Enteric viruses circulating in undiagnosed central nervous system infections at tertiary hospital in São José do Rio Preto, São Paulo, Brazil

Abstract

Enterovirus (EV) is commonly associated with central nervous system (CNS) syndromes. Recently, gastroenteric viruses, including rotavirus (RVA), human astrovirus (HAstV), and norovirus (NoV), have also been associated with CNS neurological disorders. The aim of the present study was to investigate the presence of EV, RVA, HAst, and NoV associated to CNS infections with undiagnosed etiology in Northwest region of São Paulo State, Brazil, and to conduct the molecular characterization of the positive samples detected. A total of 288 cerebrospinal fluid samples collected from July to December 2017 were tested for EV and NoV by quantitative real‐time polymerase chain reaction (RT‐qPCR), HAstV by conventional RT‐PCR, and RVA by enzyme‐linked immunosorbent assay. Positive‐EV samples were inoculated in cells lines, amplified by RT‐PCR and sequenced. RVA, NoV, and HAstV were not detected. EV infection was detected in 5.5% (16/288), and five samples successful genotyped: echovirus 3 (E3) (1/5), coxsackie virus A6 (CVA6) (1/5), and coxsackie virus B4 (CVB4) (3/5). Meningitis was the main syndrome observed (12/16; 75%). CVA6, CVB4, and E3 were identified associated with aseptic meningitis. Reports of CVA6 associated with aseptic meningitis are rare, E3 had not been previously reported in Brazil, and epidemiological data on CVB4 in the country is virtually unknown. The present investigation illustrates the circulation of diverse EV types in a small regional sample set and in a short period of time, highlighting the importance of an active EV surveillance system in CNS infections. Enhanced understanding of undiagnosed CNS infections will assist in public health and health care planning.

Cognitive decline following acute viral infections: literature review and projections for post-COVID-19

“…Viral meningitis accounts for roughly 40% of all AM cases [ 92 , 93 ]. The rates of detection of causative pathogens, particularly viruses, increases as more molecular and immunological testes are used [ 94 ], and the diversity of AM-causing viruses is ever-increasing [ 95 ], so many physicians consider AM of unknown cause as presumably of viral etiology [ 96 ]. Enteroviruses, VZV and herpes simplex virus type 2 are common causative agents.…”

High Heterogeneity of Echoviruses in Brazilian Children with Acute Gastroenteritis

“…Multiple investigations have described the molecular epidemiology of echovirus globally in both clinical and environmental samples [ 13 , 42 , 43 ] including in Brazil [ 16 , 36 ]. Nevertheless, there are limited echovirus nucleotide sequences available in the GenBank database [ 21 , 44 , 45 , 46 , 47 , 48 ], especially full-genome sequences [ 6 ].…”

“…At the present time, echovirus comprises 28 genotypes (E1 to E7, E9, E11 to E21, E24 to E27,E29 to E33) [ 1 , 11 ] and is widely detected [ 7 , 12 , 13 , 14 , 15 ] including in Brazil [ 6 , 15 , 16 , 17 , 18 , 19 , 20 ]. Brazil is a country with continental dimensions that spans from tropical to temperate latitudes, experiencing variable climatic conditions and geographically distinct populations.…”

“…Therefore, a high degree of echovirus diversity would be expected in this country. Continuous multiregional surveillance is vital to establish a more complete epidemiological molecular picture of the echovirus burden in Brazil [ 16 ]. However, detection and identification of echovirus genotypes in clinical samples is challenging due to its high genetic diversity [ 8 ].…”

Coxsackievirus A6 strains causing an outbreak of hand-foot-and-mouth disease in Northeastern Brazil in 2018

“…At the time of clinical onset, all 49 children were considered immunocompetent and were defined as mild HFMD, since no neurological and cardiopulmonary complications such as aseptic meningitis, encephalitis, encephalomyelitis, acute flaccid paralysis, as well as pulmonary hemorrhage or cardiorespiratory failure were observed 4,12 . Some patients presented with respiratory or gastrointestinal symptoms and both findings are recognized as part of EV infections 13 . The HFMD cases were reported to the Epidemiological Surveillance Center of Paraiba State (CIEVS/PB), which initiated an investigation in order to identify the EV genotype associated with the HFMD cases.…”