Prospective research of human parechovirus and cytokines in cerebrospinal fluid of young children less than one year with sepsis-like illness: Comparison with enterovirus.

ABSTRACT

BACKGROUND: Human parechovirus (PeV) and enterovirus are important pathogens that cause viral infection and aseptic meningitis in young children. We aimed to investigate the rate of HPeV and enterovirus detection, and to characterize cytokine profiles in the cerebrospinal fluid (CSF) of young infants with sepsis-like illness or meningitis/encephalitis. STUDY DESIGN: This was a prospective cohort study. CSF samples were collected from 90 infants less than 1 year of age. PeV and enterovirus detection was performed using reverse transcription polymerase chain reaction. Fifteen cytokines in the CSF were measured simultaneously by using multiplex immunoassays. RESULTS: PeV (PeV-group) and enterovirus (EV-group) were detected in 10 (11.1%) and 12 (13.3%) CSF samples, respectively. Other aseptic meningitis (AM-group) was diagnosed in 22 (24.4%) patients. Forty-six (51.1%) patients exhibited non-central nervous system infection (Ngroup). The PeV-group had the lowest CSF leukocyte (2.1 ± 3.5/mm3, p=0.022) and blood leukocyte (7,953 ± 4,583/mm3, p=0.046) count and Creactive protein levels (0.2 ± 0.1 mg/dL, p=0.036), than did those in the EV- and AM-groups. CSF leukocyte count and protein levels were not significantly different between the PeV- and N-groups. The levels of interleukin (IL)-1ß, IL-5, IL-6, IL-12, and IL-17 were higher in the EVgroup; conversely, IL-2, IL-4, IL-7, and IL-13 were higher in the PeVgroup. CONCLUSIONS: Examinations to detect PeV in the CSF may help identify the etiological basis of undiagnosed febrile illness in young children. Significant differences in CSF and blood laboratory findings were observed between PeV- and enterovirus-infected children.