An approach for differentiating echovirus 30 and Japanese encephalitis virus infections in acute meningitis/encephalitis: a retrospective study of 103 cases in Vietnam

Abstract

BackgroundIn recent decades, Echovirus 30 (E30) and Japanese encephalitis virus (JEV) have been reported to be the common causative agents of acute meningitis among patients in South East Asia. An E30 outbreak in Vietnam in 2001–2002 gained our interest because the initial clinical diagnosis of infected patients was due to JEV infection. There are few clinical insights regarding E30 cases, and there are no reports comparing E30 and JEV acute meningitis/encephalitis cases based on clinical symptoms and case histories. We therefore aimed to identify reliable clinical methods to differentiate E30 and JEV acute meningitis/encephalitis.MethodsA retrospective, cross-sectional study was conducted to compare E30 and JEV acute meningitis/encephalitis cases. We collected and analyzed the clinical records of 43 E30 confirmed cases (E30 group) and 60 JEV confirmed cases (JEV group). Clinical data were compared between the E30 and the JEV groups. Differences of clinical parameters were analyzed by certain statistical tests.ResultsFever, headache, and vomiting were the most common symptoms in both the E30 and the JEV groups. Combined symptoms of headache and vomiting and the triad of symptoms of fever, headache, and vomiting were observed in more patients in the E30 group (E30 vs. JEV: 19% vs. 0%, p < 0.001; 74% vs. 27%, p < 0.001, respectively). On the other hand, strong neurological symptoms such as seizure (5% vs. 73%, p < 0.001) and altered consciousness (12% vs. 97%, p < 0.001) were manifested primarily in the JEV group. CSF leukocytosis was observed predominantly in the E30 group (80 vs. 18 cells/μL, p = 0.003), whereas decreasing CSF sugar level was observed predominantly in the JEV group (58.7 vs. 46.9 mg/dL, p < 0.001).ConclusionFever, headache, vomiting, absence of neurological symptoms (seizure, altered consciousness), and presence of CSF leukocytosis are important parameters to consider in differentiating E30 from JEV cases during early infection. Then, proper measures can be adopted immediately to prevent the spread of the disease in the affected areas.

Surveillance of enteroviruses from paediatric patients attended at a tertiary hospital in Catalonia from 2014 to 2017

“…It is well-known that one EV type can be related to several clinical manifestations, and inversely. CV-A10, E-5, E-30, CV-B3, and EV-C109 were also associated with neurological affections, as previously described [28][29][30][31], in addition to milder diseases. Instead, E-6 was only related to respiratory symptoms or fever, in discordance with previous studies [32].…”

Enterovirus serotypes in patients with central nervous system and respiratory infections in Viet Nam 1997–2010

“…These two viruses have frequently been involved in outbreaks of aseptic meningitis worldwide [ 35 , 36 ]. While E-30 has been confirmed to be the cause of a meningoencephalitis outbreak in northern Viet Nam previously [ 37 ], E-4 has yet been associated with any local epidemic of viral meningitis among children and young adults.…”

Epidemiology of Japanese encephalitis: past, present, and future prospects

“…On the other hand, sporadic JE cases were reported throughout the year. 146 , 147 JEV was first isolated in 1951. 145 …”