Human parechovirus: sepsis-like illness with pulmonary infection

Human parechoviruses (HPeV), previously designated as echovirus 22 and 23, belong to the Parechovirus genus within the Picornaviridae family and has been designated HPeV 1 and 2 respectively.1 The HPeV genome organization and disease spectrum are similar to other viruses in the Picornaviridae family. HPeV have been frequently associated with respiratory and gastrointestinal diseases in children and severe disease in neonates that includes sepsis, meningitis, encephalitis, and hepatitis.2 In Brazil, HPeV type 8 was first reported in a gastroenteritis outbreak, where 35 stool samples were analyzed and 16.1% were HPeV positive.3 Highlighting HPeV as etiology of respiratory infection, the authors report the case of a 2-yearold girl with signs and symptoms of sepsis-like illness which progressed to sepsis with pulmonary focus. She was admitted to the pediatric emergency unit in a tertiary care hospital in Southern Brazil, with previous history of rhinorrhea, otorrhea and fever for seven days, and dry cough, poor food acceptance and emesis with grunting episodes in the three days prior to admission. Previously, the patient had two hospitalizations for pneumonia at the age of eight and 15 months. The mother reported meningitis outbreak at the patient’s daycare 15 days before, and the child had the vaccination protocol updated. Upon admission, the patient weighed 13 kg, had tachycardia (175 beats/min) and tachypnea (33 breaths/min), was in poor general condition, whining, pale, sleepy, with reduced vesicular murmur, fine crackles and dullness to percussion of left pulmonary lower medium-third. The lung ultrasound showed a small pleural effusion of 0.5 cm thick, with no need of drainage. The patient progressed with respiratory insufficiency, altered consciousness level and septic shock requiring ICU monitoring and mechanical ventilation and her oxygen saturation was 91%. The patient had hemodynamic instability, requiring vasoactive drugs, metabolic acidosis and altered renal function. X-rays showed an acute respiratory distress syndrome (ARDS) pattern (Fig. 1), with bronchopneumonia and pulmonary edema; progressed with decreased urine output and worsening of urea and creatinine levels compared Fig. 1 – X-ray reveals an acute respiratory distress syndrome (ARDS).