Backgrounds:

Enteroviruses (EVs) and human parechoviruses (HPeVs) are a major cause of CNS infection in young infants. They have been implicated in neurodevelopmental delay, limited data are available. The aim of this study is to describe clinical outcome and to assess and compare medium-term neurodevelopment following EV and HPeV-CNS-infections.

Methods

A multicentre observational ambispective study was conducted between May-2013 and March-2018. Children under 3 months with EV or HPeV CNS-infection excluding encephalitis were included. Infants were contacted one year after acute infection. Their neurological development was evaluated using ASQ-3-test. If any area was abnormal during first round, a second round was completed later.

Results:

Forty-eight young infants with EV and HPeV CNS infection were identified: 33 (68.8%) EV and 15 (31.3%) HPeV. At first assessment 14/29 (48.3%) EV and 3/15 (20%) HPeV positive cases presented some developmental concern in the ASQ-3-test. EV-positive infants showed mild and moderate alteration in all domains analysed and HPeV-positive infants showed mild alterations only in gross and fine motor domains. Significant alterations in communication were observed in EV-positive but not in HPeV-positive infants (p=0.016). At second assessment 4/13 (30.8%) EV-positive patients showed mild to moderate concerns in communication and gross motor function and 3/13 (23.1%) showed significant concern in fine motor function.

Conclusions/Learning Points:

Although CNS infections without associated encephalitis are generally assumed to be benign our study shows that at a median age of 18 months, 48.3% of the EV-infected infants and 20% of HPeV-positive infants presented some developmental concern in the ASQ-3-test. We recommend monitor neurological development of infants during the first years of life after HPeV CNS infection and especially after EV CNS infection, even in mild cases, for an early intervention and stimulation if necessary.

Backgrounds:

Human adenovirus (hAdV) infection constitutes an important cause of morbidity and mortality in immunocompromised patients as solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients.

Cidofovir is the most prescribed treatment even though its use is controversial specially in asymptomatic patients. Strategies like reducing immunosuppression, or lymphocyte infusions have not yet been well described.

This study aims to describe the impact and therapeutic management of hAdV infection in immunocompromised patients

Methods

Retrospective study examining episodes of positive hAdV viremia (>1.000 copies/mL) in immunocompromised hosts during a four-year follow-up (2017-2021) at a reference centre. Demographic, clinical, epidemiological, and microbiological data, lymphocyte count, therapeutic management, and outcome were collected and analysed.

Results:

49 immunosuppressed patients (median age 9 years; interquartile range IQR 1.0-16.0) were included. Main causes of immunosuppression were HSCT (38/49: 77.6%), hematologic malignancies (30/49; 61.2%), and SOT (11/49: 22.4%).

25 patients (51%) were symptomatic (mainly febrile syndrome and diarrhoea). Thirteen patients (26.5%) presented a viral coinfection with CMV or BK virus. Cidofovir was prescribed in 24 patients (49%). Other therapeutic measures included administration of intravenous immunoglobulins (18.4%), reducing immunosuppression (14.3%) and memory T-cell infusion (12.2%).

Cidofovir use was significantly (p<0.05) associated with presence of hAdv symptoms, lower lymphocyte count, ICU admission and high viral load (Table 1).

Despite treatment, 11 patients (45.8%) presented persistent positive viremias (associated with lower lymphocyte count p<0.05) and three patients died because hAdV infection (acute liver failure, septic shock).

Conclusions/Learning Points:

hAdV infections had high morbidity and mortality in our series. Patients with low lymphocyte count are at higher risk of persistent positive viremias and short-term survival. We did not observe a clear association between resolution of infection and Cidofovir use.

Backgrounds:

Enteroviruses (EVs) and human parechoviruses (HPeVs) are a major cause of CNS infection in young infants. They have been implicated in neurodevelopmental delay, limited data are available. The aim of this study is to describe clinical outcome and to assess and compare medium-term neurodevelopment following EV and HPeV-CNS-infections.

Methods

A multicentre observational ambispective study was conducted between May-2013 and March-2018. Children under 3 months with EV or HPeV CNS-infection excluding encephalitis were included. Infants were contacted one year after acute infection. Their neurological development was evaluated using ASQ-3-test. If any area was abnormal during first round, a second round was completed later.

Results:

Forty-eight young infants with EV and HPeV CNS infection were identified: 33 (68.8%) EV and 15 (31.3%) HPeV. At first assessment 14/29 (48.3%) EV and 3/15 (20%) HPeV positive cases presented some developmental concern in the ASQ-3-test. EV-positive infants showed mild and moderate alteration in all domains analysed and HPeV-positive infants showed mild alterations only in gross and fine motor domains. Significant alterations in communication were observed in EV-positive but not in HPeV-positive infants (p=0.016). At second assessment 4/13 (30.8%) EV-positive patients showed mild to moderate concerns in communication and gross motor function and 3/13 (23.1%) showed significant concern in fine motor function.

Conclusions/Learning Points:

Although CNS infections without associated encephalitis are generally assumed to be benign our study shows that at a median age of 18 months, 48.3% of the EV-infected infants and 20% of HPeV-positive infants presented some developmental concern in the ASQ-3-test. We recommend monitor neurological development of infants during the first years of life after HPeV CNS infection and especially after EV CNS infection, even in mild cases, for an early intervention and stimulation if necessary.