Abstract
BackgroundHuman enteroviruses (HEVs) are the most frequently reported cause of aseptic meningitis with or without CSF pleocytosis in childhood. Rapid detection and genotype of HEVs is essential to determine the causative agent and variant causing sepsis-like illness and/or aseptic meningitis.AimTo investigate the molecular epidemiology of enteroviruses (EVs) among patients with sepsis-like illness and/or aseptic meningitis admitted to three major hospitals in West Bank, Palestine from 2012 to 2015.MethodsDuring the study period, 356 CSF samples were collected from patients with sepsis-like illness and/or aseptic meningitis. Two RT-nested PCR assays targeting a partial part of 5'UTR for direct diagnosis and the VP1 region for genotyping by sequence analysis of the viral genome were used.ResultsHEV RNA was detected in 66 of 356 (18.5%) of CSF samples. Age distribution showed that 64% (42/66) were infants (<1 year), 18% were children between 1 and 5 years old, 12% were children between 5 and 10 years old, and 6% were more than 10 years old. Of the 66 EV cases, 12 were successfully genotyped. Five different EV genotypes were identified. All of them belonged to HEV-B species. The study showed that echovirus 6 genotype accounted for 42% of the sequenced cases. The HEV infections in the present study tended to show slight seasonal pattern with more cases occurring during spring and summer, yet still significant numbers were also reported in fall and winter seasons.ConclusionHEV was isolated from a significant number of children with sepsis-like illness and/or aseptic meningitis. In addition, the molecular method utilized for direct diagnosis and genotyping of HEV from CSF revealed that more than one HEV type circulated in the West Bank, Palestine during the study period.
Highlights
Human enteroviruses (HEVs) are non-enveloped viruses with positive sense single-stranded RNA genomes
HEV was isolated from a significant number of children with sepsis-like illness and/or aseptic meningitis
The molecular method utilized for direct diagnosis and genotyping of HEV from cerebrospinal fluid (CSF) revealed that more than one HEV type circulated in the West Bank, Palestine during the study period
Summary
Human enteroviruses (HEVs) are non-enveloped viruses with positive sense single-stranded RNA genomes. Many infections are asymptomatic, they still cause a diverse range of clinical manifestations including acute flaccid paralysis, myocarditis, neonatal sepsis, febrile illness, haemorrhagic conjunctivitis, hand-footand-mouth disease (HFMD), encephalitis and aseptic meningitis [2, 3]. During the last 2 to 3 decades and in many parts of the world, HEVs have been considered the major causative agents of aseptic meningitis, a meningeal inflammation not caused by an identifiable bacterial pathogen in the cerebrospinal fluid (CSF) and with CSF pleocytosis, CSF white blood cells (WBC) count (/mm3) of >35 for age 25 for age 30–60 days, and >5 for age 60 days[4]. Human enteroviruses (HEVs) are the most frequently reported cause of aseptic meningitis with or without CSF pleocytosis in childhood. Rapid detection and genotype of HEVs is essential to determine the causative agent and variant causing sepsis-like illness and/or aseptic meningitis
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