Enterovirus, parechovirus, adenovirus and herpes virus type 6 viraemia in fever without source. Issue 2 (28th August 2019)

• Record Type: Journal Article
• Authors: L'Huillier, Arnaud Gregoire; Mardegan, Chiara; Cordey, Samuel; Luterbacher, Fanny; Papis, Sebastien; Hugon, Florence; Kaiser, Laurent; Gervaix, Alain; Posfay-Barbe, Klara; Galetto-Lacour, Annick
• Is Part Of: Archives of disease in childhood. Volume 105:Issue 2(2020)
• Page Start: 180
• Page End: 186
• Publication Date: 2019-08-28
• Subjects: fever -- serious bacterial infection -- viral systemic infection -- antibiotic use; Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2019-317382
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Objectives: To evaluate the potential associations between fever without a source (FWS) in children and detection of human enterovirus (HEV), human parechovirus (HPeV), adenovirus (AdV) and human herpesvirus type 6 (HHV-6) in the plasma; and to assess whether the detection of viruses in the plasma is associated with a reduced risk of serious bacterial infection (SBI) and antibiotic use. Design and setting: Between November 2015 and December 2017, this prospective, single-centre, diagnostic study tested the plasma of children <3 years old with FWS. Real-time (reverse-transcription) PCR for HEV, HPeV, AdV and HHV-6 was used in addition to the standardised institutional work-up. A control cohort was also tested for the presence of viruses in their blood. Results: HEV, HPeV, AdV and HHV-6 were tested for in the plasma of 135 patients of median age 2.4 months old. At least one virus was detected in 47 of 135 (34.8%): HEV in 14.1%, HHV-6 in 11.1%, HPeV in 5.9% and AdV in 5.2%. There was no difference in antibiotic use between patients with or without virus detected, despite a relative risk of 0.2 for an SBI among patients with viraemia. Controls were less frequently viraemic than children with FWS (6.0% vs 34.8%; p < 0.001). Conclusions: HEV, HPeV, AdV and HHV-6 are frequently detected in the plasma of children with FWS. Antibiotic use was similar between viraemic and non-viraemic patients despite a lower risk of SBI among patients with viraemia. Point-of-care viral PCR testing of plasma might reduce antibiotic use and possibly investigations and admission rates in patients with FWS. Trial registration number: NCT03224026 .