Distribution of species enterovirus B in patients with central nervous system infections in São Paulo State, Brazil

Abstract

Enteroviruses (EV) are most common cause of central nervous system (CNS) infection, mainly aseptic meningitis. In Brazil, data available concerning the distribution of EV types are scarce. The aim of this study was to describe of types EV in patients with infection of the CNS in São Paulo State. This retrospective study was conducted in clinical samples collected from patients with infections of the CNS from 2004 to 2014. We investigated the presence of EV by virus isolation in cell culture. The samples that showed cytopathic effect in the cell culture were submitted by indirect immunofluorescence assay, reverse transcription polymerase chain reaction and VP1 partial sequencing to identification of EV isolated. A total of 176 EV isolated in cell culture was detected and typed in 14.5% (n = 176/1215) of clinical samples analyzed; corresponding to 71.0% of AM, and 19.3% of encephalitis and meningoencephalitis. Echoviruses (E) were isolated most frequently, with 155 strains (88.1%), Coxsackievirus B (CV‐B), with 20 cases (11.4%), CV‐A, with 01 case (0.6%). E‐6 was the most commonly identified followed in decreasing order by E‐30; E‐18; CV‐B5; E‐4; E‐11; CV‐B2 and E‐9; E‐7; CV‐A9, CV‐B1, CV‐B3, CV‐B4, E‐13, E‐14, and E‐21. EV detected were classified as belonging to the species enterovirus B. EV were detected in all the period of the year with the highest rate in the spring and summer months. Data obtained in this study contribute to the knowledge about EV circulation implicated in CNS infections over a 11‐year period in São Paulo State, Brazil.

High Heterogeneity of Echoviruses in Brazilian Children with Acute Gastroenteritis

“…This is especially valuable considering the capacity of EV to remain in asymptomatic circulation in populations [6]. The data obtained here together with recent reports [17,43,46,47] reinforce the urgent need to establish an effective non-polio EV surveillance system in Brazil.…”

“…The majority of E11 detection occur in infants aged <1 year [63], as observed here. E11 was detected in 6.7% of the stool samples analyzed from symptomatic acute flaccid paralysis patients in Brazil [48], and a regular distribution of its association with aseptic meningitis cases has also been reported [43,46], suggesting a high occurrence of this genotype in this country. Phylogenetic analysis of the VP1 gene has indicated the existence of multiple E11 lineages and/or subtypes [61].…”

“…A continuous circulation of E30 in Brazil has been observed since 1998, and VP1 gene phylogenetic analysis suggests that distinct E30 introductions occurred in this country [21]. The vast Brazilian territory associated with recurrent E30 detection throughout the decades [21,43,44,46,49] highlights the importance of continuous EV clinical surveillance.…”

“…E30 consistently appeared among the most commonly reported EV worldwide, particularly associated with aseptic meningitis, including in Brazil [7,43,46]. Waves of E30 activity are associated with distinct new genomic lineages, which usually replace ones that were previously circulating [8,71,72].…”

“…Multiple investigations have described the molecular epidemiology of echovirus globally in both clinical and environmental samples [13,42,43] including in Brazil [16,36]. Nevertheless, there are limited echovirus nucleotide sequences available in the GenBank database [21,[44][45][46][47][48], especially full-genome sequences [6].…”