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Epidemics of viral meningitis caused by echovirus 6 and 30 in Korea in 2008.

Kim HJ, Kang B, Hwang S, Hong J, Kim K, Cheon DS - Virol. J. (2012)

Bottom Line: In Korea, Echovirus type 30 (E30) and E6 have been associated with outbreaks and frequent meningitis.We did not observe a higher fatality rate in children with E6 or E30 infection.Identification of E6 and E30 as the prominent EVs in the 2008 outbreak in South Korea shows the potential of EVs to cause a serious disease in an unpredictable (fashion.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Enteric and Hepatitis Viruses, Center for Infectious Diseases, National Institute of Health, Korea Center for Disease Control and Prevention, South Korea.

ABSTRACT

Background: Enteroviruses (EVs) are the leading cause of aseptic meningitis, which is the most frequent central nervous system infection worldwide. We aimed to characterize the EVs involved in an aseptic meningitis outbreak in Korea in 2008. In Korea, Echovirus type 30 (E30) and E6 have been associated with outbreaks and frequent meningitis.

Methods: During 2008, through nationwide surveillance, we collected specimens from 758 patients with aseptic meningitis-related clinical manifestations. The detection of EVs from specimens was subjected to a diagnostic real-time RT-PCR in the 5' NCR. A semi-nested polymerase chain reaction (PCR) to amplify sequences from the VP1 region and sequence comparison with reference strains registered in Genbank was performed for the genotype determination.

Results: Most patients (98%) in this outbreak were children < 15 years of age. The temporal distribution of the E6 and E30 epidemics showed an obvious seasonal pattern during the short period from June to July. A large majority of the EV-positive patients experienced fever, headache, vomiting, and neck stiffness. Some patients also showed cold symptoms, sore throat, altered mental status, and seizures. We did not observe a higher fatality rate in children with E6 or E30 infection. Most of the patients recovered uneventfully. In most cases, the cerebrospinal fluid (CSF) profile was studied, and generally showed a higher than normal white blood cell count (≥ 5/mm(3)). We detected EVs from 513 patients (67.68%) and identified the EV genotype in 287 patients. E30 (n = 155, 50.4%) and E6 (n = 95, 33.1%) were the predominant genotypes. E9, E1, E7, E16, coxsackievirus A3, 4, 6, coxsackievirus B1, 3, and 10 were also identified. According to phylogenetic analysis, E30 belonged to subgroup 4b, and E6, to the C4 subgroup.

Conclusions: Conclusively, aseptic meningitis was the most common manifestation in children with either echovirus 30 or 6 infection. Identification of E6 and E30 as the prominent EVs in the 2008 outbreak in South Korea shows the potential of EVs to cause a serious disease in an unpredictable (fashion. Our findings provide new) insights into the clinical and virological features of the aseptic meningitis outbreak caused by E30 and E6.

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Phylogram based on the alignment of the E30 VP1 gene nucleotide sequences. Phylogenetic tree based on the alignment of the VP1 nucleotide sequences showing genetic affinity of the E30 samples from the 2008 outbreak in Korea. The neighbor-joining method with a maximum likelihood distance matrix was used to construct the tree. Numbers at the nodes represent the percentage of 1000 bootstrap pseudoreplicates.
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Figure 3: Phylogram based on the alignment of the E30 VP1 gene nucleotide sequences. Phylogenetic tree based on the alignment of the VP1 nucleotide sequences showing genetic affinity of the E30 samples from the 2008 outbreak in Korea. The neighbor-joining method with a maximum likelihood distance matrix was used to construct the tree. Numbers at the nodes represent the percentage of 1000 bootstrap pseudoreplicates.

Mentions: Three E6 genetic groups designated A, B, and C (subgroups C1, C2, C3, and C4), and 4 E30 genetic groups designated 1, 2, 3, and 4 (subgroups 4a and 4b) have been identified [15,16]. Based on this classification, the E30 detected in the present study belonged to subgroup 4b (Figure 3), and the E6 belonged to subgroup C4 (Figure 4).


Epidemics of viral meningitis caused by echovirus 6 and 30 in Korea in 2008.

Kim HJ, Kang B, Hwang S, Hong J, Kim K, Cheon DS - Virol. J. (2012)

Phylogram based on the alignment of the E30 VP1 gene nucleotide sequences. Phylogenetic tree based on the alignment of the VP1 nucleotide sequences showing genetic affinity of the E30 samples from the 2008 outbreak in Korea. The neighbor-joining method with a maximum likelihood distance matrix was used to construct the tree. Numbers at the nodes represent the percentage of 1000 bootstrap pseudoreplicates.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3298778&req=5

Figure 3: Phylogram based on the alignment of the E30 VP1 gene nucleotide sequences. Phylogenetic tree based on the alignment of the VP1 nucleotide sequences showing genetic affinity of the E30 samples from the 2008 outbreak in Korea. The neighbor-joining method with a maximum likelihood distance matrix was used to construct the tree. Numbers at the nodes represent the percentage of 1000 bootstrap pseudoreplicates.
Mentions: Three E6 genetic groups designated A, B, and C (subgroups C1, C2, C3, and C4), and 4 E30 genetic groups designated 1, 2, 3, and 4 (subgroups 4a and 4b) have been identified [15,16]. Based on this classification, the E30 detected in the present study belonged to subgroup 4b (Figure 3), and the E6 belonged to subgroup C4 (Figure 4).

Bottom Line: In Korea, Echovirus type 30 (E30) and E6 have been associated with outbreaks and frequent meningitis.We did not observe a higher fatality rate in children with E6 or E30 infection.Identification of E6 and E30 as the prominent EVs in the 2008 outbreak in South Korea shows the potential of EVs to cause a serious disease in an unpredictable (fashion.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Enteric and Hepatitis Viruses, Center for Infectious Diseases, National Institute of Health, Korea Center for Disease Control and Prevention, South Korea.

ABSTRACT

Background: Enteroviruses (EVs) are the leading cause of aseptic meningitis, which is the most frequent central nervous system infection worldwide. We aimed to characterize the EVs involved in an aseptic meningitis outbreak in Korea in 2008. In Korea, Echovirus type 30 (E30) and E6 have been associated with outbreaks and frequent meningitis.

Methods: During 2008, through nationwide surveillance, we collected specimens from 758 patients with aseptic meningitis-related clinical manifestations. The detection of EVs from specimens was subjected to a diagnostic real-time RT-PCR in the 5' NCR. A semi-nested polymerase chain reaction (PCR) to amplify sequences from the VP1 region and sequence comparison with reference strains registered in Genbank was performed for the genotype determination.

Results: Most patients (98%) in this outbreak were children < 15 years of age. The temporal distribution of the E6 and E30 epidemics showed an obvious seasonal pattern during the short period from June to July. A large majority of the EV-positive patients experienced fever, headache, vomiting, and neck stiffness. Some patients also showed cold symptoms, sore throat, altered mental status, and seizures. We did not observe a higher fatality rate in children with E6 or E30 infection. Most of the patients recovered uneventfully. In most cases, the cerebrospinal fluid (CSF) profile was studied, and generally showed a higher than normal white blood cell count (≥ 5/mm(3)). We detected EVs from 513 patients (67.68%) and identified the EV genotype in 287 patients. E30 (n = 155, 50.4%) and E6 (n = 95, 33.1%) were the predominant genotypes. E9, E1, E7, E16, coxsackievirus A3, 4, 6, coxsackievirus B1, 3, and 10 were also identified. According to phylogenetic analysis, E30 belonged to subgroup 4b, and E6, to the C4 subgroup.

Conclusions: Conclusively, aseptic meningitis was the most common manifestation in children with either echovirus 30 or 6 infection. Identification of E6 and E30 as the prominent EVs in the 2008 outbreak in South Korea shows the potential of EVs to cause a serious disease in an unpredictable (fashion. Our findings provide new) insights into the clinical and virological features of the aseptic meningitis outbreak caused by E30 and E6.

Show MeSH
Related in: MedlinePlus