Background

Parechovirus-A3 (PeV-A3) and enteroviruses (EV) are the most common viruses causing sepsis and meningoencephalitis in neonates and young infants. Clinical manifestations of PeV-A3 infection are more severe than those of EV infection, and no pleocytosis with a positive PCR result for PeV-A3 in cerebrospinal fluid (CSF) are characteristic findings. We hypothesized that innate immune responses to PeV-A3 and EV are distinct in serum and CSF.

Methods

We evaluated 22 cytokines/chemokines in serum and CSF from PeV-A3- or EV-infected patients younger than 4 months in Niigata, Japan, from 2015 through 2018. Infection was diagnosed with real-time PCR followed by sequencing. Febrile neonates and infants with sepsis-like syndrome who had negative bacterial culture and viral PCR for both PeV-A and EV were also included (non–PeV-A/EV patients).

Results

Among 192 febrile patients, we evaluated 16 PeV-A3-infected, 15 EV-infected, and 8 non–PeV-A/EV patients. Serum pro-/anti-inflammatory cytokine/chemokine levels were higher in PeV-A3-infected patients than in EV-infected patients (P<.02). While most cytokine/chemokine were elevated in CSF from EV-infected patients, levels were low or undetectable in PeV-A3-infected and non–PeV-A/EV patients (P<.001).

Conclusions

Distinct cytokine/chemokine patterns in serum and CSF may explain the different clinical manifestations of PeV-A3-infected and EV-infected neonates and young infants.

中文翻译：

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新生儿和感染Parechovirus-A3或肠道病毒的婴儿的血清和脑脊液中的先天免疫应答。

背景

Parechovirus-A3（PeV-A3）和肠道病毒（EV）是引起新生儿和幼儿败血症和脑膜脑炎的最常见病毒。PeV-A3感染的临床表现比EV感染更为严重，并且在脑脊液（CSF）中没有PeV-A3的卵母细胞增多症且PCR结果呈阳性。我们假设血清和脑脊液中对PeV-A3和EV的先天免疫反应是不同的。

方法

我们评估了2015年至2018年在日本新泻市小于4个月的PeV-A3-或EV感染患者的血清和CSF中的22种细胞因子/趋化因子。采用实时PCR诊断感染，然后测序。包括PeV-A和EV的细菌培养阴性和病毒PCR阴性的高热新生儿和败血症样综合征婴儿（非PeV-A / EV患者）。

结果

在192例发热患者中，我们评估了16例受PeV-A3感染，15例EV感染和8例非PeV-A / EV患者。PeV-A3感染患者的血清促炎/抗炎细胞因子/趋化因子水平高于EV感染患者（P <.02）。尽管大多数EV感染患者的脑脊液中的细胞因子/趋化因子升高，但在PeV-A3感染和非PeV-A / EV患者中CSF​​水平较低或无法检测到（P <.001）。

结论

血清和脑脊液中不同的细胞因子/趋化因子模式可能解释了感染PeV-A3和EV感染的新生儿和幼儿的不同临床表现。