Aseptic meningitis outbreak caused by echovirus 30 in two regions in Bulgaria, May–August 2012

Mladenova, Z.; Buttinelli, Gabriele; Dikova, Antoaneta; Stoyanova, Asya; Troyancheva, M.; Komitova, Р.; Stoycheva, M.; Pekova, Liliya; Parmakova, Kremena; Fiore, Lucia

doi:10.1017/s0950268813003221

Cited by 19 publications

(12 citation statements)

References 11 publications

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“…Similar incidences of E-30 outbreaks were reported in Shandong Province of China, showing that E-30 was a major pathogen in encephalitis patients (Tao et al, 2014). The outbreaks of E-30, which were closely associated with encephalitis, were also frequently reported in other parts of the world, including Italy, Bulgaria, France, United Kingdom, Spain, Brazil, and Korea (Cabrerizo et al, 2008;Yang et al, 2013;Mladenova et al, 2014;Holmes et al, 2016). Surprisingly, a recent report showed that E-30 was detected in an outbreak of acute myalgia and rhabdomyolysis, indicating that E-30 possibly caused severe nonneuropathic diseases and that E-30 could cause a variety of clinical symptoms (Sousa et al, 2019).…”

Section: Introductionsupporting

confidence: 67%

A Large-Scale Outbreak of Echovirus 30 in Gansu Province of China in 2015 and Its Phylodynamic Characterization

Chen

Han

et al. 2020

Front. Microbiol.

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Background: Echovirus 30 (E-30) has been investigated and reported worldwide and is closely associated with several infectious diseases, including encephalitis; myocarditis; and hand, foot, and mouth disease. Although many E-30 outbreaks associated with encephalitis have been reported around the world, it was not reported in northwest China until 2015. Methods: The clinical samples, including the feces, serum, throat swabs, and cerebrospinal fluid, were collected for this study and were analyzed for diagnosis. E-30 was isolated and processed according to the standard procedures. The epidemiological and phylogenetic analysis were performed to indicate the characteristics of E-30 outbreaks and phylodynamics of E-30 in China. Results: The E-30 outbreaks affected nine towns of Gansu Province in 2015, starting at a school of Nancha town and spreading to other towns within 1 month. The epidemiological features showed that children aged 6-15 years were more susceptible to E-30 infection. The genotypes B and C cocirculated in the world, whereas the latter dominated the circulation of E-30 in China. The genome sequences of this outbreak present 99.3-100% similarity among these strains, indicating a genetic-linked aggregate outbreak of E-30 in this study. Two larger genetic diversity expansions and three small fluctuations of E-30 were observed from 1987 to 2016 in China, which revealed the oscillating patterns of E-30 in China. In addition, the coastal provinces of China, such as Zhejiang, Fujian, and Shandong, were initially infected, followed by other parts of the country. The E-30 strains isolated from mainland of China may have originated from Taiwan of China in the last century. Conclusion: The highly similar E-30 genomes in this outbreak showed an aggregate outbreak of E-30, with nine towns affected. Our results suggested that, although the genetic diversity of E-30 oscillates, the dominant lineages of E-30 in China has complex

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Section: Introductionsupporting

confidence: 67%

A Large-Scale Outbreak of Echovirus 30 in Gansu Province of China in 2015 and Its Phylodynamic Characterization

Chen

Han

et al. 2020

Front. Microbiol.

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“…Though the majority of clinical symptoms are asymptomatic or mild, such as fever, irritation, agitation, sore throat, headache, myalgia, vomiting, diarrhoea, hand-foot-and-mouth disease (HFMD) and others, a few patients may develop severe neurological syndromes as aseptic meningitis, acute flaccid paralysis (AFP), hypertensive heart failure (HHF), dilated cardiomyopathy and death 5 . Of these symptoms, the viruses of species EV-B are the most common viral cause of aseptic meningitis 6–8 .…”

Section: Introductionmentioning

confidence: 99%

Molecular characterization of two novel echovirus 18 recombinants associated with hand-foot-mouth disease

Zhang

Zhao

Liu

et al. 2017

Sci Rep

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Human echovirus 18 (E-18) is a member of the enterovirus B species. To date, sixteen full-length genome sequences of E-18 are available in the GenBank database. In this study, we describe the complete genomic characterization of two E-18 strains isolated in Yunnan, China. Pairwise comparisons of the nucleotide sequences and the deduced amino acid sequences revealed that the two Yunnan E-18 strains had 87.5% nucleotide identity and 96.3–96.5% amino acid identity with the Chinese strain. Phylogenetic and bootscanning analyses revealed the two E-18 strains had the highest identity with other several EV-B serotypes than the other E-18 strains in the P3 coding region, especially, 3B region of the Swine Vesicular disease virus (SVDV) strain HK70, indicated that frequent intertypic recombination might have occurred in the two Yunnan strains. This study contributes the complete genome sequences of E-18 to the GenBank database and provides valuable information on the molecular epidemiology of E-18 in China.

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“…Outbreaks of E30 were have been registered in many European countries (Greece, Italy, France, etc), as well as in Asia and North America [5,19,20,21,22,23]. In Bulgaria, E30-associated outbreak was registered in 2012, and among 157 patients with aseptic meningitis investigated, E30 was detected in 74.5% of them [24]. According to the literature, such epidemics of neuroinfections caused by the same virus have been reported in many places around the world in 2012 [22,25] Epidemiological data collected among our 34 patients during the outbreak in 2012 revealed close contacts in the kindergarten, at school, or with close relatives of the sick persons.…”

Section: Resultsmentioning

confidence: 99%

Enteroviral infections of the central nervous system observed in Bulgaria during five consecutive seasons

Pekova¹

2020

Ann Clin Anal Med

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Aim: Enteroviruses target various organs and systems of the human body, including the central nervous system (CNS). The aim of the present study was to better understand the clinical features of enteroviral infections of the CNS and the factors influencing the clinical course of disease.Material and methods: A total of 39 patients, aged 3-16 years, admitted to the Clinic of Infectious Diseases, University Hospital in Stara Zagora, Bulgaria, between 2012-2017 with confirmed enteroviral neuroinfection were enrolled in the study. Diagnosis was confirmed by laboratory and virological tests. Instrumental investigation was performed if needed. Results: In all cases the disease began suddenly and severely followed by hospitalization within 24 hours. Meningo-radicular syndrome was observed in 25 patients and sustained for average 4,1±1,9 days. Cerebrospinal fluid (CSF) showed pleocytosis in all cases ranging from 57 to 843.106/L, in 9 patients segmented cells predominated at the first lumbar puncture. Mild proteinorachie (0,50 to 0,76 g/L) was found in 17 of the patients. Virological tests revealed echovirus 30 and coxsackievirus B in 24 and 4 patients, respectively. Discussion: All cases in the study fulfill the criteria for a confirmed enteroviralinduced disease. Echovirus 30 was the predominant causative agent, affecting mainly children between 3 and 9 years old. All patients have gone as meningitis. The majority of them had moderate clinical course. Predominance of plymorphonuclear cells in the first lumbar punctate was found in 23% of the patients. All cases had a favorable outcome.

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Aseptic meningitis outbreak caused by echovirus 30 in two regions in Bulgaria, May–August 2012

Cited by 19 publications

References 11 publications

A Large-Scale Outbreak of Echovirus 30 in Gansu Province of China in 2015 and Its Phylodynamic Characterization

A Large-Scale Outbreak of Echovirus 30 in Gansu Province of China in 2015 and Its Phylodynamic Characterization

Molecular characterization of two novel echovirus 18 recombinants associated with hand-foot-mouth disease

Enteroviral infections of the central nervous system observed in Bulgaria during five consecutive seasons

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