Abstract
BackgroundEvaluation of the primary etiologic agents that cause aseptic meningitis outbreaks may provide valuable information regarding the prevention and management of aseptic meningitis. An outbreak of aseptic meningitis occurred from May to June, 2012, in Guangdong Province, China. In order to determine the etiologic agent, CSF specimens from 121 children hospitalized for aseptic meningitis at Luoding People’s Hospital of Guangdong Province were tested for virus isolation and identification.ResultsEnterovirus RNA was positive in 62.0% of 121 CSF sspecimens by real-time polymerase chain reaction (RT-PCR). Amplification and sequencing of the VP1 region of enterovirus isolates revealed Echovirus 30 (E30) was the most common isolated serotype (80% of 40 enterovirus strains).For the molecular characterization of the E30 isolates, the VP1 gene sequence of 20 Luoding E30 isolates was compared pairwise using the MegAlign with reference strains from GenBank. The pairwise comparison of the nucleotide sequences of the VP1 genes demonstrated that the sequences of the strains differed from those of lineage groups C, D, E, F, and G. Reconstruction of the phylogenetic tree based on the VP1 nucleotide sequences resulted in a monophyletic tree, with seven clustered lineage groups. Most of the isolates were segregated from other lineage groups. Four E30 isolates causing this outbreak aggregated into the Lineage A cluster which was derived from E30 strains that circulated in other regions of China from 2003–2010.ConclusionsThis study demonstrated the Luoding strains were a distinct lineage of E30, and a probable cause of this outbreak. The study also demonstrated that different E30 variants existed in the local meningitis outbreak.
Highlights
Evaluation of the primary etiologic agents that cause aseptic meningitis outbreaks may provide valuable information regarding the prevention and management of aseptic meningitis
Aseptic meningitis is a clinical syndrome characterized by meningeal inflammation that is not caused by any identifiable bacterial pathogen in the cerebrospinal fluid (CSF) [1]
Sixty-eight distinct serotypes of Human enteroviruses (HEVs) have been identified among more than 90 serotypes [4]. These viruses are genetically classified into four species: HEV-A, HEV-B, HEV-C, and HEV-D, Echovirus 30 (E30) belongs to the B species (HEV-B), HEV-B is the largest specie comprised of 58 conventional serotypes, including Echovirus 1 ~ 7,9,11 ~ 21,24 ~ 27,29 ~ 33, coxsackie B1 ~ 6, coxsackie A9 and newly identified viruses
Summary
Evaluation of the primary etiologic agents that cause aseptic meningitis outbreaks may provide valuable information regarding the prevention and management of aseptic meningitis. In order to determine the etiologic agent, CSF specimens from 121 children hospitalized for aseptic meningitis at Luoding People’s Hospital of Guangdong Province were tested for virus isolation and identification. Human enteroviruses (HEVs), small RNA viruses belonging to the Picornaviridae family, have been identified as the major etiologic agent of aseptic meningitis. Other researchers have studied the molecular epidemiology of 112 European isolates of EV30 and presented a different classification into three genotypes (designated 1 to 3) and subdividing the last genotype into four new subgroups (3a to 3d) [10]. Researchers found that after 1977, the two genotypes comprising the prototype strain Bastianni and the oldest European isolates circulating before 1976 had apparently disappeared. The genotype containing sequences after 1977 could be divided in sub-clusters These subclusters showed a temporal relationship with each other. The level of confidence of lineage clustering was lower, the temporal clustering resulting from the lineage clustering was very definite and many researchers use this classification to present the pattern of E30 evolution
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