Identification and Phylogenetic Characterization of Human Enteroviruses Isolated from Cases of Aseptic Meningitis in Brazil, 2013-2017.

Emanuelle Ramalho,Roseane Serrano,Edson E Da Silva,Marion Burger,Eliane Costa,Osvaldo Nascimento,Renato Lopes,Maria Debur,Amanda Dias,Fernanda Burlandy,Irina Riediger,Maria Oliveira,Ivanildo Sousa,Maria L Oliveira

doi:10.3390/v11080690

Abstract

Aseptic meningitis is a common viral infection associated with human enteroviruses. The aim of the present study was to identify and characterize the enteroviruses associated with outbreaks and sporadic cases of aseptic meningitis that occurred in different regions of Brazil between 2013 and 2017. Cerebrospinal fluids obtained from patients admitted to public health facilities were analyzed. A total of 303 patients were positive for Human Enteroviruses (EV) by cell culture isolation with a median isolation rate throughout the year of 12%. We were able to identify enterovirus serotypes in 295 clinical specimens. Nineteen different serotypes were identified; the large majority corresponded to HEV-B species. Echovirus 30 (E-30) and Echovirus 6 (E-6) were the most prevalent genotypes (66.8%). Sequence analysis suggested that circulating E-30 was closely related to E-30 from other American countries; while E-6 was derived from Europe. Most of the patients consisted of children ≤ 15 years old. The temporal distribution of all aseptic meningitis and EV-positive cases showed an obvious seasonal pattern during autumn. Our results have provided valuable information about the enteroviral etiology of the aseptic meningitis cases in Brazil pointing to the importance of enterovirus surveillance in neurological diseases.

Highlights

Human enteroviruses (EV) are small non-enveloped RNA viruses belonging to the picornaviridae family and are classified into four species: EV-A, B, C, and D
The age distribution of aseptic meningitis cases ranged from 1 month to 92 years old and 1 month to 38 years old (EV-positive patients)
Numerous studies about aseptic meningitis have been conducted over the last few years and non-polio enteroviruses have mostly been reported as an important pathogen causing many outbreaks [3,4,18,19]

Summary

Introduction

Human enteroviruses (EV) are small non-enveloped RNA viruses belonging to the picornaviridae family and are classified into four species: EV-A, B, C, and D. Viruses 2019, 11, 690 and mouth disease, acute myalgia, herpangina, conjunctivitis, upper and lower respiratory disease and severe syndromes of the central nervous system (CNS) [1,2]. Among the most common manifestations involving the CNS, it is worth mentioning encephalitis, acute flaccid paralysis, paralytic myelitis and aseptic meningitis [1]. Aseptic meningitis is defined as a non-bacterial acute infectious disease of the tissue that covers the brain and spinal cord and represents the most common viral infection of the CNS. The common symptoms in patients with viral meningitis can vary with age and underlying immune state, but include fever, irritability and lethargy

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