Pediatric Enteroviral Central Nervous System Infections in Bialystok, Poland: Epidemiology, Viral Types, and Drivers of Seasonal Variation.

Kacper Toczylowski,Magdalena Wieczorek,Artur Sulik,Ewa Bojkiewicz,Magdalena Wietlicka-Piszcz,Beata Gad

doi:10.3390/v12080893

Abstract

Enteroviruses are common causes of infections of the central nervous system (CNS) that in temperate climates tend to peak in the summer. The aim of the study was to describe epidemiology, drivers of seasonality, and types of enteroviruses causing infections of the CNS in children in Northeastern Poland. We prospectively collected data on children hospitalized with infection of the CNS attributed to enteroviruses in Bialystok, Poland, from January 2015 to December 2019. In total, 224 children were included. Nineteen different enterovirus types were identified in isolates collected from 188 children. Coxsackie B5 (32%), echovirus 30 (20%), and echovirus 6 (14%) were the three most common types. Enteroviruses were more prevalent during the summer–fall season. Infections caused by echovirus 30 peaked early in June and coxsackievirus B5 in July, whereas echovirus 6 peaked late in October. Phylogenetic analyses of these three enterovirus types showed multiple lineages co-circulating in this region. Mean air temperatures and precipitation rates were independently associated with monthly number of cases. Considering lack of effective treatment or vaccine, easy transmission of enteroviruses between susceptible individuals, their high mutation rate and prolonged time of viral shedding, continued monitoring and surveillance are imperative to recognize enteroviral infections of the CNS and the changes in circulation of enteroviruses in Poland.

Highlights

Enteroviruses (EVs) belong to the Picornaviridae family and originally were classified into four groups: polioviruses, coxsackievirus A, coxsackievirus B, and echoviruses
Between 1 January 2015 and 31 December 2019, 246 stool and 301 cerebrospinal fluid pleocytosis (CSF) samples collected from 345 children with meningitis or encephalitis presenting to the Medical University of Bialystok Children’s
Two stool samples and two CSF samples collected from three children were positive in enterovirus RT-PCR (EV PCR), but those children were excluded from the analysis as they were diagnosed with tick-borne encephalitis or Lyme neuroborreliosis

Summary

Introduction

Enteroviruses (EVs) belong to the Picornaviridae family and originally were classified into four groups: polioviruses, coxsackievirus A, coxsackievirus B, and echoviruses. According to the current taxonomy based on virus genomic and biological properties, EVs are divided into 15 species, of which. EV species A-D and Rhinovirus species A-C infect humans [1]. Enteroviruses are responsible for nearly a billion infections in people annually [2]. Clinical syndromes include febrile rash, hand-foot-and-mouth disease, acute respiratory syndrome, and infections of the central nervous system (CNS). Enteroviral disease is reported year-round but exhibits a peak in the summer season. The observed seasonality can be partially explained by climatic factors, but the drivers of temporal patterns remain largely unknown [3]

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