430 - Clinical Features, Radiological Findings and Early Neurodevelopmental Outcomes in Infants with Parechovirus Central Nervous System Infections in the District of Columbia, Maryland, and Virginia

Poster Number: 430
Publication Number: 430.419

Olivier Fortin, Children's National Health System, Washington, DC, United States; Allison Markowsky, Children's National Health System, Stafford, VA, United States; Lauren McGovern, George Washington University School of Medicine and Health Sciences, Salisbury, MD, United States; Gina Gallizzi, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Nisha Tamaskar, Childrens National Medical Center, Washington, DC, United States; Benjamin Liu, Children's National Health System, Washington, DC, United States; Sarah B. Mulkey, Children's National Health System, Washington, DC, United States; Nada Harik, Children's National Health System, Washington, DC, United States

Background: Human Parechoviruses (HPeV) were noted to cause outbreaks of infection among infants in the United States in 2022, including in our region. Clinical manifestations of HPeV infection range from mild infection without sequelae to central nervous system (CNS) infection to septic shock with multiorgan failure.

Objective: We sought to investigate the recent HPeV outbreak in our community to provide insight into epidemiology of HPeV outbreaks and improve knowledge regarding clinical presentation, radiological findings, necessary neurological evaluations, and outcomes of infected neonates.

Design/Methods: This is a retrospective case series using existing medical records. From the records of regional hospitals in Maryland and Virginia, and the Children’s National Hospital (CNH) in Washington DC, we identified infants diagnosed with HPeV CNS infection in 2022 and collected data about their clinical presentation, laboratory and radiographic studies, as well as early outcomes. Data were analyzed and presented in a descriptive fashion.

Results: 20 infants were diagnosed with HPeV meningitis based on multiplex PCR panel in cerebrospinal fluid (CSF), either at CNH or through a local hospital and subsequently referred to CNH. All presented with suspected sepsis and underwent a workup that included lumbar puncture. One infant (6%) had pleocytosis in CSF and 2 (12%) had increased protein (CSF results were missing or incomplete in 3 patients). Four (20%) were admitted to the neonatal ICU. Three (15%) has seizures during their clinical course. 4 of 14 (29%) with brain MRI had abnormalities typical for HPeV meningoencephalitis, whereas the other 10 (71%) has a normal brain MRI (MRI was not done or unavailable in 6 patients). All 3 infants with seizures also had an abnormal brain MRI. 14 received follow-up by neurology around 3 months of age: 3 of those infants (21%) had developmental concerns, none had seizures, and 2 (14%) had abnormalities on neurological examination (axial hypotonia).

Conclusion(s): A group of neonates was diagnosed with HPeV meningitis in our region based on multiplex PCR panel from CSF samples, mostly in the context of a full septic workup. Despite having HPeV in the CSF, most infants had a relatively benign course, with only a few having seizures. The rate of CNS injury in those that had a brain MRI was low. Early neurological outcomes were favorable in this group, although a few patients had neurodevelopmental concerns at the time of early infantile follow-up.