#Simvastatin Improves #Neutrophil Function and Clinical #Outcomes in #Pneumonia: a Pilot #RCT (Am J Respir Crit Care Med., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Respir Crit Care Med. 2019 Jun 17. doi: 10.1164/rccm.201812-2328OC. [Epub ahead of print]

Simvastatin Improves Neutrophil Function and Clinical Outcomes in Pneumonia: a Pilot Randomised Controlled Trial.

Sapey E1, Patel JM2, Greenwood H3, Walton GM4, Grudzinska F4, Parekh D5, Mahida RY2, Dancer RC3, Lugg ST4, Howells PA6, Hazeldine J2, Newby P4, Scott A3, Nightingale P7, Hill AT8, Thickett DR9.

Author information: 1 University of Birmingham, Institute of Inflammation and Ageing, Birmingham, United Kingdom of Great Britain and Northern Ireland ; e.sapey@bham.ac.uk. 2 University of Birmingham, 1724, Institute of Inflammation and Ageing, Birmingham, West Midlands, United Kingdom of Great Britain and Northern Ireland. 3 University of Birmingham, Institute of Inflammation and Aging, Birmingham, United Kingdom of Great Britain and Northern Ireland. 4 University of Birmingham, Institute of Inflammation and Ageing, Birmingham, West Midlands, United Kingdom of Great Britain and Northern Ireland. 5 University of Birmingham, Critical Care and Pain Perioperative, Critical Care and Trauma Trials Group, School of Clinical and Experimental Medicine,, Birmingham, United Kingdom of Great Britain and Northern Ireland. 6 University of Birmingham, Centre for Translational Inflammation Research, Birmingham, United Kingdom of Great Britain and Northern Ireland. 7 University Hospital Birmingham NHS Foundation Trust, Statistics, Birmingham, United Kingdom of Great Britain and Northern Ireland. 8 Royal Infirmary of Edinburgh, Respiratory Medicine, Scotland, Edinburgh, United Kingdom of Great Britain and Northern Ireland. 9 University of Birmingham, Lung Injury and Fibrosis Treatment Programme, Birmingham, United Kingdom of Great Britain and Northern Ireland.

 

Abstract

RATIONALE:

Population studies suggest improved sepsis outcomes with statins but randomized controlled trials in patients with sepsis and organ dysfunction in critical care settings have broadly been negative. In vitro data suggest statins modulate age-related neutrophil functions improving neutrophil responses to infection, but only in older patients and at high dose.

OBJECTIVE:

To determine if high dose simvastatin improved neutrophil functions and clinical outcomes in hospitalized older adults with community acquired pneumonia with sepsis (CAP+S) not admitted to critical care.

METHODS:

A randomized, double-blinded, placebo-controlled pilot study of simvastatin 80mg or placebo for 7 days for CAP+S patients aged >55 years admitted to a secondary care hospital. Day 4 primary endpoint was change in neutrophil NETosis. Day 4 secondary endpoints included neutrophil chemotaxis, safety and tolerability, Sequential Organ Failure Assessment(SOFA) score, mortality, readmission and markers of tissue degradation/inflammation.

RESULTS:

Four days of simvastatin adjuvant therapy in CAP+S was associated with improvements in systemic neutrophil function (NETosis and chemotaxis), a reduction in systemic neutrophil elastase burden and improved SOFA scores compared with placebo. A post-hoc analysis demonstrated simvastatin therapy was associated with improved hospital-free survival compared to placebo. Simvastatin was well tolerated in this elderly and multi-morbid patient group with common co-prescription of macrolide antibiotics.

CONCLUSION:

This pilot study supports high-dose simvastatin as an adjuvant therapy in CAP+S in an older and milder disease cohort than assessed previously. A definitive multi-centred study is now warranted in this population to assess the likelihood of benefit and harm. Clinical trial registration available at clinicaltrialsregister.eu/ctr-search/search, ID: 2012-003343-29.

KEYWORDS: elderly care; innate immunity; pneumonia; sepsis; statin

PMID: 31206313 DOI: 10.1164/rccm.201812-2328OC

Keywords: Pneumonia; Sepsis; Statins.

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#Lactate normalization within 6 hours of bundle therapy and 24 hours of delayed achievement were associated with 28-day #mortality in #septic shock patients (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Lactate normalization within 6 hours of bundle therapy and 24 hours of delayed achievement were associated with 28-day mortality in septic shock patients

Seung Mok Ryoo , Ryeok Ahn , Tae Gun Shin, You Hwan Jo, Sung Phil Chung, Jin Ho Beom, Sung-Hyuk Choi, Young -Hoon Yoon, Byuk Sung Ko, Hui Jai Lee, Gil Joon Suh, Won Young Kim , for the Korean Shock Society (KoSS) Investigators

Published: June 3, 2019 / DOI: https://doi.org/10.1371/journal.pone.0217857

 

Abstract

This study evaluated the prognostic ability of lactate normalization achieved within 6 and 24 h from septic shock recognition. Data from a septic shock registry from October 2015 to February 2017 were reviewed. The study included 2,102 eligible septic shock patients to analyze the prognostic ability of lactate normalization, defined as a follow-up lactate level <2 mmol/L within six hours of bundle therapy and within 24 hours of delayed normalization. The primary outcome was 28-day mortality. The overall 28-day mortality rate was 21.4%. The rates of lactate normalization within 6 and 24 h were significantly higher in the survivor groups than in the non-survivor group (42.4% vs. 23.4% and 60.2% vs. 31.2%; P<0.001, respectively). Multivariate logistic regression analysis showed that both 6- and 24-h lactate normalization were independent predictors (odds ratio [OR] 0.58, 95% confidence interval [CI] 0.45–0.75, p<0.001 and OR 0.42, 95% CI 0.33–0.54, p<0.001, respectively). When we could not achieve the lactate normalization, the sensitivity, specificity, positive, and negative predictive value to predict mortality were 76.6%, 42.4%, 26.5% and 87.0% respectively for 6-h normalization, and 68.8%, 60.2%, 32.0% and 87.7% respectively for 24-h normalization. Besides 6-h lactate normalization, 24-h delayed lactate normalization was associated with decreasing mortality in septic shock patients. Lactate normalization may have a role in early risk stratification and as a therapeutic target.

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Citation: Ryoo SM, Ahn R, Shin TG, Jo YH, Chung SP, Beom JH, et al. (2019) Lactate normalization within 6 hours of bundle therapy and 24 hours of delayed achievement were associated with 28-day mortality in septic shock patients. PLoS ONE 14(6): e0217857. https://doi.org/10.1371/journal.pone.0217857

Editor: Chiara Lazzeri, Azienda Ospedaliero Universitaria Careggi, ITALY

Received: March 18, 2019; Accepted: May 20, 2019; Published: June 3, 2019

Copyright: © 2019 Ryoo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: This study was supported by a grant (2018-0409) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea [http://ails.amc.seoul.kr/ailsk/main.do]. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Sepsis; Septic shock.

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#Derivation, #Validation, and Potential #Treatment Implications of Novel #Clinical #Phenotypes for #Sepsis (JAMA, abstract)

[Source: JAMA, full page: (LINK). Abstract, edited.]

Original Investigation  / Caring for the Critically Ill Patient / May 19, 2019

Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis

Christopher W. Seymour, MD, MSc1,2,3; Jason N. Kennedy, MS1,3; Shu Wang, MS4; et al., Chung-Chou H. Chang, PhD3,4,5; Corrine F. Elliott, MS 6; Zhongying Xu, MS 4; Scott Berry, PhD 6; Gilles Clermont, MD, MSc 1,3; Gregory Cooper, MD, PhD 7; Hernando Gomez, MD, MPH 1,2,3; David T. Huang, MD, MPH 1,2,3; John A. Kellum, MD, FACP, MCCM 1,3; Qi Mi, PhD 8; Steven M. Opal, MD 9; Victor Talisa, MS 4; Tom van der Poll, MD, PhD 10; Shyam Visweswaran, MD, PhD 7; Yoram Vodovotz, PhD 11; Jeremy C. Weiss, MD, PhD 12; Donald M. Yealy, MD, FACEP 2; Sachin Yende, MD, MS 1,3,13; Derek C. Angus, MD, MPH 1,3,5

Author Affiliations: 1 Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; 2 Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; 3 Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; 4 Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; 5 Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; 6 Berry Consultants, Austin, Texas; 7 Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania; 8 Department of Sports Medicine and Nutrition, University of Pittsburgh, Pittsburgh, Pennsylvania; 9 Department of Medicine, Infectious Disease Division, Rhode Island Hospital, Providence; 10 Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; 11 Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; 12 Machine Learning Department, Carnegie Mellon University, Pittsburgh, Pennsylvania; 13 Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania

JAMA. 2019;321(20):2003-2017. doi:10.1001/jama.2019.5791

 

Key Points

  • Question  – Are clinical sepsis phenotypes identifiable at hospital presentation correlated with the biomarkers of host response and clinical outcomes and relevant for understanding the heterogeneity of treatment effects?
  • Findings  – In this retrospective analysis using data from 63 858 patients in 3 observational cohorts, 4 novel sepsis phenotypes (α, β, γ, and δ) with different demographics, laboratory values, and patterns of organ dysfunction were derived, validated, and shown to correlate with biomarkers and mortality. In the simulations using data from 3 randomized clinical trials involving 4737 patients, the outcomes related to the treatments were sensitive to changes in the distribution of these phenotypes.
  • Meaning  – Four novel clinical phenotypes of sepsis were identified that correlated with host-response patterns and clinical outcomes and may help inform the design and interpretation of clinical trials.

 

Abstract

Importance  

Sepsis is a heterogeneous syndrome. Identification of distinct clinical phenotypes may allow more precise therapy and improve care.

Objective  

To derive sepsis phenotypes from clinical data, determine their reproducibility and correlation with host-response biomarkers and clinical outcomes, and assess the potential causal relationship with results from randomized clinical trials (RCTs).

Design, Settings, and Participants  

Retrospective analysis of data sets using statistical, machine learning, and simulation tools. Phenotypes were derived among 20 189 total patients (16 552 unique patients) who met Sepsis-3 criteria within 6 hours of hospital presentation at 12 Pennsylvania hospitals (2010-2012) using consensus kmeans clustering applied to 29 variables. Reproducibility and correlation with biological parameters and clinical outcomes were assessed in a second database (2013-2014; n = 43 086 total patients and n = 31 160 unique patients), in a prospective cohort study of sepsis due to pneumonia (n = 583), and in 3 sepsis RCTs (n = 4737).

Exposures  

All clinical and laboratory variables in the electronic health record.

Main Outcomes and Measures  

Derived phenotype (α, β, γ, and δ) frequency, host-response biomarkers, 28-day and 365-day mortality, and RCT simulation outputs.

Results  

The derivation cohort included 20 189 patients with sepsis (mean age, 64 [SD, 17] years; 10 022 [50%] male; mean maximum 24-hour Sequential Organ Failure Assessment [SOFA] score, 3.9 [SD, 2.4]). The validation cohort included 43 086 patients (mean age, 67 [SD, 17] years; 21 993 [51%] male; mean maximum 24-hour SOFA score, 3.6 [SD, 2.0]). Of the 4 derived phenotypes, the α phenotype was the most common (n = 6625; 33%) and included patients with the lowest administration of a vasopressor; in the β phenotype (n = 5512; 27%), patients were older and had more chronic illness and renal dysfunction; in the γ phenotype (n = 5385; 27%), patients had more inflammation and pulmonary dysfunction; and in the δ phenotype (n = 2667; 13%), patients had more liver dysfunction and septic shock. Phenotype distributions were similar in the validation cohort. There were consistent differences in biomarker patterns by phenotype. In the derivation cohort, cumulative 28-day mortality was 287 deaths of 5691 unique patients (5%) for the α phenotype; 561 of 4420 (13%) for the β phenotype; 1031 of 4318 (24%) for the γ phenotype; and 897 of 2223 (40%) for the δ phenotype. Across all cohorts and trials, 28-day and 365-day mortality were highest among the δ phenotype vs the other 3 phenotypes (P < .001). In simulation models, the proportion of RCTs reporting benefit, harm, or no effect changed considerably (eg, varying the phenotype frequencies within an RCT of early goal-directed therapy changed the results from >33% chance of benefit to >60% chance of harm).

Conclusions and Relevance  

In this retrospective analysis of data sets from patients with sepsis, 4 clinical phenotypes were identified that correlated with host-response patterns and clinical outcomes, and simulations suggested these phenotypes may help in understanding heterogeneity of treatment effects. Further research is needed to determine the utility of these phenotypes in clinical care and for informing trial design and interpretation.

Keywords: Sepsis; Critical care.

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Shift from primary #pneumonic to secondary #septicemic #plague by decreasing the volume of intranasal challenge with #Yersinia pestis in the murine model (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Shift from primary pneumonic to secondary septicemic plague by decreasing the volume of intranasal challenge with Yersinia pestis in the murine model

Rachel M. Olson , Deborah M. Anderson

Published: May 23, 2019 / DOI: https://doi.org/10.1371/journal.pone.0217440

 

Abstract

Yersinia pestis is the causative agent of pneumonic plague, a disease involving uncontrolled bacterial growth and host immunopathology. Secondary septicemic plague commonly occurs as a consequence of the host inflammatory response that causes vasodilation and vascular leakage, which facilitates systemic spread of the bacteria and the colonization of secondary tissues. The mortality rates of pneumonic and septicemic plague are high even when antibiotics are administered. In this work, we show that primary pneumonic or secondary septicemic plague can be preferentially modeled in mice by varying the volume used for intranasal delivery of Y. pestis. Low volume intranasal challenge (10μL) of wild type Y. pestis resulted in a high frequency of lethal secondary septicemic plague, with a low degree of primary lung infection and rapid development of sepsis. In contrast, high volume intranasal challenge (30μL) yielded uniform early lung infection and primary disease and a significant increase in lethality. In a commonly used BSL2 model, high volume challenge with Y. pestis lacking the pigmentation locus (pgm-) gave 105-fold greater deposition compared to low volume challenge, yet moribund mice did not develop severe lung disease and there was no detectable difference in lethality. These data indicate the primary cause of death of mice in the BSL2 model is sepsis regardless of intranasal dosing method. Overall, these findings allow for the preferential modeling of pneumonic or septicemic plague by intranasal dosing of mice with Y. pestis.

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Citation: Olson RM, Anderson DM (2019) Shift from primary pneumonic to secondary septicemic plague by decreasing the volume of intranasal challenge with Yersinia pestisin the murine model. PLoS ONE 14(5): e0217440. https://doi.org/10.1371/journal.pone.0217440

Editor: Matthew B. Lawrenz, University of Louisville School of Medicine, UNITED STATES

Received: February 24, 2019; Accepted: May 10, 2019; Published: May 23, 2019

Copyright: © 2019 Olson, Anderson. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript.

Funding: Financial support for this work came from the National Institutes of Health/ National Institute of Allergy and Infectious Disease, public health service award #R01A129996 (DA). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Yersinia pestis; Pneumonic plague; Septicemic plague; Sepsis; Animal models.

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#Nontoxigenic Corynebacterium #diphtheriae #Infections, #Europe (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Summary, edited.]

Volume 25, Number 7—July 2019 / Letter

Nontoxigenic Corynebacterium diphtheriae Infections, Europe

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To the Editor: We read with interest the article by Dangel et al. analyzing nontoxigenic Corynebacterium diphtheriae infections in northern Germany during 2016–2017 (1). Among the cases, 2 patients originated from Poland; each experienced an invasive disease, 1 endocarditis and 1 sepsis. Poland and Germany are neighboring countries. In Poland, we also observed an accumulation of nontoxigenic C. diphtheriaeinfections during 2016–2017. In both countries, most infections were caused by isolates belonging to sequence type (ST) 8 biotype gravis, which we previously suspected of having increased pathogenic properties (2).

(…)

Keywords: Corynebacterium dipththeriae; European Region.

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Use of #ECMO and associated #outcomes in #children hospitalized for #sepsis in the #USA: A large population-based study (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]

OPEN ACCESS /  PEER-REVIEWED / RESEARCH ARTICLE

Use of extracorporeal membrane oxygenation and associated outcomes in children hospitalized for sepsis in the United States: A large population-based study

Katharine Robb , Aditya Badheka  , Tong Wang, Sankeerth Rampa, Veerasathpurush Allareddy, Veerajalandhar Allareddy

Published: April 26, 2019 / DOI: https://doi.org/10.1371/journal.pone.0215730

 

Abstract

Objective

The American College of Critical Care Medicine recommends that children with persistent fluid, catecholamine, and hormone-resistant septic shock be considered for extracorporeal membrane oxygenation (ECMO) support. Current national estimates of ECMO use in hospitalized children with sepsis are unknown. We sought to examine the use of ECMO in these children and to examine the overall outcomes such as in-hospital mortality, length of stay (LOS), and hospitalization charges (HC).

Methods

A retrospective analysis of the National Inpatient Sample, which approximates a 20% stratified sample of all discharges from United States community hospitals, was performed. All children (≤ 17 years) who were hospitalized for sepsis between 2012 and 2014 were included. The associations between ECMO and outcomes were examined by multivariable linear and logistic regression models.

Results

A total of 62,310 children were included in the study. The mean age was 4.2 years. ECMO was provided to 415 of the children (0.67% of the cohort with sepsis). Comparative outcomes of sepsis in children who received ECMO versus those who did not included in-hospital mortality rate (41% vs 2.8%), mean HC ($749,370 vs $90,568) and mean LOS (28.8 vs 9.1 days). After adjusting for confounding factors, children receiving ECMO had higher odds of mortality (OR 11.15, 95% CI 6.57–18.92, p < 0.001), longer LOS (6.6 days longer, p = 0.0004), and higher HC ($510,523 higher, p < 0.0001).

Conclusions

Use of ECMO in children with sepsis is associated with considerable resource utilization but has 59% survival to discharge. Further studies are needed to examine the post discharge and neurocognitive outcomes in survivors.

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Citation: Robb K, Badheka A, Wang T, Rampa S, Allareddy V, Allareddy V (2019) Use of extracorporeal membrane oxygenation and associated outcomes in children hospitalized for sepsis in the United States: A large population-based study. PLoS ONE 14(4): e0215730. https://doi.org/10.1371/journal.pone.0215730

Editor: Andrea Ballotta, IRCCS Policlinico S.Donato, ITALY

Received: July 19, 2018; Accepted: April 8, 2019; Published: April 26, 2019

Copyright: © 2019 Robb et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The data user agreement (with AHRQ-HCUP) precludes us from releasing any data. This is standard for all publications originating from NIS (HCUP datasets). Authors should not release data. However, the authors are allowed to disclose the pathway to access of all data. The NIS releases for data years 1988 through 2016 are available for purchase online through the Online HCUP Central Distributor. All HCUP data users, including data purchasers and collaborators, must complete the online HCUP Data Use Agreement Training Tool, and must read and sign the Data Use Agreement for Nationwide Databases (PDF file, 86 KB; HTML). Questions about purchasing databases can be directed to the HCUP Central Distributor: Email: HCUPDistributor@AHRQ.gov Telephone: (866) 556-4287 (toll free) Fax: (866) 792-5313 (toll free).

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: ECMO, extracorporeal membrane oxygenation; LOS, length of stay; NIS, National (Nationwide) Inpatient Sample; ACCM, American College of Critical Care Medicine; AHRQ, Agency for Healthcare Research and Quality; HCUP, Healthcare Cost and Utilization Project

Keywords: ECMO; Sepsis; Pediatrics; USA.

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#Picornavirus #etiology of acute #infections among hospitalized #infants (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 25 April 2019 / In Press, Accepted Manuscript

Picornavirus etiology of acute infections among hospitalized infants

Glen R.Abedi a, Kevin Messacar b, William Luong c, W. Allan Nix a, Shannon Rogers a, Krista Queen a, Suxiang Tong a, M. Steven Oberste a, James Watt c, Gretchen Rothrock c, Samuel Dominguez b, Susan I. Gerber a, John T. Watson a

{a} Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga, United States; {b}
Colorado Emerging Infections Program, Denver, Colo., United States; {c} California Emerging Infections Program, Richmond, Calif., United States

Received 4 December 2018, Revised 17 April 2019, Accepted 23 April 2019, Available online 25 April 2019. DOI: https://doi.org/10.1016/j.jcv.2019.04.005

 

Highlights

  • Enteroviruses (EV) and parechoviruses (PeV) are ubiquitous viruses that cause a range of illness, including acute illness in children aged <1 year.
  • Of 319 patients aged <1 year, CSF specimens from 13 (4.1%) were positive for EV and from 11 (3.4%) for PeV.
  • Sequencing revealed a variety of EV types and the predominance of PeV-A3 among the PeV-positive case-patients.
  • Clinicians should consider EV and PeV infections in infants presenting with febrile illness.

 

Abstract

Background

Enteroviruses (EV) and parechoviruses (PeV) are ubiquitous viruses that cause a range of illness, including acute illness in children aged <1 year.

Objectives

We describe EV and PeV infections among children from 2 US study sites aged <1 year and hospitalized with acute infections. For EV- and PeV-negative case-patients, we explored other viral etiologies.

Methods

Participants were aged <1 year, hospitalized during 2016, and had cerebrospinal fluid (CSF) collected for routine diagnostic testing. Demographic and clinical data were abstracted from medical charts, and residual specimens were sent to CDC for confirmatory testing and typing.

Results

Of 472 eligible case-patients, CSF specimen was available for 319 (67.6%). Among those, 13 (4.1%) were positive for EV and 11 (3.4%) for PeV. Most case-patients (86.8%, n = 277) were aged <2 months, as were all EV- or PeV-positive case-patients. None of the positive case-patients had underlying conditions, and the chief complaint for 91.7% (n = 22) was fever. Twelve positive case-patients were admitted to intensive care (ICU) and had brief hospital stays (median 2 days). Sequencing revealed a variety of EV types and the predominance of PeV-A3 among the PeV-positive case-patients.

Conclusions

A range of EVs and PeVs were associated with acute febrile illnesses leading to hospitalization in children aged <2 months. Approximately half of EV and PeV case-patients were admitted to ICU, but length of hospital stay was brief and illnesses were generally self-limiting. Clinicians should consider EV and PeV infections in infants presenting with febrile illness.

Keywords: enterovirus – parechovirus – infants – fever – sepsis – encephalitis – meningitis

{☆} The conclusions, findings, and opinions expressed by the authors do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

© 2019 Published by Elsevier B.V.

Keywords: Enterovirus; Picornavirus; Parechovirus; Encephalitis; Meningitis; Sepsis; Pediatrics.

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