Enterovirus A71 Infection and Neurologic Disease, Madrid, Spain, 2016

Niño-Taravilla, Carmen; Perez-Sebastian, I; García-Salido, Alberto; Serrano, Claudia Varela; Extremera, Verónica Cantarín; Rodríguez, A. Duat; Marín, Laura López; Sanz, Mercedes Alonso; Traba, Olga María Suárez; González, Alberto Sánchez

doi:10.3201/eid2501.181089

Cited by 18 publications

(16 citation statements)

References 40 publications

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“…Outcome of EV-A71 infection was very good (84.6% of patients asymptomatic 60 days following the onset), which is in accordance with reports from other Spanish series. [7][8][9][10][11][12][13] Nevertheless, this contrasts with reports of previous outbreaks in Asia in which grade III rhombencephalitis was more frequent and several deaths were reported. 6 Further investigations are needed to clarify if these differences are due to different strains of EV-A71 in each outbreak or to genetic individual susceptibility of the host-low expression of CD40 and IL-4, HLA genotype, CTLA-4 expression 1 -among other factors.…”

Section: Discussioncontrasting

confidence: 84%

“…Brainstem encephalitis caused by EV-A71, which was rarely observed in these regions previously, manifested mainly with ataxia, lethargy, tremor, myoclonus, and dysmetria (grade I rhombencephalitis 6 in 30 cases) in accordance with what has been described in previous reports. [7][8][9][10][11][12][13] Additionally, seven patients presented with cranial nerve involvement (grade II rhombencephalitis 6 ). Only one patient had mild dysautonomic signs but could not be classified as grade III rhombencephalitis (no coma, apnea or shock reported).…”

Section: Discussionmentioning

confidence: 99%

“…The geographical distribution of cases was variable according to the different reports: Catalonia had the first and most numerous reports with 65 confirmed cases of EV-A71 with neurological involvement 8,9 followed by other crowded regions as Madrid (26 cases). 10,11 In other regions, sporadic cases were reported: only one case of aseptic meningitis by EV-A71 was reported in the Balearic Islands 12 and four not-typed EV related with brainstem encephalitis in Andalusia. 13 Phylogenetic analysis showed that most of these EV-A71 belonged to subgenogroup C1 7 that had not previously been detected in Spain 14 and seemed related to EV-A71 C1 viruses identified in Germany 15,16 and France, 17 which probably spread to Spain.…”

Section: Introductionmentioning

confidence: 99%

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Outbreak of Enterovirus Infection with Neurological Presentations in a Pediatric Population in Northern Spain: A Clinical Observational Study

et al. 2021

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Objective The study aimed to describe the cases of neurological disease related to the outbreak of enterovirus (EV) in three regions in Northern Spain during 2016. Materials and Methods Multicenter retrospective observational study. Clinical, radiological, and microbiological data were analyzed from patients younger than 15 years with confirmed EV-associated neurological disease admitted to 10 hospitals of Asturias, Cantabria, and Castile and Leon between January 1 and December 31, 2016. Results Fifty-five patients were included. Median age was 24 months (interquartile range = 18.5 months). Fifteen patients were classified as aseptic meningitis (27.3%). In total, 37 cases presented brainstem encephalitis (67.3%), 25 of them due to EV-A71 with excellent prognosis (84.6% asymptomatic 2 months following the onset). Three cases of acute flaccid myelitis (5.5%) by EV-D68 were reported and presented persistent paresis 2 months following the onset. Microbiological diagnosis by reverse transcriptase polymerase chain reaction was performed in all cases, finding EV in cerebrospinal fluid in meningitis, but not in brainstem encephalitis and acute flaccid myelitis, where EV was found in respiratory or rectal samples. Step therapy was administrated with intravenous immunoglobulin (IVIG; 32.7%), methylprednisolone (10%), and plasmapheresis (3.6%). Four patients received fluoxetine (7.3%). Twenty patients needed to be admitted to pediatric intensive care unit (36.4%). Conclusion Clinical, microbiological, and radiological diagnosis is essential in outbreaks of EV neurological disease, taking into account that it can be difficult to identify EV-A71 and EV-D68 in CSF, requiring throat or rectal samples. There is not specific treatment to these conditions and the efficacy and understanding of the mechanism of action of immune-modulatory treatment (IVIG, corticosteroids, and plasmapheresis) is limited.

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Section: Discussioncontrasting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Outbreak of Enterovirus Infection with Neurological Presentations in a Pediatric Population in Northern Spain: A Clinical Observational Study

et al. 2021

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“…Another study reported some additional cases of EV-A71 infection in children in that same year (2016) in Spain, but without neurological involvement [15]. This genotype was previously detected in other European countries (Germany and France) [18], and later (2018) in the United States, although these outbreaks were milder than those in Spain [19].…”

Section: Introductionmentioning

confidence: 66%

Neurological Disease Associated With Enterovirus Infection: Retrospective Analysis of Risk Factors in a Pediatric Population

Turón-Viñas

Gómez

Calderón

et al. 2022

Preprint

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Enteroviruses are a type of RNA-strained virus with more than 100 different genotypes. Infection can be asymptomatic, or symptoms can range from mild to severe. Some patients can develop neurological involvement, such as aseptic meningitis, encephalitis, or even cardiorespiratory failure. However, in children, the risk factors for developing severe neurological involvement are not well understood. The aim of this retrospective study was to determine the risk factors associated with severe neurological involvement in children hospitalized for neurological disease after enterovirus infection. One-hundred and seven children hospitalized from 2009 to 2019 were included. Patients were classified according to the World Health Organization case definition for neurological complications in hand, foot and mouth disease. Our findings showed that, in children between age 2 and 5, the appearance of neurological symptoms within the first 12 hours from infection onset—especially if associated with skin rash—was a significant risk factor for severe neurological involvement. Detection of enterovirus in cerebrospinal fluid was more likely in patients with aseptic meningitis. By contrast, other biological samples (e.g., feces or nasopharyngeal fluids) were necessary to detect enterovirus in patients with encephalitis. The genotype most commonly associated with the most severe neurological conditions was EV-A71. E-30 was mostly associated with aseptic meningitis. Awareness of the risk factors associated with worse neurological outcomes could help clinicians to better manage these patients to avoid unnecessary admissions and/or ancillary tests.

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“…Age, gender, and host immune status can influence the clinical presentation and severity of infection [10]. Furthermore, emerging enterovirus variants have been recognized worldwide as causes of severe clinical manifestations in both sporadic and epidemic cases [11][12][13][14][15][16][17][18].…”

Section: Introductionmentioning

confidence: 99%

Molecular Characterization and Clinical Description of Non-Polio Enteroviruses Detected in Stool Samples from HIV-Positive and HIV-Negative Adults in Ghana

Cristanziano

Weimer

Böttcher

et al. 2020

Viruses

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In the post-polio eradication era, increasing attention is given to non-polio enteroviruses. Most of the data about enteroviruses in sub-Saharan Africa are related to acute flaccid paralysis surveillance and target the pediatric population. This study aimed to investigate the presence of enterovirus in PLHIV (people living with HIV) and HIV-negative individuals in Ghana. Stool samples from HIV-positive individuals (n = 250) and healthy blood donors (n = 102) attending the Komfo Anokye Teaching Hospital in Kumasi, Ghana, were screened by real-time PCR for enterovirus. Molecular typing of the VP1 region was performed. Enterovirus-positive samples were tested for norovirus, adenovirus, rotavirus, sapovirus, and cosaviruses. Twenty-six out of 250 HIV-positive subjects (10.4%) and 14 out of 102 HIV-negative individuals (13.7%) were detected enterovirus-positive, not showing a significant different infection rate between the two groups. HIV-negative individuals were infected with Enterovirus C strains only. HIV-positive participants were detected positive for species Enterovirus A, Enterovirus B, and Enterovirus C. Co-infections with other viral enteric pathogens were almost exclusively detected among HIV-positive participants. Overall, the present study provides the first data about enteroviruses within HIV-positive and HIV-negative adults living in Ghana.

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Enterovirus A71 Infection and Neurologic Disease, Madrid, Spain, 2016

Abstract: For children with brainstem encephalitis or encephalomyelitis, clinicians should look for enterovirus and not limit testing to cerebrospinal fluid.

Cited by 18 publications

References 40 publications

Outbreak of Enterovirus Infection with Neurological Presentations in a Pediatric Population in Northern Spain: A Clinical Observational Study

Outbreak of Enterovirus Infection with Neurological Presentations in a Pediatric Population in Northern Spain: A Clinical Observational Study

Neurological Disease Associated With Enterovirus Infection: Retrospective Analysis of Risk Factors in a Pediatric Population

Molecular Characterization and Clinical Description of Non-Polio Enteroviruses Detected in Stool Samples from HIV-Positive and HIV-Negative Adults in Ghana

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