What is Parechovirus Meningitis: Causes, Symptoms, treatment, Transmission, Prevention, Diagnosis

Meningitis caused by parechovirus is known as parechovirus meningitis. Meningitis is a condition characterized by inflammation of the meninges; i.e. the membrane that covers the brain and the spinal cord. It occurs when the pathogen infects the cerebrospinal fluid that circulates around the spinal cord and the brain.

The human parechovirus or HPeV is a type of virus that may cause severe viral infections in young infants and neonates. This strain of virus was first identified in the 1956. This virus was previously termed as echovirus 23 and 22. The human parechovirus is known to cause respiratory and gastrointestinal issues in infants. Some strains are also capable of causing life threatening illness in infants such as meningitis and encephalitis. It is important to know about the spread, symptoms and treatment of parechovirus meningitis.

Parechovirus can cause illness all-round the year; however, it reaches a peak during warmer months. This virus spreads through direct contact transmission. It spreads from one person to another through respiratory secretions, droplets, saliva or fecal material. It is important to note that the viral shedding occurs at about 3 to 4 weeks from the pharynx and from feces at 5 to 6 weeks. There is usually an incubation period of 2 to 14 days. A person infected with parechovirus meningitis is generally not infectious once the symptoms subside. It is very important to follow good hygiene and hand washing technique to avoid spreading of this virus.

In the initial stages of infection, the condition often goes undiagnosed due to absence of any symptoms. There may be mild diarrhea or respiratory issues. Once the condition has progressed there may be infection of the blood (also known as sepsis) followed by infection of the lining of the brain. This may be also accompanied by infection of the brain (or encephalitis). The infection is generally very severe when it affects babies below 3 months of age. Infants tend to become unwell very soon, but they also recover very quickly provided they are given appropriate supportive treatment and care.

The most common signs and symptoms of parechovirus meningitis include:

• High fever or 38 degree Celsius or more
• Jerking movements or abnormal movement of the body
• Irritability possibly from apparent pain
• Marked tachycardia (elevation of heart rate)
• Rash over skin which spreads from one area to another
• Heavy breathing and rapid breathing (tachypnoea)
• Generalized weakness and tiredness
• Excessive sleepiness or drowsiness
• Lack of energy
• Bloating or distended abdomen
• Diarrhea
• Hepatitis with or without coagulopathy.

The diagnosis of parechovirus meningitis is done by obtaining a detailed medical history followed by physical examination of the child. Provisional diagnosis is often made based on the signs and symptoms of the disease observed. The condition is often confirmed with laboratory tests such as blood work, urine test and stool test. Pathological studies are done on the sample swabs collected from the nose or throat. Specialized tests are done to study the cerebrospinal fluid. MRI may also be recommended.

Parechovirus meningitis does not have any specific treatment. However, the treatment of parechovirus meningitis is palliative in nature and depends on the symptoms elicited by the patient. In most of the cases, supportive treatment is recommended, i.e. paracetamol and adequate hydration. Generally, aspirin is avoided in children below 12 years of age. Antibiotics may be given to arrest sepsis. Some children may also require respiratory and circulatory support. In severe cases, admission to intensive care unit may be needed. In mild cases, the patients usually recover in 4 to 7 days. Severe cases may take longer to recover.

Unfortunately, there are no vaccines present to prevent the occurrence of parechovirus meningitis. The only way to prevent this condition is by practicing good hygiene techniques. It is very important (especially for children) to practice good hand washing technique.

Hands should be washed with soap and water after visiting the toilet, before and after eating, after wiping nose or coughing, before and after changing nappies or other soiled clothing. Care should be taken to avoid sharing personal items such as utensils, towels, clothes, toothbrushes, undergarments, shoes, socks etc. Few preventive measures that can be practiced include:

• Covering the mouth with a tissue rather than hands while coughing or sneezing is advisable. It is recommended to cough into the elbow rather than into bare hands while coughing.
• Dispose contaminated tissues into bins immediately.
• Washing hands with soap and water after coughing or sneezing.
• Unwell individuals should stay away from small children and babies as their immunity are low, making them more susceptible to viral infection.
• Using an alcohol based hand sanitizer before touching or feeding baby.

Parechovirus meningitis is a condition that is commonly seen in infants and children. It is caused by severe infection of the cerebrospinal fluid with parechovirus leading to symptoms such as jerking, generalized weakness and irritation. Diagnosis often involves laboratory testing such as blood work, urine test and fecal tests. Microscopic examination of nasal swabs and throat swabs are also done. Other studies includes MRI, CSF studies etc. Treatment is generally supportive with paracetamol, antibiotics and lots of fluid. Admission to ICU may also be needed. In most of the cases, the child recovers without any complications.

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