Epidemic myalgia in adults associated with human parechovirus type 3 infection, Yamagata, Japan, 2008

Abstract

Human parechovirus has rarely been shown to cause clinical disease in adults. During June-August 2008, a total of 22 adults sought treatment at Yonezawa City Hospital in Yamagata, Japan, for muscle pain and weakness of all limbs; most also had fever and sore throat. All patients received a clinical diagnosis of epidemic myalgia; clinical laboratory findings suggested an acute inflammatory process. Laboratory confirmation of infection with human parechovirus type 3 (HPeV3) was made for 14 patients; we isolated HPeV3 from 7 patients, detected HPeV3 genome in 11, and observed serologic confirmation of infection in 11. Although HPeV3 is typically associated with disease in young children, our results suggest that this outbreak of myalgia among adults was associated with HPeV3 infection. Clinical consideration should be given to HPeV3 not only in young children but also in adults when an outbreak occurs in the community.

Figure 1

Schematic representation of the human parechovirus 3 (HPeV3) genome sequence and coding polyprotein. Reverse transcription PCR results are shown below the sequence. VP, viral protein; UTR, untranslated region.

Figure 2

Phylogenetic tree of the viral protein 1 region sequence in the available human parechovirus (HPeV) genomes, including HPeV1–8. The tree was constructed by the neighbor-joining method with 1,000× bootstrapping. Scale bar indicates nucleotide substitutions per site.