P-903. Human Parechovirus Central Nervous System (CNS) Infection in Infants: A Multicenter Retrospective Case Series of the 2022 outbreak

Abstract Background Human parechovirus (PeVA) typically causes self-limiting respiratory and gastrointestinal infections. However, in infants, it can cause severe sepsis-like illness and CNS disease. In 2022, a CDC Health Advisory reported severe PeVA infections in young infants in multiple states. Our aim was to describe the clinical features, laboratory characteristics, and outcomes in infants with PeVA CNS infection during the 2022 multistate outbreak. Methods A multicenter retrospective chart review was conducted at 7 children’s hospitals (6 states) of infants with PeVA CNS infection. Cases were identified by positive CSF PCR testing using the FilmArray meningitis/encephalitis panel (BioFire Diagnostics, Salt Lake City, UT). Data were entered in REDCap and pertinent demographic and clinical data were analyzed. Results 103 infants were admitted from March-October 2022 with 30 (29%) of the admissions occurring in July. Patients’ median age was 18 days, 55% were male, and 93% born full term. The median length of hospital stay was 3.3 days. 19% required admission to an intensive care unit, 29% had increased oxygen requirement, and 5% required inotropic support. The most common clinical manifestations were fever (84%), irritability (63%), poor feeding (37%), tachycardia (31%), seizures (23%) and hypothermia (19%). The median peripheral white blood cell count was 5.6 x109/L and median CSF white blood cell count was 3 cells/mm3. The median CRP was 0.3 mg/dL and 54% of the infants had transaminitis. Brain MRIs were obtained in 55 cases; 31 (56%) demonstrated abnormalities with diffusion restriction involving white matter and thalami. EEGs were obtained in 40 cases; 22 (55%) revealed abnormalities. 99% of our infants survived, 13% were discharged with anti-seizure medications, and 10% received developmental follow-up. Conclusion PeVA should be considered in young infants presenting with fever or hypothermia, sepsis-like symptoms, or meningitis even with no laboratory findings of significant inflammatory responses. PeVA CNS infection in young infants can cause neurologic injury requiring long term neurodevelopmental follow up. Nationwide epidemiological studies are necessary to elucidate the dynamics of this infection. Disclosures Cristina Tomatis Souverbielle, MD, Merck, inc: Grant/Research Support