Rapid Communication| Volume 19, ISSUE 1, P144-148, 2013

Human parechovirus-3 infection in nine neonates and infants presenting symptoms of hemophagocytic lymphohistiocytosis

      This paper is only available as a PDF. To read, Please Download here.


      Human parechovirus-3 (HPeV-3) has been reported to cause a sepsis-like illness in neonates and young infants. We experienced the occurrence of HPeV-3 infection in nine neonates and young infants (eight boys, one girl; aged 14–52 days, median 31 days). They were admitted to our hospital with the chief complaints of fever persisting for 3–5 days (median 4 days) and lethargy. Five infants presented with abdominal distension and six had a rash (including acral reddening), as was previously reported with this viral infection. Abdominal distension with navel protrusion and acral reddening during the course were characteristic. Laboratory data were characterized by elevated values for serum AST, LDH, FDP, D-dimer, ferritin, soluble IL-2 receptor, triglyceride, choline esterase, and urinary β2-microglobulin. Two of our nine patients presented with a hemophagocytic lymphohistiocytosis (HLH)-like illness and required specific therapy. These data suggest that HPeV-3 is an important virus that can cause hypercytokinemia, which sometimes leads to HLH, and systemic inflammatory response syndrome in neonates and young infants.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Infection and Chemotherapy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Minagawa H.
        • Ito M.
        • Yamashita T.
        Human parechovirus (HPeV) infection.
        Clin Virol. 2011; 39 (in Japanese): 139-146
        • Abed Y.
        • Boivin G.
        Human parechovirus infections in Canada.
        Emerg Infect Dis. 2006; 12 (10.3201/eid1206.051675): 969-975
        • Yonekura K.
        • Hyodou S.
        • Okano R.
        • Takamoto S.
        • Kaneko Y.
        • Shimozono S.
        • et al.
        An epidemic of human parechovirus type 3 among neonates and early infants.
        J Jpn Pediatr Soc. 2009; 113 (in Japanese): 1228-1233
        • Harvala H.
        • Robertson I.
        • Chieochansin T.
        • McWilliam Leitch E.C.
        Specific association of human parechovirus type 3 with sepsis and fever in young infants, as identified by direct typing of cerebrospinal fluid samples.
        J Infect Dis. 2009; 199 (10.1086/599094): 1753-1760
        • Verboon-Maciolek M.A.
        • Groenendaal F.
        • Vries L.S.
        • et al.
        Human parechovirus causes encephalitis with white matter injury in neonates.
        Ann Neurol. 2008; 64 (10.1002/ana.21445): 266-273
        • Ito M.
        • Yamashita T.
        • Tsuzuki H.
        • Takeda N.
        • Sakae K.
        Isolation and identification of a novel human parechovirus.
        J Gen Virol. 2004; 85 (10.1099/vir.0.19456-0): 391-398
        • Piñeiro L.
        • Vicente D.
        • Cilla G.
        • et al.
        Human parechoviruses in infants with systemic infection.
        J Med Virol. 2010; 82 (10.1002/jmv.21878): 1790-1796
        • Wolthers K.C.
        • Benschop K.S.
        • Pajkrt D.
        • et al.
        Human parechoviruses as an important viral cause of sepsislike illness and meningitis in young children.
        Clin Infect Dis. 2008; 47 (10.1086/589752): 358-363
        • Ito M.
        • Yamashita T.
        • Tsuzuki H.
        • Takeda N.
        • Minagawa H.
        Detection of human parechovirus from clinical stool samples in Aichi, Japan.
        J Clin Microbiol. 2010; 48 (10.1128/JCM.00086-10): 2683-2688
        • Joki-Korpela P.
        • Hyypia T.
        Diagnosis and epidemiology of echovirus 22 infections.
        Clin Infect Dis. 1998; 26 (10.1086/514615): 129-136
        • Takao S.
        • Shimazu Y.
        • Miyazaki K.
        Seroepidemiological study of human parechovirus 1.
        Jpn J Infect Dis. 2001; 54: 85-87
        • van Zwol A.L.
        • Lequin M.
        • Govaert P.
        Fatal neonatal parechovirus encephalitis.
        BMJ Case Rep. 2009; 2009 (bcr05.2009.1883)
        • Nirei J.
        • Ohtsuka T.
        • Okazaki M.
        Three infants suffered from apnea caused by human parechovirus type 3.
        Pediatr Jpn. 2010; 51 (in Japanese): 363-365
        • Bangalore H.
        • Ahmed J.
        • Tong C.Y.
        Abdominal distension: an important feature in human parechovirus infection.
        Pediatr Infect Dis J. 2011; 30: 260-262
        • Imashuku S.
        Advances in the management of hemophagocytic lymphohistiocytosis.
        Int J Hematol. 2000; 72: 1-11
        • Henter J.I.
        • Horne A.
        • Aricó M.
        • et al.
        HLH-2004: diagnostic and therapeutic guidelines for hemophagocytic lymphohistiocytosis.
        Pediatr Blood Cancer. 2007; 48 (10.1002/pbc.21039): 124-131
        • Tanaka T.
        Diagnosis and treatment of hemophagocytic syndrome (HPS) in neonate.
        Perinat Med (Tokyo). 2011; 41 (in Japanese): 356-364
        • Suzuki N.
        Hemophagocytic lymphohistiocytosis in neonate.
        Jpn J Pediatr Hematol. 2007; 21 (in Japanese): 263-270