A rare case of neonatal viral meningitis caused by co-infection HHV6 and HPeV

Mustafa M. Alkazak; Samiha N. Alkaysi

doi:10.18203/2349-3291.ijcp20252175

Authors

Mustafa M. Alkazak Department of Pediatrics, Sheikh Khalifa Medical City, Ajman, UAE
Samiha N. Alkaysi Department of Pediatrics, Sheikh Khalifa Medical City, Ajman, UAE

DOI:

https://doi.org/10.18203/2349-3291.ijcp20252175

Keywords:

Neonate, Co-infection, Viral meningitis, CSF, Multiplex PCR testing

Abstract

Neonatal meningitis is considered a serious, life-threatening condition. Human parechovirus (HPeV) and herpesvirus 6 (HHV-6) are well-known neurotropic viruses with the ability to affect the central nervous system (CNS) of children, even in the neonatal period. However, isolated viral meningitis with single infections caused by both pathogens were previously reported, but co-infection in the neonatal period remains very uncommon. We are reporting a case of a 14-day-old term neonate admitted with history of low-grade fever for one day with no other significant symptoms. A full septic workup was conducted, including cerebrospinal fluid (CSF) analysis, and started on antibiotic therapy CSF analysis came with white blood cell count of 8 - (considering normal range for this age) - with a predominance of lymphocytes (95%), and normal levels of glucose and protein. Others inflammatory markers such as CRP and procalcitonin and all bacterial cultures (blood, urine and CSF) were reported also within normal limits. PCR testing of the CSF confirmed the presence of both Human Parechovirus (HPeV) and Human Herpesvirus 6 (HHV-6), leading to a diagnosis of dual viral meningitis. The neonate continued on conservative care with close monitoring. The patient gradually recovered and discharged home with no immediate neurological deficits. Despite an initial presentation, inflammatory markers were within normal, the case supported consideration multiple viral etiologies in the workup of neonatal meningitis and highlights the utility of multiplex PCR testing in the diagnosis of co-infections. Identification of such atypical presentations is crucial in early diagnosis, appropriate management, and counseling of the prognosis.

Metrics

Metrics Loading ...

References

Olijve L, Jennings L, Walls T. Human parechovirus: an increasingly recognized cause of sepsis-like illness in young infants. Clin Microbiol Rev. 2018;31(1):10-128.

Ancora G, Faldella G, Chiereghin A, Marsico C, Nigro CS, Lazzarotto T, et al. Parechovirus infection causing sepsis-like illness in newborns: a NICU approach. New Microbiol. 2020;43(3):144-7.

Britton PN, Dale RC, Nissen MD, Crawford N, Elliott E, Macartney K, et al. PAEDS-ACE Investigators. Parechovirus encephalitis and neurodevelopmental outcomes. Pediatrics. 2016;137(2).:2848. DOI: https://doi.org/10.1542/peds.2015-2848

De Bolle L, Naesens L, De Clercq E. Update on human herpesvirus 6 biology, clinical features, and therapy. Clin Microbiol Rev. 2005;18(1):217-45. DOI: https://doi.org/10.1128/CMR.18.1.217-245.2005

Ansari A, Li S, Abzug MJ, Weinberg A. Human Herpesviruses 6 and 7 and Central Nervous System Infection in Children1. Emerging Infect Dis. 2004;10(8):1450. DOI: https://doi.org/10.3201/eid1008.030788

D'Onofrio G. Alcohol research in the emergency department setting: methodological challenges and real-world implications. J Ped. 2004;145(3):290-1. DOI: https://doi.org/10.1016/j.jpeds.2004.06.034

Hall CB, Caserta MT, Schnabel KC, Shelley LM, Carnahan JA. Transplacental congenital human herpesvirus 6 infection caused by maternal chromosomally integrated virus. J Infect Dis. 2010;201(4):505-7. DOI: https://doi.org/10.1086/650495

McCarthy PL. Fever without apparent source on clinical examination. Curr Opin Ped. 2004;16(1):94-106. DOI: https://doi.org/10.1097/00008480-200402000-00018

Olijve L, Jennings L, Walls T. Human parechovirus: an increasingly recognized cause of sepsis-like illness in young infants. Clin Microbiol Rev. 2018;31(1):10-128. DOI: https://doi.org/10.1128/CMR.00047-17

Khatami A, McMullan BJ, Webber M, Stewart P, Francis S, Timmers KJ, et a. Sepsis-like disease in infants due to human parechovirus type 3 during an outbreak in Australia. Clin Infect Dis. 2015;60(2):228-36. DOI: https://doi.org/10.1093/cid/ciu784

Esposito S, Rahamat-Langendoen J, Ascolese B, Senatore L, Castellazzi L, Niesters HG. Pediatric parechovirus infections. J Clin Virol. 2014;60(2):84-9. DOI: https://doi.org/10.1016/j.jcv.2014.03.003

Verboon-Maciolek MA, Krediet TG, Gerards LJ, de Vries LS, Groenendaal F, van Loon AM. Severe neonatal parechovirus infection and similarity with enterovirus infection. Pediat Infect Dis J. 2008;27(3):241-5. DOI: https://doi.org/10.1097/INF.0b013e31815c1b07

Rubak S, Sandbæk A, Lauritzen T, Christensen B. Motivational interviewing: a systematic review and meta-analysis. Br G Gen Pract. 2005;55(513):305-12.

Hall CB, Caserta MT, Schnabel K. Chromosomal integration of human herpesvirus 6 is the major mode of congenital human herpesvirus 6 infection. Pediatrics. 2008;122(3):513-20. DOI: https://doi.org/10.1542/peds.2007-2838

Agut H, Bonnafous P, Gautheret-Dejean A. Laboratory and clinical aspects of human herpesvirus 6 infections. Clin Microbiol Rev. 2015;28(2):313-35. DOI: https://doi.org/10.1128/CMR.00122-14

Zerr DM, Meier AS, Selke SS, Frenkel LM, Huang ML, Wald A, et al. A population-based study of primary human herpesvirus 6 infection. New England J Med. 2005;352(8):768-76. DOI: https://doi.org/10.1056/NEJMoa042207