Predominance of enterovirus B and echovirus 30 as cause of viral meningitis in a UK population

doi:10.1016/j.jcv.2016.06.007

Journal of Clinical Virology

Volume 81, August 2016, Pages 90-93

https://doi.org/10.1016/j.jcv.2016.06.007 Get rights and content

Highlights

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Enterovirus B is still the predominant cause of aseptic or viral meningitis.
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Echovirus 30 is the predominant serotype in adults.
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Few 1–17-year olds present with viral meningitis in this study.
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These echovirus 30 VP1 sequences cluster closely with those from Europe and China.
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More surveillance is required, though this is difficult to perform using CSF samples.

Abstract

Background/Objectives

Enteroviruses are the most common cause of aseptic or lymphocytic meningitis, particularly in children. With reports of unusually severe neurological disease in some patients infected with enterovirus D68 in North America, and a recent increase in the number of paediatric enterovirus meningitis cases presenting in this UK Midlands population, a retrospective regional surveillance study was performed.

Study design

Cerebrospinal fluid (CSF) samples received were tested using the polymerase chain reaction (PCR) for HSV-1/2, VZV, enteroviruses and parechoviruses. Enterovirus PCR positive CSF samples were sent for further serotyping. A phylogenetic tree was constructed of the echovirus 30 VP1 sequences, where sufficient sample remained for sequencing.

Results

The number of enterovirus positive CSFs from each year were: 21 (2008), 7 (2011), 53 (2012), 58 (2013) and 31 (2014). Overall, 163 of the 170 serotyped enteroviruses belonged to the species B (echovirus 5, 6, 7, 9, 11, 13, 16, 17, 18, 21, 25, 30; coxsackie B1, B2, B3, B4, B5, A9), with only 7 belonging to species A (coxsackie A2, A6, A16 and enterovirus 71). Echovirus 30 was the predominant serotype overall, identified in 43 (25.3%) of samples, with a significantly higher proportion in the adult age group (37.3%) compared to the infant age group (12.3%). Phylogenetic analysis showed that these UK Midlands echovirus 30 VP1 sequences clustered most closely with those from Europe and China.

Conclusion

This study showed a continued predominance of echovirus 30 as a cause of viral meningitis, particularly in adults, though more surveillance is needed.

Section snippets

Background/objectives

Viral meningitis is usually a self-limiting disease, affecting all ages, typically presenting with fever, headache, neck stiffness, photophobia, nausea and vomiting. Enteroviruses (EVs) are the most common cause of such aseptic or lymphocytic meningitis, particularly in children. Various studies over several decades have shown that enteroviruses are the predominant causal agents for this disease, with echovirus 30 being one of the commonest [10], [3], [4].

With the appearance of unusually severe

Study design

Cerebrospinal fluid (CSF) samples collected by clinicians (neonatal, paediatric, adult, neurology, etc.) according to their local clinical protocols were sent for the investigation, i.e. neonates with generalised sepsis, where CSF was taken as part of the general work up; or older children and adults who presented with typical features of viral meningitis (fever, headache, photophobia and/or neck stiffness).

Each sample was tested using real-time polymerase chain reaction (PCR) assays for:

Results

The number of enterovirus positive CSFs from each year (by collection date) were: 21 (2008), 7 (2011), 53 (2012), 58 (2013) and 31 (2014). Overall, 163 of the 170 samples sent for serotyping belonged to species B enteroviruses (echovirus 5, 6, 7, 9, 11, 13, 16, 17, 18, 21, 25, 30; coxsackie B1, B2, B3, B4, B5, A9), with only 7 belonging to species A enteroviruses (coxsackie A2, A6, A16 and enterovirus 71).

Echovirus 30 was the predominant serotype, overall, identified in 43 (25.3%) of samples,

Discussion

The most striking findings in this study were the continued predominance of the enterovirus B species, particularly echovirus 30, as causes of viral meningitis and the marked predilection for the infant and adult age groups. This is consistent with other recent studies [14], [9], [4].

A large proportion of the enterovirus positive CSF samples originated from infants, which was likely the result of local clinical assessment and sampling protocols, with 82/170 (48.2%) of cases in infants (i.e.

Conflict of interest

None of the authors have any conflicts of interest to declare.

Funding

None.

Ethical approval

Not required.

Competing interests

None declared.

Acknowledgements

The contents of this paper were presented, in part, at the: 12th International Conference on Molecular Epidemiology and Evolutionary Genetics of Infectious Diseases (MEEGID), 11–13 December 2014, Bangkok, Thailand; and the 25th European Conference on Clinical Microbiology and Infectious Diseases (ECCMID), 25–28 April 2015, Copenhagen, Denmark. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England.

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Citation Excerpt :
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Short communicationPredominance of enterovirus B and echovirus 30 as cause of viral meningitis in a UK population

Highlights

Abstract

Background/Objectives

Study design

Results

Conclusion

Section snippets

Background/objectives

Study design

Results

Discussion

Conflict of interest

Funding

Ethical approval

Competing interests

Acknowledgements

J. Clin. Virol.

Lancet Infect. Dis.

Clin. Microbiol. Infect.

J Clin Virol.

J. Clin. Virol.

Centers for disease control and prevention (CDC). acute flaccid paralysis with anterior myelitis – California, June 2012-June 2014

MMWR Morb. Mortal. Wkly. Rep.

Molecular and epidemiological characterization of enteroviruses isolated in Chungnam, Korea from 2005 to 2006

J. Microbiol. Biotechnol.

Short communication
Predominance of enterovirus B and echovirus 30 as cause of viral meningitis in a UK population