Echovirus Research Articles

Analysis on pathogeny and clinical of encephalitis and meningitis syndrome in children

Objective To understand the clinical features and pathogenic spectrum of encephalitis and meningitis syndrome in children. Methods A total of 667 cases of children with encephalitis or meningitis diagnosed and documented at Changchun Children′s Hospital from May 2012 to July 2015 were enrolled.A variety of samples in diffe-rent types were collected and presented, including 335 cerebrospinal fluid specimens, 530 blood samples, and 332 stool samples.All the samples were collected from the patients within 72 hours on admission.Moreover, these samples are analyzed and tested, including PCR for enterovirus(EV), herpesvirus(HSV), mycobacterium tuberculosis(TB) and Mycoplasma pneumoniae(MP) nucleic acid in cerebrospinal fluid samples; fecal specimens were tested for EV, enterovirus 71 (EV71), coxsackievirus A6 (CA6), coxsackievirus A16 (CVA16), coxsackievirus A10 (CVA10) nucleic acids; degenerate primers to amplify Echovirus 30 (Echo30). Clinical data of children were collected. Results The peak incidence of encephalitis and meningitis syndrome was from June to August, age distribution was from 0 to 15 years old, the proportion of children aged from 0-6 accounted for 81.41%; the highest proportion was among 0-1 years old infants, occupying 32.38%; 408 males and 259 females; the main symptoms were fever(586 cases), apathy(337 cases), vomiting (307 cases) and headache(203 cases). And clinical signs included drowsiness (103 cases), neck stiffness (71 cases), meningeal irritation (12 cases), and pathological reflex (313 cases), etc.The clinical diagnosis included 272 cases of viral encephalitis, 332 cases of severe hand, foot and mouth disease complicated by encephalitis, 30 cases of bacterial meningitis, and 33 other cases; the etiological detection included: the positive rates of EV, EBV and Echo30 in cerebrospinal fluid specimens were 59.72%, 3.16% and 70.00%, respectively.And EV71, CVA16, CVA6, EV71+ CA16 and EV71+ CVA16+ CVA6 nucleic acids were detected in fecal samples, in which the highest detection rate was EV71(98.96%). Conclusions In Changchun Children′s Hospital, the children with encephalitis and meningitis are mainly viral encephalitis.The main symptoms were fever, apathetic, drowsiness, vomiting and headache.Signs included, neck stiffness, meningeal irritation, and pathological reflexes, etc.The main pathogen of the disease is EV71. Key words: Child; Encephalitis and meningitis syndrome; Clinical feature; Pathogen spectrum

Response and Control Measures for Enterovirus Echo 11 Infections in Neonates, 2018

In 2018, enteric cytopathic human orphan virus 11 (Echo 11) was prevalent in the community, and the neonatal cases of Echo 11 infections with severe complications and Echo 11 clusters in neonatal care units of hospitals or postpartum nursing care centers were also confirmed successively. In addition to the completion of existing control measures for enterovirus such as hygiene promotion for enterovirus infection prevention and pre-symptoms of severe syndromes, professionals training, and visiting and counseling for enterovirus-responsible hospitals, Taiwan Centers for Disease Control (TCDC) and local governments adopted series of special measures, including strengthening the risk communication in prevention and awareness of severity of neonatal enterovirus infection with pregnant women, baby-caregiver and medical staff, improving the quality of medical care and maintaining the referral system, and supervising hospitals and postpartum nursing care centers to implement infection control and epidemic prevention measures. In order to reduce the health hazards and social impacts caused by enterovirus, TCDC will continue to monitor the trend of the epidemic and adjust the prevention and control strategies timely in the future.

Prevention and Control Measures for Neonatal Enterovirus Infections

Echovirus type 11, a less common cause in outbreak previously, was the main virus responsible for the epidemic of enterovirus infection in Taiwan in June 2018. More than half of the cases of enteroviruses infection with severe complications were neonates, resulting in six fatalities. In addition, several outbreaks of neonatal enterovirus infections had been reported in hospitals. In order to prevent the neonatal enterovirus infections and outbreaks, healthcare workers (HCWs) in hospitals and postpartum care institutions should be aware of the epidemic to diagnose case early, detect outbreak timely, and adhere to relevant infection control measures appropriately when providing medical services. HCWs should also educate pregnant woman to inform her physician when she shows symptoms of suspected enterovirus infections such as fever, upper respiratory tract infection, diarrhea, or pleural pain, during 14 days before delivery and after delivery.

Environmental Surveillance of Human Enteroviruses in Córdoba City, Argentina: Prevalence and Detection of Serotypes from 2009 to 2014.

Environmental surveillance is an effective approach to investigate the circulation of human enteroviruses (EVs) in the population. EVs excreted by patients who present diverse clinical syndromes can remain infectious in the environment for several weeks, and limited data on circulating environmental EVs are available. A 6-year (2009-2014) surveillance study was conducted to detect non-polio enteroviruses (NPEVs) in the urban sewage of Cordoba city, Argentina. Echovirus 6 (E-6) was the most prevalent (28%), followed by E-14 (17%), E-16 (14%), Coxsackievirus (CV) A9 (11%), E-20 (9%), and CVA24 (6%). Other minority serotypes (E-7, E-13, E-21, E-25, and CVB4) were found, which together represented 14% of the total. In the absence of a systematic EV disease surveillance system, the detection and characterization of sewage-borne NPEVs will help us better understand the changes in EV disease trends and the epidemic background of circulating EVs, which could help interpret the EV trends and warn of future outbreaks in this area.

Clinical and laboratory characteristics of enteroviral meningitis in children, including qRT-PCR and sequencing analysis.

Enteroviruses (EVs) are the most common agents of aseptic meningitis. Some serotypes can cause serious neuroinfection leading to death. The aim of this study was to determine the representation of EVs in the etiology of aseptic meningitis in children and to analyze the demographic, clinical, laboratory, and epidemiological characteristics of patients with EV meningitis. This was a prospective study including 147 patients in three groups: EV meningitis, tick-borne encephalitis, and aseptic meningitis with unidentified agent. Boys with EV meningitis predominated over girls. The average patient age was 11 years. Compared to the control group, these patients suffered more from stiff back (P=0.010), vomiting and nausea (P=0.009). They had shorter symptom duration (P<0.001), higher C-reactive protein in blood (P<0.001), higher predominance of polynuclears (P=0.026), and greater lactate (P=0.003) in cerebrospinal fluid (CSF). The serotype seen most frequently (68%) was ECHO virus (ECV) 30. Enteroviruses play the most important role in the differential diagnosis of aseptic meningitis. Short symptom duration, slightly higher inflammatory parameters in blood, predominance of polynuclears, and elevated CSF lactate have predictive value in diagnosing this disease. ECV 30 (frequently the agent of epidemics in the Czech Republic) was the aseptic meningitis agent most often seen.

Enterovirus Echo 11 Infections in Neonates, Taiwan, 2018

Taiwan Centers for Disease Control detected that enteric cytopathic human orphan virus 11, Echo 11 was prevalent in the community through contract laboratory surveillance in May, 2018. Neonatal cases of Echo 11 infections with severe complications and Echo 11 clusters in neonatal care units of hospitals or nursing homes were also confirmed successively. As of September 14, 2018, a total of 181 Echo 11 cases were detected, showing a significant increase compared with the numbers in 2016 and 2017. Among these 181 cases, 35 were neonates (19.3%); 8 of which were with severe complications. The proportion of neonatal Echo 11 infection with severe complications (22.9%) was higher than other age groups, and the number of cases with severe complications and deaths was also higher than those in previous years, indicating that neonatal Echo 11 infection was associated with a higher risk of severe complications. Echovirus used to cause severe complications or death in newborns. Because the virus can be transmitted through the placenta, birth canal or asymptotic care unit personnel, it is hard to prevent. We recommended strengthening the neonatal and maternal enterovirus infection prevention and protection measures to reduce cases with severe complications and deaths, and strengthening implementation of infection control measures in maternal and neonatal care units to avoid clusters.

Severe Echovirus 11 Infection in Newborns, Taiwan, 2018

Beginning May 2018, Taiwan Centers for Disease Control was notified of an increase in reports related to severe enterovirus (EV) infection in newborns. Through July 31, severe echovirus 11 infections were confirmed in eight neonatal patients (5 males, age 0-12 days). Clinical presentations included hepatitis with coagulopathy (n = 8), sepsis syndrome (n = 8), myocarditis (n = 2), and multiorgan dysfunction (n = 7); 7 (87.5%) died. Neonatal echovirus 11 infections may be acquired transplacentally, during delivery, or from postnatal transmission, and are associated with severe complications. Clinicians should consider and report severe EV infection in neonates having myocarditis, hepatitis, encephalitis, thrombocytopenia, sepsis syndrome, or multiorgan dysfunction, but with sterile bacterial cultures. In EV epidemic seasons, we recommend appropriate hand and respiratory hygiene of pregnant women; obstetric notification of fever and other illness from 14 days before delivery; keeping sick people away from a newborn; and infection controls in healthcare/postpartum care facilities.

CORRELATION BETWEEN ENROVIRUS INFECTION AND ACUTE STROKE ON THE GROUND OF VIROLOGICAL, MOLECULAR GENETIC AND SEROLOGICAL METHODS OF DIAGNOSIS

Relevance. Numerous virological studies prove the importance of enteroviruses in human somatic pathology. However, the etiopathogenetic role of enterovirus infection in patients with acute cerebrovascular disorder (GVMK) is not sufficiently highlighted.&#x0D; Objective: to establish the value of enterovirus infection as a trigger factor in the pathogenesis of acute stroke.&#x0D; Materials and methods. The pear blood serum of 72 patients with acute stroke (main group) and 35 patients with neurological pathology without vascular pathology (group of comparison) were screened for presence of enteroviruses using the virological method, detection of enterovirus genomes using a polymerase chain reaction and the presence of specific Ig M and Ig G to enteroviruses in the enzyme-linked immunosorbent assay (ELISA).&#x0D; Results. The enterovirus genomes were isolated from blood serum in 23,6±5,9 % of patients with acute stroke, that is significantly higher than in patients of the comparison group – 2,9±2,8 % (p &lt;0,05). The enteroviruses were isolated in 11 cases of 17 PCR-positive blood serum samples of the main group. These viruses were identified as Coxsackie B viruses (serotypes 2, 3, 4) and ECHO viruses (serotypes 6, 9, 27 (two strains), 29), three strains of viruses could not be identified. The presence of specific Ig M and Ig G in blood serum of 4 patients with HPMC, as well as enterovirus genomes, has been established. It suggest that they have a recent enterovirus infection, or can indicate a recent enterovirus infection or exacerbation of chronic enterovirus infection. Only specific Ig G in the absence of Ig M were detected in blood serum of 4 PCR positive patients, that can indicate chronic enterovirus infection. Only Ig M in the absence of Ig G was detected in blood serum of 6 PCR-positive patients, that can indicate acute enterovirus infection. No Ig M or Ig G in serum from three PCR-positive patients were detected, possibly due to the presence of latent enterovirus infection.&#x0D; Conclusions. Acute and chronic persistent enterovirus infection plays a possible trigger role in the development of acute stroke.&#x0D; The combination of PCR to detect genomes of enteroviruses, virological for the isolation and identification of viruses, and ELISA for the detection of specific Ig M and Ig G to enteroviruses should be recommended for the diagnosis of persistent enterovirus infection in patients with acute stroke.

Evolution of echovirus 11 in a chronically infected immunodeficient patient.

Deep sequencing was used to determine complete nucleotide sequences of echovirus 11 (EV11) strains isolated from a chronically infected patient with CVID as well as from cases of acute enterovirus infection. Phylogenetic analysis showed that EV11 strains that circulated in Israel in 1980-90s could be divided into four clades. EV11 strains isolated from a chronically infected individual belonged to one of the four clades and over a period of 4 years accumulated mutations at a relatively constant rate. Extrapolation of mutations accumulation curve into the past suggested that the individual was infected with circulating EV11 in the first half of 1990s. Genomic regions coding for individual viral proteins did not appear to be under strong selective pressure except for protease 3C that was remarkably conserved. This may suggest its important role in maintaining persistent infection.

ПРОБЛЕМНЫЕ ВОПРОСЫ ЭПИДЕМИОЛОГИЧЕСКОГО НАДЗОРА ЗА ЭНТЕРОВИРУСНЫМИ НЕПОЛИОМИЕЛИТНЫМИ ИНФЕКЦИЯМИ В УКРАИНЕ

Enteroviruses are widespread everywhere and present a serious problem for public health. Purpose: to study the epidemic process of enteroviral non-poliomyelitis infections in Ukraine. Material and methods: the official reports of the Ministry of Health of Ukraine on the isolation of enteroviruses from healthy and sick persons as well as environmental objects were studied. The detection of enteroviruses RNA was performed using the PCR method. Results: the epidemic process of non-poliomyelitis enterovirus infections is characterized by varying intensity in long-term and annual dynamics, expressed territorial unevenness, a general trend towards the decrease in the frequency of enterovirus isolation against the background of increasing incidence of enteroviral meningitis. In the strain structure, Coxsackie B and ECHO viruses predominate. Conclusions: it is necessary to improve the epidemiological control of enterovirus infections by optimizing the structure and scope of research.

Etiologic Involvement of Enterovirus and Human Bocavirus in Acute Flaccid Paralysis Cases in India

BackgroundAcute flaccid paralysis (AFP), characterized by the rapid onset of asymmetric paralysis, can be caused by a variety of viral infections or coinfections. Besides wild-type and revertant vaccine strains of polioviruses, several nonpolio enteroviruses, have also been associated with AFP. Enteroviruses (EVs) are RNA viruses in the family Picornaviridae comprising more than 100 serotypes that are divided into four species, human enteroviruses A to D. The clinical manifestations of EVs range from conjunctivitis, respiratory tract infection, myocarditis, meningitis, encephalitis, and neonatal sepsis, like illness. Human Bocavirus (HBoV), a newly classified member of the Parvoviridae family, has been detected frequently in feces of diarrhoeic children suggesting its possible etiological involvement in the disease.MethodsTotal 586 stool specimens were collected in 2016 from children suspected for AFP. Molecular method for targeting 5’ untranslated region (UTR) and VP1 capsid region was used for detection of human enteroviruses (HEV), human boca viruses (HBoV) and saffold viruses in direct clinical specimen.ResultsEV RNA was detected in 103 (17.6%) of 586 stool specimens by real-time RT-PCR targeting the highly conserved 5’ UTR region. Out of them, 71 (12.11%) were NPEV, partially sequenced by VP1 which revealed the prevalence of echovirus (ECV) 19 (n = 6), ECV 11 (n = 7), ECV 18 (n = 4), ECV 33 (n = 5), ECV 29 (n = 1), ECV 25 (n = 2), ECV 24 (n = 3), ECV 3 (n = 3), ECV 14 (n = 2), ECV 13 (n = 1), ECV 2 (n = 1), ECV 20 (n = 2), ECV 27 (n = 4), ECV 6 (n = 2), CV A10 (n = 2), CV A9 (n = 1), CV A6 (n = 2), CV B4 (n = 1), CV B5 (n = 3), CV B6 (n = 3), EV 80 (n = 1), EV 83 (n = 1), EV 97 (n = 2).Total 63 (10.75%) HBoVs were detected by real-time PCR which were further sequenced by VP1, consists of HBoV-1 (n = 8), HBoV-2 (n = 15), HBoV-3 (n = 9) and HBoV-4 (n = 5). Out of them 9 (1.5%) were detected as co infection with NPEVs. Phylogenetic analysis showed 0.9 - 5.6% divergence at nucleotide level among HBoVs.Total 9 (1.5%) saffold viruses was detected and characterized by VP1 sequencing.ConclusionECV and HBoV were found the main etiologic agent in children suspected with AFP. Molecular typing of these viruses is useful for characterizing emerging serotypes and their epidemiological investigation.Disclosures All authors: No reported disclosures.

Isolation and Detection of Echoviruses in Acute Flaccid Paralysis among children under 15 years old in different Iraqi Provinces

Acute flaccid paralysis (AFP) is a clinical syndrome characterized by rapid onset of weakness, affecting the muscles then progressing to maximum severity within several days to weeks and sometimes may lead to death. The objective of this study was the isolation and detection of Non-Polio Enteroviruses, The ECHO virus from three hundred stool specimens obtained from children aged less than 15 years old showing symptoms of acute flaccid paralysis (AFP) from different Iraqi provinces and characterization the different serotypes of these viruses using both tissue culture (using RD cells) and neutralization-assay methods. This was done according to protocols applied by reference laboratories recommended by World Health Organization. The common diagnostic approach in a suspected Enteroviruses infection is the isolation of the virus (stool samples) in susceptible cell cultures such as RD cell line this cells appearance cytopathic effect (CPE ) for polio viruses and NPEVs . Virus isolation is then followed by the use of a neutralization-type assay to identify the serotype of the isolated Enterovirus, a process commonly known as serotyping. The current study, which covered in different Iraqi provinces shows that echoviruses (ECHO) had the highest prevalence affecting 79 cases (26.33%) out of 101 NPEVs. The present study showed that the maximum frequency of ECHO virus isolation was reported in Baghdad 31 (51.67%) and Basrah 21 (52.5%).

An outbreak of aseptic meningitis in Podlaskie Voivodeship in 2014

Enteroviruses cause common infections with various clinical course and forms, such as hand-foot-and-mouth disease (Boston exanthem disease), herpangina, myocarditis and pericarditis, widespread myositis (epidemic pleurodynia, Bornholm disease), or aseptic inflammation of the nervous system, among children and adolescents. An increase in aseptic meningitis cases of enteroviral aetiology, including the E30 virus, was occasionally observed in various European countries. In 2014, an outbreak of aseptic meningitis was reported in Podlaskie Voivodeship. A total of 640 cases were reported between June 1 and November 30, 2014, of which 228 had confirmed enteroviral aetiology. Summer and autumn seasons favour the incidence of viral infections of the central nervous system. Symptomatic infections are more common in males than females. Infections with enterovirus show the tendency to form endemic regions.

Molecular characterization of environmental and clinical echovirus 6 isolates from Poland, 2006-2014.

The aim of this study was to investigate the genetic variability of echovirus 6 (E6) isolates from environmental samples and clinical cases of aseptic meningitis from 2006 to 2014. The analysis of the VP1 region showed the extensive diversity (up to 18.8%) and revealed that E6 circulating in Poland belong to four groups. Environmental strains clustered in three groups excepting the 2012 outbreak group, which shows the sudden introduction of new epidemic variant with Asiatic origin. Data from the study established relationships of E6 from Poland with previously characterized strains and confirmed the importance of both clinical and environmental surveillance. J. Med. Virol. 89:936-940, 2017. © 2016 Wiley Periodicals, Inc.

Widespread circulation of echovirus 6 causing aseptic meningitis in paediatric patients in the area of Modena, Italy, in 2011

&lt;p&gt;&lt;em&gt;Introduction&lt;/em&gt;: Between May and November 2011, enterovirus RNA was detected in the cerebrospinal fluids (CSFs) of 72 children with signs of aseptic meningitis admitted to paediatric departments of different Hospitals of the prefecture of Modena, Emilia Romagna region, Italy. Enterovirus RNA was detected in 34 CSFs by commercial reverse transcriptase-polymerase chain reaction (RT-PCR). Twenty-one samples, resulted human enterovirus B by species-specific RT-nested PCR, were submitted to sequencing of the 3’ terminus of the VP1 gene. &lt;br /&gt;&lt;em&gt;Materials and Methods:&lt;/em&gt; Upon sequencing and interrogation of the National Center for Biotechnology Information database, all 21 viruses were characterized as echovirus 6 (E6), and posses a 100% nucleotide identity each other.&lt;br /&gt;&lt;em&gt;Results&lt;/em&gt;: This study reports the molecular detection and typing of E6 isolated from clinical specimens from paediatric patients with aseptic meningitis in the wide area of Modena, Italy, in 2011.&lt;/p&gt;

Increase in ECHOvirus 6 infections associated with neurological symptoms in the Netherlands, June to August 2016.

The Dutch virus-typing network VIRO-TypeNed reported an increase in ECHOvirus 6 (E-6) infections with neurological symptoms in the Netherlands between June and August 2016. Of the 31 cases detected from January through August 2016, 15 presented with neurological symptoms. Ten of 15 neurological cases were detected in the same province and the identified viruses were genetically related. This report is to alert medical and public health professionals of the circulation of E-6 associated with neurological symptoms.

Surveillance for enteroviruses in healthy children in Yunnan Province from 2014 to 2015

Objective To investigate the enterovirus (EV)-carrying status and the circulating serotypes in healthy children from inner and border areas of Yunnan Province in 2014 and 2015 and to analyze the genetic characteristics of echovirus 6 (ECHO6), ECHO25 and ECHO11 strains. Methods Stool samples were collected from children less than 15 years old living in 6 to 7 counties of 3 inner prefectures/cities and 8 to 9 counties of border prefectures/cities. Altogether 921 samples were collected including 453 samples in 2014 (213 samples in inner counties and 240 samples in border counties) and 468 samples in 2015 (195 samples in inner counties and 273 samples in border counties). Viruses were isolated from the stool samples and their serotypes were identified by gene sequencing. Results The numbers of EV strains isolated from the samples collected in inner counties and border counties in 2014 were 20 (isolating rate: 9.39%, 20/213) and 16 (isolating rate: 6.67%, 16/240), respectively. The overall isolating rate for 2014 was 7.95% (36/453). The predominant species was enterovirus B, accounting for 88.89% of all isolated strains (32/36), followed by enterovirus A species (11.11%, 4/36). No strains of enterovirus species C (including poliovirus) and D was detected in 2014. In total, 46 EV strains were isolated in 2015 with an overall isolating rate of 9.83% (46/468), including 13 strains in inner counties (isolating rate: 6.67%, 13/195) and 33 strains in border counties (isolating rate: 12.09%, 33/273). Most of the strains were enterovirus B species, accounting for 78.26% (36/46), followed by enterovirus C species (19.57%, 9/46) and enterovirus A species (2.17%, 1/46). Altogether 82 EV strains were isolated in 2014 and 2015 with an isolating rate of 8.90% (82/921), of which 33 strains were isolated in inner counties (8.09%, 33/408) and 49 strains were isolated in border counties (9.55%, 49/513). Among the 82 EV strains, 9 strains were polioviruses (0.98%, 9/921) and all of them were Sabin-like polioviruses. The rest of the strains were non-polio enterovirus (7.93%, 73/921). Conclusion In 2014, the EV isolating rate in inner counties (9.39%) was higher than that in border counties (6.67%). However, the EV isolating rate in border counties (12.09%) was higher than that in inner counties (6.67%) in 2015. Enterovirus B was the predominant species in both 2014 and 2015. No wild type polioviruses and enterovirus D species were detected. Polio-free status was maintained well in Yunnan Province. Key words: Enterovirus; Healthy children; Border areas; Serotyping by gene sequencing

Surveillance and genetic characteristics of echovirus 6 strains isolated from environmental sewage and aseptic encephalitis cases

Objective To analyze the genetic characteristics of echovirus 6 (E-6) strains isolated from patients with acute meningitis/encephalitis syndrome (AMES) in 2014 and sewage samples in 2013—2014 in Shandong province and to investigate their correlations. Methods Enterovirus strains were isolated from cerebrospinal fluid, stool and throat swab samples collected from 940 cases of AMES and 96 sewage samples used for environmental surveillance. The positive isolates were identified by molecular typing method. Homologous and phylogenetic analyses based on the VP1 sequences of E-6 isolates were performed. Results Altogether 47 E-6 strains were isolated from patients with AMES in 2014, accounting for 29.56% of all isolated enteroviruses (EVs) strains. No E-6 strains were isolated from AMES cases in 2013. Data of the environmental surveillance showed that E-6 virus strains had been frequently detected in sewage samples since the summer of 2013 to the end of 2014. In total, 40 E-6 virus strains were isolated (7.87% of total isolated EVs strains) in 2013 and 139 E-6 virus strains (26.18%) in 2014. Phylogenetic analysis indicated that the E-6 isolates recruited in this study belonged to clusters A and C with high intracluster sequence identities between AMES and environmental isolates. The nucleotide identities were 98.3%-100% among cluster A E-6 virus strains isolated from AMES cases in 2014 and 96.6%-100% among cluster A E-6 virus environmental isolates during the surveillance year 2013—2014. The cluster A E-6 virus strains shared 97.1%-100% nucleotide identities between the AMES and environmental isolates. For cluster C E-6 virus strains, the nucleotide identities were 100%, 98.7%-100% and 99.1%-100%, respectively. Conclusion The epidemic of viral encephalitis in Shandong province in 2014 was associated the transmission of two lineages of E-6 virus. Environmental surveillance revealed the potential epidemic of E-6 virus even before the epidemic of viral encephalitis in Shandong province, indicating the possibility of using environmental surveillance for early warning of related diseases. Key words: Viral meningitis; Viral encephalitis; Environmental surveillance; Human echovirus 6; Sequence homology; Phylogeny

Echoviruses diagnosed in two Children presenting with Acute Flaccid Paralysis (AFP): An Illustration of the Evolving role of the Zambian AFP Surveillance Programme in the Absence of Polio

Background: The Enteric Cytopathic Human Orphan virus commonly referred to by the acronym ECHO virus has been known to cause acute flaccid paralysis (AFP). Zambia has since 1993 run a national AFP surveillance program to primarily detect and confirm poliomyelitis cases. Through this program other enteroviruses have been confirmed to be associated to the non-polio cases. We describe two patients with acute flaccid paralysis presenting like poliomyelitis and yet are non-polio cases associated with ECHO virus.Case reports: In March 1995, a 2 year old male from Misisi compound, presented at the UTH with muscle weakness and paralysis of sudden onset. Aside from the acute flaccid paralysis presenting in both legs and arms, the child had no other signs of symptoms of significance. Laboratory investigations using the WHO polio laboratory network standard protocols revealed the presence of ECHO 7 virus. In April 1995, a 4 year old girl from Kamwala South in Lusaka presented at the UTH with symptoms and signs of AFP of asymmetrical presentation affecting the Left upper and lower limbs, fever and sore throat. Two stool specimens collected for laboratory analysis revealed the presence of Echovirus untyped.Discussion: AFP is a neurological condition primarily suspected as a poliomyelitis commonly seen in children below 15 years defined by sudden onset of weakness and floppiness affecting usually one or more limbs. Laboratory analysis has revealedother viruses including the Echovirus being associated with acute flaccid paralysis. This case series reveals Echovirus 7 and Echovirus untyped as being associated with AFP cases that presented to the UTH initially suspected to be poliomyelitis.Conclusion: The clinical manifestations and laboratory results provide evidence of ECHO virus causing acute flaccid paralysis similar to that caused by polio virus. The last wild polio cases circulating in Zambia were in 2001. It is important that Zambia continues to investigate other causes of AFP for clinical decision making, scientific documentation and policy guidance.

心臓交感神経過亢進が関連したと考えられた浸水性肺水腫の1例(Immersion pulmonary edema due to sympathetic over–activation of heart: a case report)

要旨浸水性肺水腫（Immersion Pulmonary Edema，以下IPE）とは潜水や水泳で急性発症する肺水腫であり，多くは速やかに改善するが死亡例の報告もある。IPEの発症機序は不明な点が多く，非心原性肺水腫であると報告されていたが，近年では一過性心筋障害が関与している可能性が報告されている。今回我々は，一過性の心筋トロポニン上昇と心臓壁運動低下を認め，心臓核医学検査で交感神経過亢進と考えられる所見を認めたIPE症例を経験したので報告する。【症例】52歳の女性。水温18°C，最大深度8.4m，平均深度5.5m，潜水時間20分のSCUBAダイビングを行った。潜水中にトラブルはなかったが，浮上後5分程度で呼吸困難が出現したため近医を受診し，減圧症の可能性が考えられ当院に転院搬送となった。来院時の胸部単純レントゲン及び胸部単純CTでは両側肺水腫を認めた。また心筋トロポニンの軽度上昇，心電図検査では非特異的STの変化，心臓超音波検査では軽度の瀰漫性壁運動低下を認めた。肺水腫に伴う低酸素血症の診断で人工呼吸器管理下に集中治療を行った。翌日，肺水腫と低酸素血症は著明に改善し呼吸器を離脱し，第11病日に合併症なく退院となった。入院中の検査では，冠動脈CTで有意狭窄はなく，第2，第3病日の心臓超音波検査は正常であった。また第9病日に行った心筋SPECT MIBGシンチグラフィでは明らかな心筋障害はなかったが，交感神経過亢進と考えられる所見があった。経過，検査結果より減圧症・動脈ガス塞栓・急性冠症候群などは否定的であった。来院時は心筋障害を示す検査結果であったが，症状軽快後の心臓核医学検査では心筋障害はないことから，本症例は交感神経過亢進に伴う一過性心筋障害が関与したIPEと考えた。ダイビングは運動負荷や冷水刺激等により交感神経が刺激されることからIPE発症機序の一つに交感神経過亢進による一過性心筋障害の可能性があると考える。