Parechovirus is a viral genus in the family Picornaviridae. The genus is composed of two species: Human parechovirus and Ljungan virus.  Six types of human parechovirus have been identified: human parechovirus 1 (formerly echovirus 22), human parechovirus 2 (formerly echovirus 23), and human parechoviruses 3, 4, 5 and 6, respectively. Human parechoviruses cause mild respiratory illness, but have been implicated in cases of myocarditis and encephalitis in neonates. Human parechoviruses are commonly spread and more than 95% of humans are infected by human parechoviruses early in life, within two to five years of age.

Miracle in Motion is pleased to announce that we have contributed to the funding for Dr. Samir Shah's research study at the Children's Hospital of Philadelphia:

Title: Human parechoviruses as a cause of meningitis in neonates and young infants

Goal of the Current Research Study
Background and Study Rationale. Human parechoviruses (HPeV), members of the Picornaviridae family, cause diarrhea, respiratory tract infections, and meningitis. This group of viruses is now thought to be an important cause of serious illness in neonates and young infants. HPeV was identified in (15.0%) of 80 infants <3 months of age with meningitis or sepsis. In a subsequent study, HPeV was identified in 4.3% of children less than 5 years of age with viral meningitis; almost half of the patients with positive HPeV testing were less than 28 days of age. These studies underscore the importance of HPeV infections in neonate and young infants. Yet the prevalence and characteristics of such infection in this patient population are not well documented, meaning that the true burden of HPeV infection among neonates and young infants is not well known. 

Study Objectives. The objectives of this study are to describe the prevalence of HPeV as a cause of meningitis in previously healthy neonates and young infants who underwent lumbar puncture, to describe differences in the clinical features of different subtypes of HPeV, and to compare the clinical features and outcomes of meningitis caused by HPeVs and enteroviruses.  Better understanding of the characteristics of parechovirus infection will provide insight into its identification as well as shed light on the benefits of parechovirus screening in the management of febrile neonates and young infants.

Study Processes. This retrospective study will include over 700 neonates and young infants, making it the largest such study on the topic. Spinal fluid specimens from these infants will be tested for HPeVs using a new polymerase chain reaction (PCR) test that detects viral genome. All positive samples will undergo additional testing to determine the HPeV subtype. The medical records of all infants will be reviewed to collect clinical features, laboratory test results, and outcomes that will be used in the analysis

Biography
Samir S. Shah, MD, MSCE is a Pediatric Infectious Diseases and Hospital Medicine Physician. He is Assistant Professor of Pediatrics and Epidemiology at the University of Pennsylvania School of Medicine and Research Director of Global Health at The Children’s Hospital of Philadelphia. Dr. Shah’s research focuses on improving the efficiency and quality of care for children with serious infections, including pneumonia and meningitis. Dr. Shah receives research support from the National Institute of Allergy and Infectious Diseases, the Robert Wood Johnson Foundation, and the Agency for Research and Healthcare Quality. Dr. Shah has over 160 publications. He is also the editor or co-editor of 7 books in the fields of Pediatric Hospital Medicine and Pediatric Infectious Diseases. The latest book, titled Pediatric Practice: Infectious Diseases (McGraw-Hill, 2009), serves as a reference textbook for physicians caring for hospitalized children. Dr. Shah also has a leadership role in several leading medical journals. He is Associate Editor of Pharmacoepidemiology & Drug Safety, Assistant Editor of the Journal of Hospital Medicine, and an editorial board member of Archives of Pediatrics & Adolescent Medicine, the leading clinical research journal in the field of Pediatrics.


Human Parechovirus Causes Encephalitis with White Matter Injury in Neonates
The following is an excerpt from a medical journal article released in 2008:  This is the study from the Netherlands that influenced Isabella's doctors to change her diagnosis

Malgorzata A. Verboon-Maciolek, MD, PhD,1 Floris Groenendaal, MD, PhD,1 Cecil D. Hahn, MD, MPH,2
Jonathan Hellmann, MBBCh,3 Anton M. van Loon, PhD,4 Guy Boivin, MD, PhD,5
and Linda S. de Vries, MD, PhD1

Objective: To assess the role of human parechoviruses (HPeVs) as a cause of neonatal cerebral infection and to report neuroimaging findings of newborn infants with encephalitis caused by HPeVs.

Methods: Clinical presentation, cranial ultrasonography, magnetic resonance imaging (MRI) findings, and neurodevelopmental outcome of 10 infants admitted to a neonatal intensive care unit and diagnosed with encephalitis caused by HPeVs are reported.

Results: Nine of 10 infants, with a gestational age of 29 to 41 weeks, presented at 36 to 41 weeks postmenstrual age with clinical seizures. Seven had a fever and six had a rash. Clinical presentation was similar to that of infants with enterovirus infection. Cranial ultrasonography showed increased echogenicity in the periventricular white matter in all infants. Neonatal MRI confirmed white matter changes in nine infants, which changed to gliosis on later MRI. Outcome was variable with cerebral palsy in one, a suspect outcome at 18 months in one, learning disabilities at 7 years of age in one, epilepsy in one, and normal neurodevelopmental outcome in five children. Follow-up of one infant was only 9 months.

Interpretation: HPeVs should be added to the list of neurotropic viruses that may cause severe central nervous system infection in the neonatal period. White matter injury can be visualized with cranial ultrasonography, but more detailed information is obtained with MRI and especially diffusion-weighted imaging. Because clinical presentation of HPeV encephalitis is similar to that of enterovirus, real-time polymerase chain reaction for both viruses should be performed in atypical presentation of neonatal seizures.