Neuroinvasive Human Parvovirus 4 is associated with increased mortality in children: a multiyear retrospective observational study

Neuroinvasive Human Parvovirus 4 is associated with increased mortality in children: a multiyear retrospective observational study | medRxiv Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Neuroinvasive Human Parvovirus 4 is associated with increased mortality in children: a multiyear retrospective observational study Deb Purna Keya , Apurba Rajib Malaker , Naito Kanon , View ORCID Profile Arif Mohammad Tanmoy , Saffat Reaz , Preonath Chondrow Dev , Hafizur Rahman , Lubana Tanvia , Anisur Rahman , Afroza Akter Tanni , Dipu Chandra Das , Anannya Barman Jui , Mirza Md. Ziaul Islam , Reaz Mobarak , Shamsun Nahar , Cristina Tato , ASM Nawshad Uddin Ahmed , Farhad Imam , Joseph L DeRisi , Samir K Saha , View ORCID Profile Yogesh Hooda , View ORCID Profile Senjuti Saha doi: https://doi.org/10.64898/2026.03.17.26348513 Deb Purna Keya 1 Child Health Research Foundation , Dhaka, Bangladesh (MSc) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Apurba Rajib Malaker 1 Child Health Research Foundation , Dhaka, Bangladesh (MSc) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Naito Kanon 1 Child Health Research Foundation , Dhaka, Bangladesh (MSc) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Arif Mohammad Tanmoy 1 Child Health Research Foundation , Dhaka, Bangladesh (PhD) Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Arif Mohammad Tanmoy Saffat Reaz 1 Child Health Research Foundation , Dhaka, Bangladesh (BSc) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Preonath Chondrow Dev 1 Child Health Research Foundation , Dhaka, Bangladesh (MSc) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Hafizur Rahman 1 Child Health Research Foundation , Dhaka, Bangladesh (BSc) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Lubana Tanvia 1 Child Health Research Foundation , Dhaka, Bangladesh (MSc) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Anisur Rahman 1 Child Health Research Foundation , Dhaka, Bangladesh (MSc) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Afroza Akter Tanni 1 Child Health Research Foundation , Dhaka, Bangladesh (MSc) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Dipu Chandra Das 1 Child Health Research Foundation , Dhaka, Bangladesh (MSc) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Anannya Barman Jui 1 Child Health Research Foundation , Dhaka, Bangladesh (MBBS) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Mirza Md. Ziaul Islam 2 Bangladesh Institute of Child Health, Bangladesh Shishu Hospital & Institute , Dhaka, Bangladesh (MD) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Reaz Mobarak 3 Department of Epidemiology & Research, Bangladesh Shishu Hospital & Institute , Dhaka, Bangladesh (FRCP) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Shamsun Nahar 1 Child Health Research Foundation , Dhaka, Bangladesh (MBBS) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Cristina Tato 4 Chan Zuckerberg Biohub , San Francisco, California, USA (PhD) Find this author on Google Scholar Find this author on PubMed Search for this author on this site ASM Nawshad Uddin Ahmed 1 Child Health Research Foundation , Dhaka, Bangladesh (FCPS) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Farhad Imam 5 Gates Foundation , Seattle, WA, USA (PhD) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Joseph L DeRisi 4 Chan Zuckerberg Biohub , San Francisco, California, USA 6 Department of Biochemistry and Biophysics, University of California , San Francisco, California, USA (PhD) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Samir K Saha 1 Child Health Research Foundation , Dhaka, Bangladesh (PhD) Find this author on Google Scholar Find this author on PubMed Search for this author on this site Yogesh Hooda 1 Child Health Research Foundation , Dhaka, Bangladesh (PhD) Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Yogesh Hooda Senjuti Saha 1 Child Health Research Foundation , Dhaka, Bangladesh (PhD) Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Senjuti Saha For correspondence: senjutisaha{at}chrfbd.org Abstract Full Text Info/History Metrics Supplementary material Data/Code Preview PDF Abstract Background Infections of the central nervous system (CNS) in children remain a major cause of mortality and long-term disability globally, particularly in low- and middle-income countries (LMICs), where a high proportion of cases lack an identified pathogen. Sporadically, human parvovirus 4 (PARV4) has been detected in a small number of cerebrospinal fluid (CSF) from children with CNS infections, but its pathogenic role is unclear. We investigated the prevalence, clinical impact, and genomic characteristics of PARV4 in children with suspected meningitis. Methods We retrospectively analyzed CSF samples collected from children with WHO-defined suspected meningitis at the largest pediatric hospital in Bangladesh between 2015-2022. All samples underwent routine diagnostics, including bacterial culture and serological testing. Additional testing for PARV4 and parvovirus B19 was performed using qPCR of samples with >9 white blood cell (WBC)/µl followed by metagenomic sequencing of a subset. Clinical and laboratory data were extracted from patient records. Associations between PARV4 detection and mortality were assessed using logistic regression, adjusting for age, WBC count, and co-infections. Genomic and phylogenetic analyses were conducted on PARV4-positive samples. Findings Among 2,793 CSF samples with >9 WBC/µl, 526 (18·8%) were PARV4-positive. The median age of PARV4-positive cases was lower than that of PARV4-negative cases (4 vs 7 months, p<0·001). Co-infections were more common among PARV4-positive cases (49·6%) than PARV4-negative cases (16·4%). PARV4 positivity was independently associated with increased in-hospital mortality (adjusted odds ratio 2·09, 95%CI:1·46–2·96; p<0·001). Phylogenetic analysis indicated most strains belonged to genotype 2, with two sequences forming a distinct clade. Interpretation PARV4 is frequently detected in the CSF of children with suspected meningitis and is associated with increased in-hospital mortality. Its high prevalence, detection early in life, and frequent co-infection with other pathogens highlight the need to investigate PARV4 as an emerging CNS pathogen in LMICs. Competing Interest Statement The authors have declared no competing interest. Funding Statement This study was funded by the Gates Foundation. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study protocol was approved by the Ethics Review Committee of the Bangladesh Institute of Child Health. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes ↵ # senior authors Nothing changed in the main text, figures or appendix. Only the acknowledgement section was edited slightly. Data Availability All data produced in the present study are available upon reasonable request to the authors Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC 4.0 International license . Back to top Previous Next Posted March 20, 2026. Download PDF Supplementary Material Data/Code Email Thank you for your interest in spreading the word about medRxiv. NOTE: Your email address is requested solely to identify you as the sender of this article. Your Email * Your Name * Send To * Enter multiple addresses on separate lines or separate them with commas. 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Ziaul Islam , Reaz Mobarak , Shamsun Nahar , Cristina Tato , ASM Nawshad Uddin Ahmed , Farhad Imam , Joseph L DeRisi , Samir K Saha , Yogesh Hooda , Senjuti Saha medRxiv 2026.03.17.26348513; doi: https://doi.org/10.64898/2026.03.17.26348513 Share This Article: Copy Citation Tools Neuroinvasive Human Parvovirus 4 is associated with increased mortality in children: a multiyear retrospective observational study Deb Purna Keya , Apurba Rajib Malaker , Naito Kanon , Arif Mohammad Tanmoy , Saffat Reaz , Preonath Chondrow Dev , Hafizur Rahman , Lubana Tanvia , Anisur Rahman , Afroza Akter Tanni , Dipu Chandra Das , Anannya Barman Jui , Mirza Md. Ziaul Islam , Reaz Mobarak , Shamsun Nahar , Cristina Tato , ASM Nawshad Uddin Ahmed , Farhad Imam , Joseph L DeRisi , Samir K Saha , Yogesh Hooda , Senjuti Saha medRxiv 2026.03.17.26348513; doi: https://doi.org/10.64898/2026.03.17.26348513 Citation Manager Formats BibTeX Bookends EasyBib EndNote (tagged) EndNote 8 (xml) Medlars Mendeley Papers RefWorks Tagged Ref Manager RIS Zotero Tweet Widget Facebook Like Google Plus One Subject Area Infectious Diseases (except HIV/AIDS) Subject Areas All Articles Addiction Medicine (638) Allergy and Immunology (917) Anesthesia (350) Cardiovascular Medicine (4989) Dentistry and Oral Medicine (494) Dermatology (427) Emergency Medicine (675) Endocrinology (including Diabetes Mellitus and Metabolic Disease) (1689) Epidemiology (16248) Forensic Medicine (36) Gastroenterology (1241) Genetic and Genomic Medicine (7270) Geriatric Medicine (751) Health Economics (1093) Health Informatics (5279) Health Policy (1465) Health Systems and Quality Improvement (1830) Hematology (599) HIV/AIDS (1379) Infectious Diseases (except HIV/AIDS) (16480) Intensive Care and Critical Care Medicine (1201) Medical Education (699) Medical Ethics (156) Nephrology (751) Neurology (7581) Nursing (377) Nutrition (1127) Obstetrics and Gynecology (1295) Occupational and Environmental Health (1039) Oncology (3740) Ophthalmology (1091) Orthopedics (407) Otolaryngology (465) Pain Medicine (500) Palliative Medicine (143) Pathology (721) Pediatrics (1856) Pharmacology and Therapeutics (755) Primary Care Research (785) Psychiatry and Clinical Psychology (6119) Public and Global Health (9976) Radiology and Imaging (2526) Rehabilitation Medicine and Physical Therapy (1513) Respiratory Medicine (1268) Rheumatology (658) Sexual and Reproductive Health (803) Sports Medicine (595) Surgery (801) Toxicology (109) Transplantation (318) Urology (307)

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