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Article| September 12 2025

Predicting Severe Short-Term Neurologic Outcomes in Human Parechovirus Meningoencephalitis Available to Purchase

Nisha Shah, MD;

 

Aspasia Katragkou, MD, PhD;

 

Olivier Fortin, MD;

 

Cristina Tomatis Souverbielle, MD;

 

Marina Santos Oren, MD;

 

Avni Sheth, DO;

 

Sarah Calardo, DO;

 

Sarmistha B. Hauger, MD;

 

Dimitrios Angelis, MD;

 

Christina Gagliardo, MD;

 

Adil Solaiman, MD;

 

Guliz Erdem, MD;

 

Nada Harik, MD, MA;

 

Sarah B. Mulkey, MD, PhD;

 

Rachel Downey, APRN, CPNP-PC/AC;

 

Emily Ansusinha, MA;

 

Lina Chalak, MD;

 

Stephanie Chiu, MS, MPH;

 

M. Cecilia Di Pentima, MD, MPH;

 

Pablo J. Sánchez, MD;

 

Paul R. Teran, MDCorresponding Author

Address correspondence to: Paul Teran, Department of Pediatrics, University of Kansas School of Medicine-Wichita, 550 N Hillside St Wichita, KS 67214. pteran@kumc.edu

Pediatrics e2025071878.

https://doi.org/10.1542/peds.2025-071878

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BACKGROUND AND OBJECTIVES

Human parechovirus (PeV) is an increasingly recognized cause of meningoencephalitis (ME) in infants. The US 2022 outbreak provided opportunity to analyze the clinical presentation and predictors of severe disease in affected infants.

METHODS

We conducted a multicenter retrospective review of infants diagnosed with PeV ME during the outbreak. We examined demographics, clinical features, laboratory findings, and neuroimaging results. Logistic regression was used to identify predictors of complicated disease and abnormal brain magnetic resonance imaging (MRI). Complicated disease was defined as requiring intensive care or findings of an abnormal brain MRI or electroencephalogram.

RESULTS

139 infants had PeV ME. The median age was 19 days. Fever was the most common presenting symptom (89.2%) and was associated with uncomplicated disease and normal MRI. A total of 42 (30.2%) infants had complicated disease. Hypothermia (36.5% vs 5.1%), somnolence (38.1% vs 13.4%), poor feeding (76.1% vs 47.4%), hemodynamic instability (28.5% vs 3%), seizures (57.1% vs 4.1%), apnea (40.4% vs 0%), hypoglycemia (16.6% vs 1%), mechanical ventilation (23.8% vs 0%), and inotropic support (11.9% vs 0%) were associated with complicated disease. Younger age and seizures were predictors of abnormal MRI on multivariable analysis (adjusted odds ratio, 0.92 [0.48–0.99] and 40.1 [3.49–460.7], respectively). Laboratory findings, including cerebrospinal fluid indices, were rarely abnormal.

CONCLUSION

Despite nonspecific symptoms on presentation and normal laboratory values, PeV can cause complicated disease, requiring clinicians to maintain high suspicion for this infection. We suggest PeV evaluation in workup of infant sepsis cases, neuroimaging in patients at high risk, and long-term developmental follow-up.

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• Gravity and electromagnetism explain the first layer of reality, but other, less familiar force fields are crucial in the subatomic world.

• The strong nuclear force is necessary to answer the question: What keeps positively charged protons from flying apart in an atomic nucleus despite their electrical repulsion?

  • This force acts as a "glue" that binds the protons and neutrons (the nucleus) and their constituents (quarks).

  • It is hundreds of times stronger than electromagnetism and vastly stronger than gravity.

• The weak nuclear force is the fourth natural force, along with gravity, electromagnetism, and the strong nuclear force.

• It has a very limited range of influence (one thousandth the size of a proton).

• Its primary role is governing the rate and process of radioactive decay within the nucleus.

• It is an "essential sidekick" to the strong force in the process of fusing hydrogen into helium in the sun.

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• Despite its name, the weak nuclear force is still vastly stronger than gravity (by over a million billion billion billion times).

• The disparity in the strengths of the fundamental forces is crucial for the existence of the universe's features, including life (e.g., if gravity wasn't weak, matter would collapse).

• Unification of forces is explained by nature's symmetries.

  • Symmetry in physics means that fundamental forces and particles lose their distinctions and behave according to the same natural laws.

  • The forces we observe are the result of broken symmetries; restoring these symmetries is the key to unification.

• In the late 1960s, Steven Weinberg, Abdus Salam, and Sheldon Glashow unified the electromagnetic force and the weak nuclear force (the Electroweak Unification).

• They showed that at very high temperatures or very small distances, the distinction between these two forces vanishes.

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