mother had a <span class="elsevierStyleItalic">Streptococcus</span> group B (SGB)-positive culture during pregnancy. His mother refused to hospitalize him and returned the following day reporting fever, irritability, and decreased feeding. He also presented with mild aqueous diarrhea that was self-limiting. He was admitted to the neonatal ICU. Laboratory tests included lumbar puncture, urine, stool, and a set of blood cultures. His white blood cell count (WBCc) was 8.7<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span><span class="elsevierStyleHsp" style=""></span>WBC/mm<span class="elsevierStyleSup">3</span> and his C-reactive protein (CRP) level was 1.6<span class="elsevierStyleHsp" style=""></span>mg/l. He was administered intravenous ampicillin and gentamicin. The cerebrospinal fluid (CFS) was clear and colorless, had no pleocytosis, only mild proteinorrachy (87<span class="elsevierStyleHsp" style=""></span>mg/dl). Bacterial cultures of blood, urine, and CFS were negative and his chest X-ray was normal. The ME panel was positive for HPeV and rotavirus antigen was detectable in the stool. On day 2 of admission, he developed left tonic–clonic movements and episodes of bradycardia and desaturation. Phenobarbital was administered (15<span class="elsevierStyleHsp" style=""></span>mg/kg). Brain ultrasound showed subcortical white matter hypoechogenicity of both cerebral hemispheres, corpus callosum, and both temporal lobes. Brain magnetic resonance imaging (MRI) showed acute leukoencephalitis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). He also presented an erythematous palmar–plantar rash (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Levetiracepam was added to his treatment scheme as he manifested new desaturation episodes and hypertonia. He gradually improved and was discharged on day 15. Due to the severity of the case, HPeV was identified by real-time RT-PCR as HPeV-3. He is currently followed-up in Child Neurology, continues on an anticonvulsant treatment, and receives early stimulation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">A 16-day-old girl was admitted to the emergency department for a history of decreased oral intake, irritability, and fever of 38<span class="elsevierStyleHsp" style=""></span>°C without gastrointestinal or respiratory symptoms. She was born full-term by vaginal delivery without complications and her mother had an SGB-positive culture during pregnancy. On physical examination, no rash was observed. Laboratory tests included lumbar puncture, urine, and a set of blood cultures. Her WBCc was 6.2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span><span class="elsevierStyleHsp" style=""></span>WBC/mm<span class="elsevierStyleSup">3</span> and her CRP level was 2.0<span class="elsevierStyleHsp" style=""></span>mg/l. She was administered intravenous gentamicin and cefotaxime. Her CFS was clear and colorless and without pleocytosis. Bacterial cultures of blood, urine, and CFS were negative. The ME panel was positive for HPeV. Her chest X-ray was normal and a nasopharyngeal swab was negative for respiratory viruses. She was admitted for 3 days, and after 24<span class="elsevierStyleHsp" style=""></span>h with no fever and a favorable evolution, she was discharged.</p><p id="par0035" class="elsevierStylePara elsevierViewall">A 4-month-old boy, born full-term by vaginal delivery, was admitted to the emergency department after 4<span class="elsevierStyleHsp" style=""></span>h of persistent crying and two febrile episodes of 38<span class="elsevierStyleHsp" style=""></span>°C in the last 24<span class="elsevierStyleHsp" style=""></span>h. He had normal weight-for-age. On physical examination, he was irritable with abdominal tenderness and no rash was observed. His brother was having an upper respiratory tract infection. His WBCc was 6.2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">3</span><span class="elsevierStyleHsp" style=""></span>WBC/mm<span class="elsevierStyleSup">3</span> and his CRP level was 5.2<span class="elsevierStyleHsp" style=""></span>mg/l. Abdominal ultrasound only showed meteorism. A lumbar puncture was performed, and CFS was clear and colorless, without pleocytosis. The ME panel was positive for HPeV. Bacterial cultures of blood, urine, and CFS were negative. A cerebral ultrasound was performed and was normal. He had intermittent sub-febrile episodes and was discharged on day 4 of admission, after 30<span class="elsevierStyleHsp" style=""></span>h with no fever.</p><p id="par0040" class="elsevierStylePara elsevierViewall">HPeV is one of the picornaviruses that has been associated with fever of unknown origin, gastroenteritis, clinical sepsis, meningitis, or encephalitis in very young infants. We report three different cases of HPeV CNS infection that presented in our hospital between December 2018 and December 2019.</p><p id="par0045" class="elsevierStylePara elsevierViewall">HPeV infections have been reported worldwide, and previous studies have shown a prevalence of HPeV in CSF samples ranging from 0 to 17%<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">10,14</span></a>. Gutierrez et al. reported HPeV as the etiologic agent of meningitis and sepsis-like illness in infants with a detection rate of 18% in South America, which is higher than any other series worldwide<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a>. However, the prevalence rates differ depending on the design of the study, sampling sites, and demographic characteristics. As HPeV infection is not a notifiable disease in Argentina and the test is not widely accessible, epidemiological information is not available. For the same age group in the studied period, the incidence of HPeV and EV infections was similar, as there were three viral encephalitis cases due to EV. We, therefore, conclude that further studies are needed to estimate the burden of HPeV infections.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The three cases were recorded during the spring, as it has been previously described<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">6,8</span></a>. However, most HPeV infections tend to occur in late summer and autumn months<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a>. The age distribution of patients with HPeV infection is characterized for presenting in children under three months of age, and mainly in neonates<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a>. In this cohort, the three patients were less than 4 months of age.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Transmission of HPeV occurs through the fecal–oral route and possibly infective respiratory droplets<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">2,10</span></a>. There is scant data regarding respiratory transmission, however, it is supposed to be the route in children with CNS symptoms<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a>. The risk of transmission is probably highest during acute symptomatic illness. Confirmed cases should be under standard, contact, and respiratory precautions to prevent transmission to other young infants during admission<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0060" class="elsevierStylePara elsevierViewall">All cases presented with fever and irritability as common clinical features. However, the severity of case 1 was quite different, reflecting the wide range of clinical features of this viral infection. Although most mild HPeV infections have no specific symptoms, severe infections have some clinical features that may suggest the etiology. Clinical syndromes caused by HPeV vary by genotype, and HPeV-3 illness can be severe with up to 20–50% of admitted patients presenting with sepsis-like syndrome<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a>. The combination of fever, rash, and severe irritability with characteristics of sepsis in neonates should lead clinicians to consider HPeV infection as a differential diagnosis<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a>. Long term follow-up is strongly advised, as neonates are considered a vulnerable population at risk for neurodevelopmental delay and neurological sequelae<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a>.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The absence of CSF pleocytosis and normal protein and glucose levels in CSF are commonly reported in most cases of HPeV CNS infections, as observed in these three cases<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a>. HPeV should be considered for testing in CFS samples of neonates as it can lead to severe encephalitis associated with white matter injury in the neonatal period<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a>. Syndromic molecular testing allowed us to establish the specific cause of encephalitis at around 3<span class="elsevierStyleHsp" style=""></span>h since sample collection. A shorter time to result could lead to shorter hospital stays and a decrease in the use of antimicrobial therapy<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a>.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Molecular diagnostic techniques could help improve patient care and understand the real prevalence of this infection in Argentina.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflict of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres1688158" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1497087" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1688159" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1497086" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 5 => array:2 [ "identificador" => "xack595656" "titulo" => "Acknowledgments" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-10-05" "fechaAceptado" => "2021-02-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1497087" "palabras" => array:5 [ 0 => "Human parechovirus" 1 => "HPeV-3" 2 => "Neonates" 3 => "CNS infection" 4 => "Molecular diagnosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1497086" "palabras" => array:4 [ 0 => "Parechovirus humano" 1 => "HPeV-3" 2 => "Neonatos" 3 => "Diagnóstico molecular" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Human parechovirus (HPeV) is one of the members of the family <span class="elsevierStyleItalic">Picornaviridae</span> that has been associated with fever of unknown origin, gastroenteritis, clinical sepsis, meningitis, or encephalitis in very young infants. HPeV detection is not routinely performed in most clinical microbiology laboratories in Argentina and, therefore, its real prevalence is unknown. We here report three cases of HPeV CNS infection that presented to our hospital with different clinical features after the implementation of a multiplex PCR meningitis/encephalitis panel. Molecular diagnostic techniques could help improve patient care and understand the real prevalence of this infection in Argentina.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los parechovirus humanos (HPeV) son virus de la familia <span class="elsevierStyleItalic">Picornaviridae,</span> que se han asociado a diferentes cuadros clínicos, como fiebre de origen desconocido, gastroenteritis, sepsis, meningitis o encefalitis en niños pequeños. Su detección no está disponible de rutina en la mayoría de los laboratorios de nuestro país, por lo que su prevalencia es desconocida. Reportamos 3 casos de infección del sistema nervioso central por HPeV con diferentes características clínicas, que se presentaron luego de la implementación de un panel molecular para el diagnóstico sindrómico de meningitis/encefalitis. Las técnicas de diagnóstico molecular podrían ayudar a mejorar el abordaje y el cuidado de estos pacientes, así como también a conocer la prevalencia de esta infección en Argentina.</p></span>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 538 "Ancho" => 1255 "Tamanyo" => 57172 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Case 1 – axial magnetic resonance imaging. Diffusion sequence (a) and apparent diffusion coefficient (ADC) map (b) where extensive restrictive areas of diffuse and symmetric distribution are observed, compromising the supratentorial bihemispheric white matter, dorso-lateral nuclei of both thalamus and corpus callosum. T2 * Sequence (c) showing the bleeding area (red arrow).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1140 "Ancho" => 1207 "Tamanyo" => 152811 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Case 1 – erythematous plantar rash.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0075" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Human parechovirus type 3 infection: an emerging infection in neonates and young infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Y. Aizawa" 1 => "R. Izumita" 2 => "A. Saitoh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jiac.2017.04.009" "Revista" => array:6 [ "tituloSerie" => "J Infect Chemother" "fecha" => "2017" "volumen" => "23" "paginaInicial" => "419" "paginaFinal" => "426" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28511987" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0080" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parechovirus: an important emerging infection in young infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.N. Britton" 1 => "C.A. Jones" 2 => "K. Macartney" 3 => "A.C. Cheng" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5694/mja18.00149" "Revista" => array:6 [ "tituloSerie" => "Med J Aust" "fecha" => "2018" "volumen" => "208" "paginaInicial" => "365" "paginaFinal" => "369" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29716506" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0085" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parechovirus encephalitis and neurodevelopmental outcomes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:9 [ 0 => "P.N. Britton" 1 => "D. Russell" 2 => "M. Nissen" 3 => "N. Crawford" 4 => "E. Elliot" 5 => "K. Macartney" 6 => "G. Khandaker" 7 => "R. Booy" 8 => "C. 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Kesson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/cid/ciu784" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2015" "volumen" => "60" "paginaInicial" => "228" "paginaFinal" => "236" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25301212" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0110" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiological and clinical characteristics of infants admitted to hospital due to human parechovirus infections: a prospective study in Spain" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Grupo de Estudio de las infecciones por enterovirus y Parechovirus" "etal" => false "autores" => array:15 [ 0 => "F. Martin Del Valle" 1 => "C. Calvo" 2 => "I. Martinez-Rienda" 3 => "A. Cilla" 4 => "M.P. Romero" 5 => "A.I. Menasalvas" 6 => "L. Reis-Iglesias" 7 => "D. Roda" 8 => "M.J. Pena" 9 => "N. Rabella" 10 => "M.D.M. Portugues de la Red" 11 => "G. Megias" 12 => "A. Moreno-Docon" 13 => "A. Otero" 14 => "M. Cabrerizo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2018" "volumen" => "88" "paginaInicial" => "82" "paginaFinal" => "88" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0115" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Potential clinical impact of the film array meningitis encephalitis panel in children with suspected central nervous system infections" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Messacar" 1 => "G. Breazeale" 2 => "C.C. Robinson" 3 => "S.R. Dominguez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.diagmicrobio.2016.05.020" "Revista" => array:6 [ "tituloSerie" => "Diagn Microbiol Infect Dis" "fecha" => "2016" "volumen" => "86" "paginaInicial" => "118" "paginaFinal" => "120" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27342782" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0120" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Human parechovirus: an increasingly recognized cause of sepsis-like illness in young infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. Olijve" 1 => "L. Jennings" 2 => "T. Walls" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Clin Microbiol Rev" "fecha" => "2018" "volumen" => "31" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0125" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurological and neurodevelopmental outcomes after human parechovirus CNS infection in neonates and young children: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T. van Hinsbergh" 1 => "R.G. Elbers" 2 => "J. Hans Ket" 3 => "A.M. van Furth" 4 => "C.C. Obihara" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2352-4642(20)30181-4" "Revista" => array:6 [ "tituloSerie" => "Lancet Child Adolesc Health" "fecha" => "2020" "volumen" => "4" "paginaInicial" => "592" "paginaFinal" => "605" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32710840" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0130" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Human parechovirus causes encephalitis with white matter injury in neonates" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "M.A. Verboon Maciolek" 1 => "F. Groenendaal" 2 => "C.D. Hahn" 3 => "J. Hellmann" 4 => "A.M. van Loon" 5 => "G. Boivin" 6 => "L.S. de Vries" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/ana.21445" "Revista" => array:6 [ "tituloSerie" => "Ann Neurol" "fecha" => "2008" "volumen" => "64" "paginaInicial" => "266" "paginaFinal" => "273" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18825694" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0135" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics and outcomes of human parechovirus infection in infants" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:9 [ 0 => "S. Vergnano" 1 => "S. Kadambari" 2 => "K. Whalley" 3 => "E. Menson" 4 => "N. Martinez-Alier" 5 => "M. Cooper" 6 => "E. Sanchez" 7 => "P. Heath" 8 => "H. Lyall" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00431-014-2483-3" "Revista" => array:6 [ "tituloSerie" => "Eur J Pediatr" "fecha" => "2015" "volumen" => "174" "paginaInicial" => "919" "paginaFinal" => "924" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25573462" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0140" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence, type and concentration of human enterovirus and parechovirus in cerebrospinal fluid samples of pediatric patients over a 10-year period: a retrospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "S. Vollbach" 1 => "A. Müller" 2 => "J.F. Drexler" 3 => "A. Simon" 4 => "C. Drosten" 5 => "A.M. Eis-Hübinger" 6 => "M. Panning" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12985-015-0427-9" "Revista" => array:5 [ "tituloSerie" => "Virol J" "fecha" => "2015" "volumen" => "12" "paginaInicial" => "199" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26607060" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack595656" "titulo" => "Acknowledgments" "texto" => "<p id="par0080" class="elsevierStylePara elsevierViewall">We thank María Cecilia Freire, Servicio de Neurovirosis, INEI-ANLIS Dr. Carlos G. Malbran, for genotyping HPeV-3 from case 1.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/03257541/0000005400000001/v1_202204020607/S0325754121000365/v1_202204020607/en/main.assets" "Apartado" => array:4 [ "identificador" => "37861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Microbiología clínica y enfermedades infecciosas" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03257541/0000005400000001/v1_202204020607/S0325754121000365/v1_202204020607/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0325754121000365?idApp=UINPBA00004N" ]
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