Publication:

A rare case of neonatal viral meningitis caused by co-infection HHV6 and HPeV

Neonatal meningitis is considered a serious, life-threatening condition. Human parechovirus (HPeV) and herpesvirus 6 (HHV-6) are well-known neurotropic viruses with the ability to affect the central nervous system (CNS) of children, even in the neonatal period. However, isolated viral meningitis with single infections caused by both pathogens were previously reported, but co-infection in the neonatal period remains very uncommon. We are reporting a case of a 14-day-old term neonate admitted with history of low-grade fever for one day with no other significant symptoms. A full septic workup was conducted, including cerebrospinal fluid (CSF) analysis, and started on antibiotic therapy CSF analysis came with white blood cell count of 8 - (considering normal range for this age) - with a predominance of lymphocytes (95%), and normal levels of glucose and protein. Others inflammatory markers such as CRP and procalcitonin and all bacterial cultures (blood, urine and CSF) were reported also within normal limits. PCR testing of the CSF confirmed the presence of both Human Parechovirus (HPeV) and Human Herpesvirus 6 (HHV-6), leading to a diagnosis of dual viral meningitis. The neonate continued on conservative care with close monitoring. The patient gradually recovered and discharged home with no immediate neurological deficits. Despite an initial presentation, inflammatory markers were within normal, the case supported consideration multiple viral etiologies in the workup of neonatal meningitis and highlights the utility of multiplex PCR testing in the diagnosis of co-infections. Identification of such atypical presentations is crucial in early diagnosis, appropriate management, and counseling of the prognosis.