Abstract 36: Parvovirus B19 DNA Prevalence is Increased in Pediatric Stroke Patients Compared to Controls: Pilot Findings From the Vascular Effects of Infection in Pediatric Stroke (VIPS) Study

Background: Mechanisms underlying childhood arterial ischemic stroke_and childhood cerebral arteriopathies in particular_remain poorly understood. There is evidence that viral syndromes are associated with stroke onset. Objective: We hypothesized that an unbiased pathogen discovery approach utilizing MassTag polymerase chain reaction (PCR), a multiplex assay that permits simultaneous testing, would identify candidate pathogens associated with stroke risk in blood from childhood stroke patients compared to controls. Methods: Serum samples from 162 pediatric arterial ischemic stroke cases and 36 stroke-free control children with minor traumatic injuries were collected in the multi-center international VIPS study; parental interview included questions on recent infections. Samples were analyzed by MassTag-PCR for a panel of 28 bacterial and viral pathogens. Presence of arteriopathy was determined by blinded, centralized review of vascular imaging. Results: Median (IQR) age of cases was 8.1 (2.8, 16.0) years; 31% were girls; and 34% had a reported infection in the prior 4 weeks. Median (IQR) age of controls was 7.3 (2.5, 14.3) years; and 41% were girls. Viral pathogen DNA was detected in 14 of 163 (9.2%) of cases and 0 of 37 (0%) of controls: parvovirus B19 (n=10), herpesvirus 6 (n=2), adenovirus (n=1), and rhinovirus 6C (n=1). Copy number of parvovirus B19/microliter of plasma varied from 11 to 1.3 x 104. Among 10 patients with parvovirus B19, 8 had other, non-infectious stroke risk factors, and 5 had a distinct arteriopathy involving a long-segment of the internal carotid artery (Table). Conclusion: Parvovirus B19, a virus capable of infecting erythrocytes and endothelial cells, may be a multi-factorial contributor to childhood ischemic stroke, potentially triggering events among children with congenital heart disease or trauma. MassTag-PCR enhances the detection of pathogens potentially associated with stroke in pediatric stroke patients.