Identification and Phylogenetic Characterization of Human Enteroviruses Isolated from Cases of Aseptic Meningitis in Brazil, 2013–2017

Abstract

Aseptic meningitis is a common viral infection associated with human enteroviruses. The aim of the present study was to identify and characterize the enteroviruses associated with outbreaks and sporadic cases of aseptic meningitis that occurred in different regions of Brazil between 2013 and 2017. Cerebrospinal fluids obtained from patients admitted to public health facilities were analyzed. A total of 303 patients were positive for Human Enteroviruses (EV) by cell culture isolation with a median isolation rate throughout the year of 12%. We were able to identify enterovirus serotypes in 295 clinical specimens. Nineteen different serotypes were identified; the large majority corresponded to HEV-B species. Echovirus 30 (E-30) and Echovirus 6 (E-6) were the most prevalent genotypes (66.8%). Sequence analysis suggested that circulating E-30 was closely related to E-30 from other American countries; while E-6 was derived from Europe. Most of the patients consisted of children ≤ 15 years old. The temporal distribution of all aseptic meningitis and EV-positive cases showed an obvious seasonal pattern during autumn. Our results have provided valuable information about the enteroviral etiology of the aseptic meningitis cases in Brazil pointing to the importance of enterovirus surveillance in neurological diseases.

Molecular characterization and epidemiological aspects of non-polio enteroviruses isolated from acute flaccid paralysis in Brazil: a historical series (2005–2017)

“…According to previous studies, E6 and E11 have been the most commonly detected EV types, especially among patients showing severe central nervous system syndromes [16,30,33,[42][43][44]. In this investigation, EV-A71 was the main pathogen associated with AFP (7.6%), followed by E6 (7.3%) and E11 (6.7%) suggesting a high occurrence of these types from 2005 to 2017.…”

Enterovirus and Encephalitis

“…Serotype CNS symptoms References Huang Y. et al, 2015;Mao et al, 2016;B'Krong et al, 2018;Suresh et al, 2018;Ramalho et al, 2019 EV CV-A16 E/M/AFP Goto et al, 2009;Xu et al, 2012;Huang Y. et al, 2015;Holmes et al, 2016;Suresh et al, 2018 B CV-A9 E/M/AFP Holmes et al, 2016;Chen et al, 2017;B'Krong et al, 2018;Suresh et al, 2018;Ramalho et al, 2019;Sun et al, 2019 CV-B1 E/M/AFP Holmes et al, 2016;B'Krong et al, 2018;Suresh et al, 2018;Fan and Liu, 2019;Ramalho et al, 2019;Sun et al, 2019 CV-B2 E/M/AFP Holmes et al, 2016;B'Krong et al, 2018;Suresh et al, 2018;Fan and Liu, 2019;Ramalho et al, 2019 CV-B3 E/M/AFP Holmes et al, 2016;Mao et al, 2016;Mao et al, 2018;Suresh et al, 2018;Fan and Liu, 2019;Ramalho et al, 2019;Sun et al, 2019 CV-B4 E/M/AFP Holmes et al, 2016;Mao et al, 2016;B'Krong et al, 2018;Mao et al, 2018;Suresh et al, 2018;Sun et al, 2019 CV-B5 E/M/AFP Holmes et al, 2016;Mao et al, 2016;Chen et al, 2017;…”

“…Non-polio enteroviruses are also known to infect the CNS and account for the majority of recent enteroviral infections with neurological disorders. Among the non-polio enteroviruses, the species Enterovirus A like enterovirus 71 (EV-A71), coxsackievirus A6 (CV-A6), and CV-A16 (Goto et al, 2009;Xu et al, 2012;Huang Y. et al, 2015;Holmes et al, 2016;B'Krong et al, 2018;Suresh et al, 2018), the species Enterovirus B like CV-B1 (Sun et al, 2019), CV-B3 (Fan and Liu, 2019), CV-B5 (Mao et al, 2018), CV-A9, Echovirus 6 (E-6), E-7, E-11, and E-13 (Holmes et al, 2016;Chen et al, 2017;B'Krong et al, 2018;Suresh et al, 2018;Chen et al, 2019;Ramalho et al, 2019;Sun et al, 2019), the species Enterovirus C like CV-A24 (Tapparel et al, 2013;B'Krong et al, 2018;Suresh et al, 2018), and the species Enterovirus D like EV-D68 (Tapparel et al, 2013;Messacar et al, 2018) have been shown to involve the CNS and cause diverse neurological complications such as encephalitis, meningitis and acute flaccid paralysis (AFP) (Tapparel et al, 2013) (see Table 1 for details).…”

“…Holmes et al, 2016;Chen et al, 2017;B'Krong et al, 2018;Suresh et al, 2018;Ramalho et al, 2019; Sun et al, 2019 E-7 E/M/AFPTapparel et al, 2013;Holmes et al, 2016;Suresh et al, 2018;Ramalho et al., 2019 E-9 E/M/AFP Holmes et al, 2016; B'Krong et al, 2018; Suresh et al, 2018; Ramalho et al, 2019; Sun et al, 2019 E-11 E/M/AFP Holmes et al, 2016; Suresh et al, 2018; Ramalho et al, 2019; Sun et al, 2019 E-12 M/AFP Tapparel et al, 2013; B'Krong et al, 2018; Suresh et al, 2018 E-13 E/M/AFP Tapparel et al, 2013; Holmes et al, 2016; Suresh et al, 2018; Ramalho et al, 2019 E-14 E/M/AFP Chen et al, 2017; Suresh et al, 2018; Ramalho et al, 2019; Sun et al, 2019 E-15 M/AFP Suresh et al, 2018; Ramalho et al, 2019 E-16 E/M/AFPHolmes et al, 2016;B'Krong et al, 2018;Suresh et al, 2018;Sun et al, 2019 E-17 E/M/AFPTapparel et al, 2013;Holmes et al, 2016;Suresh et al, 2018 E-18 E/M/AFPHolmes et al, 2016;Chen et al, 2017;B'Krong et al, 2018;Suresh et al, 2018;Chen et al, 2019; Ramalho et al., 2016;B'Krong et al, 2018;Suresh et al, 2018;Ramalho et al, 2019;Sun et al…”

Molecular typing and characterization of a novel genotype of EV-B93 isolated from Tibet, China

“…AFP is not a single disease type, but a group of syndromes characterized by an acute onset, decreased muscle tone, decreased muscle strength, and reduction or complete loss of tendon reflexes. Poliovirus is one of the major causes of AFP and belongs to EV-C [18,19]. Children are prone to acute paralysis syndrome mainly because the neuro-immune system of infants and young children is not yet mature; their immune function is weak and susceptible to viral infection, and their nervous system is still developing.…”