Enterovirus meningitis in Brazil, 1998–2003

Abstract

Acute viral infections of the central nervous system (CNS) such as acute flaccid paralysis, meningitis, and encephalitis, are responsible for a high morbidity, particularly in children. Non‐Polio enteroviruses (NPEV) are known to be responsible for over 80% of viral meningitis in which the etiologic agent is identified. In the present study, we show the frequency of enterovirus meningitis in Brazil from December 1998 to December 2003. Enterovirus were isolated from 162 (15.8%), of a total of 1,022 cerebrospinal fluid (CSF) specimens analyzed. Echovirus 30 was identified in 139 of these isolates (139/162–85.2%). Other identified enteroviruses were: Coxsackievirus B5 (3.7%), Echovirus 13 (3.7%), Echovirus 18 (3%), Echovirus 6 (1.2%), Echovirus 25 (1.2%), Echovirus 1 (0.6%), and Echovirus 4 (0.6%). Patients's age ranged from 28 days to 68 years old. The most frequent symptoms were fever (77%), headache (69.5%), vomiting (71.3%), neck stiffness (41.3%), convulsion (7.1%), and diarrhea (3.7%). Although, the majority of the patients recovered without any complication or permanent squeal, five deaths occurred. Throughout the surveillance period, five viral meningitis outbreaks were confirmed: four in the Southern Brazil and one in the Northeast Brazil. Echovirus 30 was responsible for four out of the five outbreaks while Echovirus 13 caused the fifth one. Besides the outbreaks, 734 sporadic cases were also identified during the study period and 59 of these were positive for virus isolation (8%). Echovirus 30 accounted for 70% of the isolates. Our results showed that Echovirus 30 was the most prevalent etiological agent of viral meningitis in Brazil, causing both outbreaks and sporadic cases. J. Med. Virol. 78:98–104, 2006. © 2005 Wiley‐Liss, inc.

RT-PCR for confirmation of echovirus 30 isolated in Belém, Brazil

“…In our study the peak incidence of AM cases occurred in May, at the end of the heavy rainfall period, when the temperature tends to increase. This finding is similar to that reported by dos Santos et al [22]. They examined sporadic cases and outbreaks of meningitis in four Brazilian regions during five years; they found a trend for cases to occur mainly during periods of high temperatures.…”

“…The rate for children up to 5 years old, in our study, was 28.3% (79/279). A higher rate (61.3%, 398/ 648) was reported by dos Santos et al [22] for children up to six-years-old living in other Brazilian regions. It therefore seems that meningitis cases in children up to five years is less common in children living in Belém than in those who live in other Brazilian regions.…”

“…In these cases, the isolation rate was 7.5% (7/94). In another Brazilian study dos Santos et al [22] reported a rate of 15.8% (162/1,022) using RD and HEp-2 cells. A higher rate (53%, 36/ 68) was reported by Guney et al [18] who studied AM in Turkey.…”

“…Sporadic cases have also been reported in the states of Paraná, Rio Grande do Sul (south region) and Rio de Janeiro (southeast region) [22]. The first occurrence of AM caused by Echo 30 in the northern region was reported by Ferreira et al [12] in 2002.…”

“…Outbreaks of AM due to Echo 30 have been reported in the Brazilian states of Paraná, Pernambuco and São Paulo, in the south, northeast and southeast Brazilian regions, respectively [14,15,22]. Sporadic cases have also been reported in the states of Paraná, Rio Grande do Sul (south region) and Rio de Janeiro (southeast region) [22].…”