Differences in Clinical Manifestations of Human Parechovirus-Related Meningitis in Neonates After the COVID-19 Pandemic: A Single-Center Exploratory Study.

Purpose: Human parechovirus (HPeV) is one of the major causes of viral meningitis in neonates. Following the COVID-19 pandemic, a resurgence of HPeV infections was reported worldwide. This exploratory case series is aimed at describing the symptoms of neonatal HPeV meningitis occurring after the lifting of large-scale quarantine measures. Methods: We retrospectively reviewed eight neonates admitted between June 1, 2023, and September 30, 2023, with fever and HPeV detected in cerebrospinal fluid (CSF) using the FilmArray Meningitis/Encephalitis Panel. Demographic variables, clinical presentation, laboratory data, respiratory support requirements, and treatment courses were analyzed. Results: Fever was the primary presenting symptom. Despite the absence of leukocytosis or pleocytosis, fever duration was prolonged (mean 4.3 days). Four patients (50%) exhibited respiratory symptoms requiring high-flow nasal cannula support. Hyponatremia occurred in two neonates without neurological manifestations-an observation not commonly described in previous cohorts. No patients required invasive ventilation. Conclusion: This small, single-center series suggests possible variations in neonatal HPeV presentation after the COVID-19 pandemic; however, findings are preliminary and hypothesis-generating. Larger multicenter studies with subtype analysis and long-term neurodevelopmental follow-up are essential.