Journal article

2569. High Incidence of Enterovirus, HHV6, Parechovirus and Adenovirus Blood Viremia in Children 0 to 3 Years Old Presenting With Fever Without Source

  • L’Huillier, Arnaud G Pediatric Infectious Diseases Division, University Hospitals of Geneva, Geneva, Switzerland
  • Mardegan, Chiara Department of Paediatrics, University Hospitals of Geneva, Geneva, Switzerland
  • Cordey, Samuel Laboratory of Virology, University Hospitals of Geneva, Geneva, Switzerland
  • Luterbacher, Fanny Pediatric Emergency Medicine Division, University Hospitals of Geneva, Geneva, Switzerland
  • Papis, Sebastien Department of Paediatrics, University Hospitals of Geneva, Geneva, Switzerland
  • Hugon, Florence Pediatric Emergency Medicine Division, University Hospitals of Geneva, Geneva, Switzerland
  • Kaiser, Laurent Laboratory of Virology, University Hospitals of Geneva, Geneva, Switzerland
  • Gervaix, Alain Pediatric Emergency Medicine Division, University Hospitals of Geneva, Geneva, Switzerland
  • Posfay-Barbe, Klara Pediatric Infectious Diseases Division, University Hospitals of Geneva, Geneva, Switzerland
  • Galetto-Lacour, Annick Pediatric Emergency Medicine Division, University Hospitals of Geneva, Geneva, Switzerland
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  • 2018-11-26
Published in:
  • Open Forum Infectious Diseases. - Oxford University Press (OUP). - 2018, vol. 5, no. suppl_1, p. S74-S74
English Abstract

Background
Fever without source (FWS) is defined as a fever in which an extensive history and clinical examination fail to identify a cause. Although the vast majority of children with FWS have a self-limited viral infection, up to 10–25% have a serious bacterial infection (SBI). Therefore, many children require invasive diagnostic tests, hospital admission, and empirical administration of broad-spectrum antibiotics. The aim of this study was to assess the respective role of Human enterovirus (HEV), human parechovirus (HPeV), adenovirus (ADV) and herpesvirus type 6 (HHV6) viremia in children <3 years old presenting with FWS.


Methods
Prospective monocentric diagnostic study. Between November 2015 to December 2017, children <3 year olds with FWS had, in addition to the standardized institutional work-up for FWS, plasma tested by real-time (reverse-transcription) polymerase chain reaction (PCR) for ADV, HHV6, HEV, and HPeV. Specimens with cycle threshold values <40 were considered positive. Quantification was performed on positive specimens for HEV, ADV, and HHV6 specimens when volume permitted.


Results
One hundred thirty-five patients had plasma PCR for ADV, HHV6, HEV, and HPeV. Male:female ratio was 1.45:1 and median age was 2.4 months (interquartile range 1.3–9.7). Among those, 47/135 (34.8%) had at least 1 virus detected in the plasma. More specifically, HEV was detected in 19 patients (14.1%), HHV6 in 15 (11.1%), HPeV in 8 (5.9%), and ADV in 7 (5.2%). Co-infection with 2 viruses was detected in 2 patients (ADV/HEV and ADV/HPeV). No patient with positive plasma PCR had a positive blood or CSF culture. Two patients with positive plasma PCR fulfilled American Academy of Pediatrics criteria for urinary tract infection. The first was HEV+ in plasma and CSF, midstream urine was positive for leukocytes and grew E. coli 106 CFU/mL, whereas the second was HHV6+ in plasma and catheter urine was positive leukocytes/nitrites and grew P. mirabilis 105 CFU/mL.


Conclusion
This epidemiological study highlights the frequent detection of active enteroviral, adenoviral, and HHV6 infections in plasma of children with FWS. Virus–virus and virus–bacteria co-infections are rare. Further studies are needed to establish causality between FWS and viremia.


Disclosures
A. G. L’Huillier, Gertrude Von Meissner foundation: Investigator, Research grant. Ernst and Lucie Schmidheiny foundation: Investigator, Research grant. Research and Development Grant, Geneva University Hospitals: Investigator, Research grant. L. Kaiser, Swiss National Funds: Investigator, Research grant. A. Galetto-Lacour, Gertrude Von Meissner foundation: Investigator, Research grant. Ernst and Lucie Schmidheiny foundation: Investigator, Research grant. Research and Development Grant, Geneva University Hospitals: Investigator, Research grant.
Language
  • English
Open access status
gold
Identifiers
Persistent URL
https://sonar.ch/global/documents/149742
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