Enteroviruses in Respiratory Samples from Paediatric Patients of a Tertiary Care Hospital in Germany

Abstract

Enteroviruses are associated with various diseases accompanied by rare but severe complications. In recent years, outbreaks of enterovirus D68 and enterovirus A71 associated with severe respiratory infections and neurological complications have been reported worldwide. Since information on molecular epidemiology in respiratory samples is still limited, the genetic diversity of enteroviruses was retrospectively analysed over a 4-year period (2013–2016) in respiratory samples from paediatric patients. Partial viral major capsid protein gene (VP1) sequences were determined for genotyping. Enteroviruses were detected in 255 (6.1%) of 4187 specimens. Phylogenetic analyses of 233 (91.4%) strains revealed 25 different genotypes distributed to Enterovirus A (39.1%), Enterovirus B (34.3%), and Enterovirus D (26.6%). The most frequently detected genotypes were enterovirus D68 (26.6%), coxsackievirus A6 (15.9%), and enterovirus A71 (7.3%). Enterovirus D68 detections were associated with lower respiratory tract infections and increased oxygen demand. Meningitis/encephalitis and other neurological symptoms were related to enterovirus A71, while coxsackievirus A6 was associated with upper respiratory diseases. Prematurity turned out as a potential risk factor for increased oxygen demand during enterovirus infections. The detailed analysis of epidemiological and clinical data contributes to the non-polio enterovirus surveillance in Europe and showed high and rapidly changing genetic diversity of circulating enteroviruses, including different enterovirus D68 variants.

Whole-genome analysis of coxsackievirus B3 reflects its genetic diversity in China and worldwide

“…To date, CVB3 strains are associated with various diseases, and the manifestations vary from mild respiratory [ 33 ], gastrointestinal infections [ 34 , 35 ], herpangina [ 36 ], and hand, foot, and mouth disease [ 7 , 8 , 37 ], to more severe diseases such as heart disease (including viral myocarditis [ 6 , 38 ], pericarditis [ 39 ], and acute myocardial infarction [ 40 ]), CNS involvement (meningitis [ 30 , 36 , 41 – 43 ], meningo-cerebellitis [ 11 ], encephalitis [ 44 ], and AFP [ 45 – 47 ]), and pancreatic interrelated disease (pancreatitis [ 48 ], diabetes [ 49 ]). More seriously, the virus can cause neonatal sepsis-like illness and sudden death in infected infants [ 38 , 50 ] and adults with low immune function.…”

Phylogenetic characteristics and recombination analysis of echovirus 5 associated with severe acute respiratory infection in China

“…The epidemic of E5 has caused several outbreaks of aseptic meningitis, seriously endangering human health worldwide and causing a heavy disease burden ( 17 ). Information on E5 is less available in respiratory infection studies ( 13 ), which focus mainly on the gastrointestinal tract and central nervous system domains ( 10 , 11 , 20 ). Combining the complete VP1 region and WGS data available in GenBank, we performed the first whole-genomic characterization and evolutionary analysis of E5.…”

“…The genotype classification analysis of most enteroviruses, such as EV-71, CVA9, CVA8, CVA6, and E5 ( 5 – 9 ), is based on this approach. Enteroviruses have been isolated from cases of various diseases, including aseptic meningitis, meningoencephalitis, and gastrointestinal and respiratory diseases ( 10 – 13 ). The prototype strain of Noyce was isolated in the United States in 1954 from patients with aseptic meningitis ( 14 ).…”