Human parechovirus meningitis and gross-motor neurodevelopment in young children
This multicenter prospective cohort study describes the impact of human parechovirus meningitis on gross-motor neurodevelopment of young children. Gross-motor function was measured using Alberta Infant Motor Scale. Of a total of 38 eligible children < 10 months of age at onset, nine cases had clinical evidence of meningitis and polymerase chain reaction positive for human parechovirus in cerebrospinal fluid; 11 had no meningitis and polymerase chain reaction positive for human parechovirus in nasopharyngeal aspirate, blood, urine, or feces; and in 18, no pathogen was identified (reference group).
The children with human parechovirus meningitis showed more frequent albeit not statistically significant suspect gross-motor function delay (mean Z-score (standard deviation) − 1.69 (1.05)) than children with human parechovirus infection-elsewhere (− 1.38 (1.51)). The reference group did not fall in the range of suspect gross-motor function delay (− 0.96 (1.07)). Adjustment for age at onset and maternal education did not alter the results.
What is Known:
• Human parechovirus is progressively becoming a major viral cause of meningitis in children.
• There is keen interest in the development of affected infants with human parechovirus meningitis.
What is New:
• This study describes prospectively gross-motor functional delay in children with both clinical evidence of meningitis and polymerase chain reaction positive for human parechovirus in cerebrospinal fluid.
• It shows the importance of screening young children for developmental delay in order to refer those with delay for early intervention to maximize their developmental potential.
KeywordsHuman parechovirus Meningitis Children Neurodevelopment
Alberta Infant Motor Scale
Central nervous system
Reverse transcriptase real-time quantitative polymerase chain reaction
Standard deviation of the mean
Presenting at emergency or outpatient departments of the participating hospitals
Follow-up 6 months after visiting the emergency or outpatient departments of the participating hospitals
We thank all children and their parents/legal guardians; pediatricians; nurses in St. Elisabeth, Tweesteden, and Amphia Hospital for participating in this study; Mrs. C.A.M. Smid for her work as study-secretary; and Mrs. N. Hmimsa for her work as planning-secretary.
HPeV-meningitis: children with clinical evidence of meningitis and RT-qPCR positive for HPeV in CSF
HPeV-infection-elsewhere: children with no clinical evidence of meningitis and RT-qPCR HPeV-positive in nasopharyngeal aspirate swab, blood, urine, or feces
Reference: children with no clinical evidence of meningitis and in whom no pathogen was identified
No show: did not show after 3× reminded
Lost to follow-up: moved to another address, changed telephone number, parents too busy to come
Mrs. van Hinsbergh, MSc., conceptualized and designed the follow-up study. She was responsible for the data collection, carried out the initial statistical analyses, drafted the initial manuscript, revised the manuscript, and approved the final manuscript.
Dr. R. Lindeboom interpreted the statistical data, reviewed the manuscript, and approved the final manuscript.
Prof. Dr. van Furth, Dr. de Crom, and Dr. Obihara conceptualized and designed the study, interpreted the data, reviewed the manuscript, and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved of by the medical ethics committee of each participating center (NL-21361.008.07). This article does not contain any studies with animals performed by any of the authors.
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