Enterovirus Infection in Young Infants: Prevalence, Clinical and Laboratory Characteristics in Columbus, Ohio

BACKGROUND: All infants under two months of age evaluated for fever or sepsis undergo routine work up at Nationwide Children’s Hospital that includes blood, CSF, and mucosal site PCRs for enteroviruses (EV). We sought to determine the local EV prevalence, clinical characteristics and viral correlates of disease severity in this large population. METHODS: EMRs of all infants 4–60 days of age evaluated for fever or sepsis from January 2015 to September 2016 were reviewed. An in-house developed real-time PCR was used for EV detection. We analyzed cycle threshold values for positive samples. RESULTS: Of the 713 patients tested, 151 (21%) patients were positive for EV in at least one site. Majority of the patients (76%) presented between the months of June and October. Median age was 24 days (IQR 16–37). Median length of stay (LOS) was 40.82 hours (IQR 33.4–47.5). 122 (81%) had fever and 27 (18%) had a rash on admission. Median duration of antibiotic treatment was 2 days (IQR 1.5–2) and median hospital charges were 13,169 USD. CBC values and transaminases were normal. 75 (49%) patients had EV PCR positive in CSF, 120 (79%) in superficial sites, and 109 (72%) in blood and 51 (34%) patients had positive EV PCR in all three sites. 5 patients were admitted to PICU (3.3%), of which 2 had EV detected in CSF. Two patients required pressor support and 3 had seizures. All patients recovered and had no complications at discharge. Among CSF positive patients, median CSF WBC count was 50 (IQR 5–360 cells/µl). Median PCR cycle threshold (Ct) values were: 35.88 (IQR 34.1–37.5) for CSF, 32.54 (IQR 30–36.42) for blood, and 34.58 (31.96–37.36) for superficial sites. CSF and blood Ct values in PICU patients were not significantly different. Ct values in CSF or blood had no significant correlation with length of stay. 55 patients (36%) had coinfections – 53 viral (parechovirus, parainfluenza and rhinovirus/EV [these cannot be distinguished by testing method]), and 2 bacterial (group B Streptococcus and coagulase negative staphylococcus bacteremia). CONCLUSION: EV was commonly identified in infants undergoing sepsis evaluation. Almost half of the patients had EV meningitis. Although, there were no serious complications, 3% of patients required PICU admission. Bacterial coinfection rates were low. DISCLOSURES: O. Ramilo, Abbvie: Board Member, Consulting fee; Regeneron: Board Member, Consulting fee; Janssen: Board Member and Investigator, Consulting fee and Research grant; NIH: Grant Investigator, Research grant; A. Leber, BioFIre Diagnostics: Research Contractor and Scientific Advisor, Research support, Speaker honorarium and Travel expenses