Abstract
BackgroundEnteroviruses are among the most common viruses infecting humans worldwide and they are associated with diverse clinical syndromes. Acute flaccid paralysis (AFP) is a clinical manifestation of enteroviral neuropathy, transverse myelitis, Guillian-Barre Syndrome, Traumatic neuritis and many other nervous system disorders. The objective of this study was to understand the role of Non-Polio Enteroviruses (NPEV) towards this crippling disorder.MethodsStool specimens of 1775 children, aged less than 15 years, suffering from acute flaccid paralysis were collected after informed consent within 14 days of onset of symptoms during January 2003 to September 2003. The specimens were inoculated on RD and L20B cells using conventional tube cell culture while micro-neutralization test was used to identify the non-polio enterovirus (NPEV) serotypes. Detailed clinical information and 60-days follow-up reports were analyzed for NPEV-associated AFP cases.ResultsNPEV were isolated from 474 samples. The male to female ratio was 1.4:1. The isolation of NPEV decreased significantly with the increase in age. Cases associated with fever at the onset of NPEV-associated AFP were found to be 62%. The paralysis was found asymmetrical in 67% cases, the progression of paralysis to peak within 4 days was found in 72% cases and residual paralysis after 60 days of paralysis onset was observed in 39% cases associated with NPEV. A clinical diagnosis of Guillian-Barre syndrome was made in 32% cases. On Microneutralization assay, echo-6 (13%) and coxsackievirus B (13%) were the most commonly isolated serotypes of NPEV along with E-7, E-13, E-11, E-4 and E-30. The isolates (n = 181) found untypable by the antiserum pools were confirmed as NPEV by PCR using Pan-Enterovirus primers.ConclusionThe present study suggests that NPEV are a dominant cause of AFP and different serotypes of NPEV are randomly distributed in Pakistan. The untypable isolates need further characterization and analysis in order to determine their association with clinical presentation of a case.
Highlights
Enteroviruses are among the most common viruses infecting humans worldwide and they are associated with diverse clinical syndromes
The detection of Non-Polio Enteroviruses (NPEV) in Acute flaccid paralysis (AFP) cases decreased with the increase in age (Fig. 2) and statistical analysis showed strong negative correlation (r = -0.913) between age and detection of NPEV
The present study suggests that after the eradication of poliomyelitis, AFP cases negative for wild poliovirus but positive for NPEV will continue to be detected
Summary
Enteroviruses are among the most common viruses infecting humans worldwide and they are associated with diverse clinical syndromes. Enteroviruses (genus Enterovirus, family Picornaviridae) are among the most common viruses infecting humans worldwide. Serotypes of human enteroviruses have traditionally been classified into echoviruses, coxsackieviruses group A and B, and polioviruses. This traditional taxonomy was based on the associated disease in humans and animal model systems, sometimes resulting in overlaps between groups and difficulties with classification. Echoviruses 22 and 23 have been reclassified as a new genus (Parechovirus) in Picornaviridae and are termed human parechoviruses 1 and 2, respectively They belong to genetically and biologically distinct genera, human parechoviruses and human enteroviruses share many epidemiologic and clinical characteristics [3]
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