Enterovirus 71 Infection with Central Nervous System Involvement, South Korea

Wi-Sun Ryu,Byunghak Kang,Ahyoun Kim,Jonghyun Kim,Doo-Sung Cheon,Seoyeon Hwang,Jiyoung Hong

doi:10.3201/eid1611.100104

Abstract

We assessed neurologic sequelae associated with an enterovirus 71 (EV71) outbreak in South Korea during 2009. Four of 94 patients had high signal intensities at brainstem or cerebellum on magnetic resonance imaging. Two patients died of cardiopulmonary collapse; 2 had severe neurologic sequelae. Severity and case-fatality rates may differ by EV71 genotype or subgenotype.

Highlights

Several major outbreaks of enterovirus 71 (EV71) have been reported since 1974 [1,2]
Total we found 112 cases of hand-foot-and-mouth disease (HFMD) with central nervous system (CNS) complications; EV was detected in 95 (85%) and EV71 in 92 (82%) case-patients
The partial VP1 sequences of Korean EV71 strains were registered in GenBank (HM443164–644), and viral genetic identity belonged to C4a genotype, which was not a prevailing genotype in the previous reports of other Asian Pacific countries

Summary

Introduction

Several major outbreaks of enterovirus 71 (EV71) have been reported since 1974 [1,2]. Viral disease were reported to the Korea Centers for Disease Control and Prevention through a web-based system. An experienced neurologist (W.-S.R.) collected detailed clinical information about, and results of imaging studies of, patients reported to have central nervous system (CNS) involvement. Seminested RT-PCR was used to amplify part of the viral protein (VP) 1 gene of EV, based on the Korea Centers for Disease Control and Prevention protocol for detection of pan-EV, and sequencing analysis for VP1 amplicon was performed by using automatic sequencer and DNAstar software package [9].

Results

Conclusion