What to watch for with human parechovirus (HPeV) infections...

With HPeV infections generally around during summer (see specific earlier story arising from cases in babies from New South Wales), it's well worth mirroring the advice form NSW health on what to look for. 

The full sources of this information can be visited at the pages listed below.

A brief agglomeration of the information...

HPeV (closely related to enteroviruses) has been detected in a number of neonates and young infants admitted to NSW hospitals during October and November 2019. Infants present very unwell with a rapid onset of acute sepsis-like (whole-body or systemic inflammation to a widespread infection) symptoms and can infect teh central nervous system. This is often followed by an erythematous, often confluent rash. Children under 3 months of age are the group most likely to develop severe disease, but most recover with supportive treatment.

Suspect HPeV infections in neonates (newborn) or young infants can present with a fever (>38.0°C) and:

• Irritability and appearing to be in pain 
• Tachypnoea
• Maculopapular or erythematous rash 
• Encephalitis
• Diarrhoea or loose stools 
• Myoclonic jerks
• Tachycardia 
• Hepatitis

How is it diagnosed?

Stool samples, nose and throat swabs, cerebrospinal fluid (CSF), or blood can be tested for HPeV at a specialist laboratory.

Initial Management and Treatment

Children presenting with a fever, sepsis-like signs &/or neurological signs, including irritability, should be assessed and treated for suspected sepsis using local protocols and discussed with an Emergency Consultant or Paediatrician.
There is no specific treatment for HPeV, treatment is supportive only.

How is HPeV disease prevented?

There is no vaccine to protect you from HPeV infection.

Good hygiene is the best protection: wash hands with soap and water after going to the toilet, before eating, after wiping noses, and after changing nappies or soiled clothing
Ensure the mouth and nose are covered when coughing and sneezing. Wipe the nose and mouth with tissues, dispose of used tissues and then wash your hands.

People who are unwell with colds, flu-like illness or gastro illness should stay away from small babies. 

If you are caring for a small baby and are unwell, wash your hands or use an alcohol-based hand rub before touching or feeding the baby.

Further reading...

• News from Medicare local south eastern Sydney.
  http://www.sesml.org.au/news.php?newsid=261
• A NSW Health factsheet on HPeV.
  http://www.health.nsw.gov.au/Infectious/factsheets/Pages/parechovirus.aspx

How mice lie....

In a nice 9:40 video presentation to TEDMED 2019, H. Shaw Warren brings us up to speed on some of the shortcomings of using mice to understand our complex human immune responses to bacterial infection.

Some key points he makes are:

1. We use inbred mice. They "all look the same" because they are. That does not capture the diversity of responses to infection that we must deal with in trying to understand human infections
2. Mice are resistant to infection and inflammation requiring lots of material o be injected. This is not what happens in the wild (100-100,000x more resistant than humans)
3. Trauma and burns can be studied by examining gene responses in humans. These studies found poor correlation with mouse models.
4. Mice look very different from us, why wouldn't their immune responses be equally different?
5. Mice have evolved in environments rich in microbial exposures
6. Mice have large litter sizes and short gestational periods which would increase adaptive evolutionary cycles - perhaps they have adapted to tolerate larger inocula than humans
7. Mouse model success often determines whether a candidate drug proceeds to human trials. Some of these may work in humans
8. All of the drugs studied in mice that have worked, have failed in humans (I did not know that)
9. Mice still useful for gene, gene pathways, techniques and toxicity studies but extrapolating to complex human inflammatory disease networks may be a stretch
10. The scientific community should raise the bar in justifying a link between human and mice responses before proceeding

Very nice talk.

Thanks to @MsWZ for tweeting link