Human parechovirus-3 encephalitis in two neonates: acute and follow-up magnetic resonance imaging and evaluation of central nervous system markers of inflammation.

BACKGROUND: Human parechovirus-3 has been known to cause neonatal sepsis and encephalitis for nearly a decade. However, information about magnetic resonance imaging and cerebrospinal fluid findings as well as outcomes has been limited. PATIENTS: Acute presentations and diagnostic testing of two neonates with Human parechovirus-3 encephalitis are described. Clinical and radiographic follow-up is provided. CONCLUSIONS: Evaluation of central nervous system neurochemistry with inflammatory markers such as neopterin, may be helpful for diagnosis in neonatal encephalitis. The pattern of white matter injury seen in these two patients should raise suspicion for Human parechovirus-3 infection. Testing for this virus should be more routinely considered in neonates presenting with encephalitis and normal cerebrospinal fluid results. The severity of radiographic abnormality may not correlate with long-term findings as the clinical and radiographic follow-up after a year is better than expected in the first patient.