Echoviruses are a major cause of aseptic meningitis in infants and young children in Kuwait

Abstract

BackgroundThe etiologic agents of aseptic meningitis (AM) often include human enteroviruses. The role of enteroviruses causing AM in young children was investigated during a 3-year period in Kuwait.ResultsEnteroviral RNA was detected in cerebrospinal fluid (CSF) by reverse transcription-PCR and specific genotypes of enteroviruses were identified by direct DNA sequencing of VP4-VP2 region. Enteroviral RNA was detected in 92 of 387 (24%) suspected AM cases and the results were confirmed by hybridization of amplicons with an internal, enterovirus-specific probe. The CSF samples from 75 of 281 (27%) children < 2 years old but only from 3 of 38 (8%) 4-12 year-old children were positive for enteroviral RNA (p = 0.011). Majority of infections in children < 2 years old (49 of 75, 65%) were due to three echoviruses; echovirus type 9 (E9), E11 and E30. Only three other enteroviruses, namely coxsackievirus type B4, coxsackievirus type B5 and enterovirus 71 were detected among AM cases in Kuwait.ConclusionsOur data show that three types of echoviruses (E9, E11 and E30) are associated with the majority of AM cases in Kuwait. To the best of our knowledge, this is the first report to characterize different enterovirus genotypes associated with AM in the Arabian Gulf region.

Acute meningoencephalitis associated with echovirus 9 infection in Sri Lanka, 2009

“…However, only limited sequence information for this genomic region was available for contemporary E‐9 strains at the time of analysis. The most recent strains for which sequences were available were detected in Kuwait in 2004–2005 [Dalwai et al, ] and China, 2010. These strains clustered in distinct lineages, indicating independent circulation, and evolution of the Sri Lankan strains.…”

“…Previous studies have used the 5′UTR‐VP4‐VP2 region of the E‐9 genome for molecular typing and investigating the molecular epidemiology of this and other EV serotypes [Jung et al, ; Dalwai et al, ]. Since only 14 other comparable E‐9 sequences were available at the time of analysis, our phylogenetic analysis was restricted in its scope.…”

Molecular characterisation of enteroviruses and clinical findings from a cluster of paediatric viral meningitis cases in Tshwane, South Africa 2010–2011

“…A single strain of CV-B5 was detected while two strains could not be typed. The predominance of echoviruses in this study was not an unusual finding as in recent years echoviruses have been implicated in numerous outbreaks of aseptic meningitis worldwide [18][19][20][21][22][23][24][25], including SA [10], with E-30, and to a lesser extent E-6 and E-9,being the most frequent EV serotypes identified in outbreaks, including Brazil [20], France [22], Greece [26], India [19], Italy [27,28], Kuwait [23] and Panama [25], and E-4 considered to be a "rare" serotype [21]. The occurrence of E-4 however appears to be a localized rather than global phenomenon as E-4 has been identified as the predominant serotype in outbreaks of aseptic meningitis in Australia [24], Argentina [29], India [19], Italy [27], and in a travel-associated outbreak imported from India to Italy [28].…”

Viral diseases of the central nervous system

“…Neonatal humans are especially at risk for developing severe morbidity and mortality following infection by group B coxsackieviruses and echoviruses [41,42]. A pathological report of a child who succumbed to coxsackievirus B5 noted intense inflammation around the choroid plexus as well as the lateral and fourth ventricles [43].…”