Molecular diagnosis of echovirus 30 as the etiological agent in an outbreak of aseptic meningitis in Panama: May – June 2008

Abstract

Introduction: Aseptic meningitis outbreaks are commonly caused by viral pathogens with enterovirus a common etiological agent. Between May and June of 2008, an outbreak of 173 cases of aseptic meningitis occurred in the Chiriqui Province of Panama. Molecular techniques were used to identify the etiological agent. Methodology: Cerebrospinal fluid (CSF) samples from 75 patients were received at the Gorgas Memorial Institute for Health Studies. RNA extraction and one-step RT-PCR were performed on each sample to determine the presence of enterovirus. Thirty-four samples which were positive for enterovirus were subject to group-specific PCR, sequencing, and phylogenetic analysis to identify the etiological agent of the outbreak. Results: The CSF of 58 subjects was found positive for the enterovirus family using RT-PCR. Thirty-four samples were found to belong to the enterovirus B group. Phylogenetic analysis of four successfully sequenced samples revealed echovirus 30 as the etiological agent. Conclusion: Echovirus 30 is reported as the likely cause of an outbreak of aseptic meningitis in Panama, the first since the 1980s.

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

“…Interestingly the E-4 strains from this study were most closely related to E-4 strains from India [34], but no relevant travel history was reported for the patients. The age distribution of patients and seasonality of this cluster of aseptic meningitis cases correlates with findings from other studies in SA [10,33] and other temperate regions [20,25,29,35]. However in temperate regions outbreaks of HEV-associated meningitis can occur in other seasons, especially in closed settings, as was noted in Cape Town [31].…”

“…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].…”

Enteroviruses Associated with Aseptic Meningitis in Poland, 2011–2014

“…E30 is the most commonly associated with aseptic meningitis. Increases in echovirus 30 activity are characterized by global spread and large-scale aseptic meningitis outbreaks (Martinez et al, 2012;Hyeon et al, 2013;Xiao et al, 2014;Nougairede et al, 2014).…”

Infectious Meningitis

“…Recently, molecular typing approaches to enteroviruses targeting the VP1 region of the enteroviral genome that encodes serotypespecific neutralization epitopes have been successfully applied during enteroviral-meningitis outbreak investigations in many countries worldwide (18,23,24,25,27,33,34,44,47). They have provided details of enteroviral molecular phylogeny that help us to understand its association with specific disease manifestations and possible clonal geographical clustering (34) ( Table 2).…”