Detection of Aichi virus shedding in a child with enteric and extraintestinal symptoms in Hungary

Aichi virus, genus Kobuvirus, family Picornaviridae, has been proposed as a causative agent of gastroenteritis in human. Although high seroprevalence has been detected, it has been identified in only a few cases. We report detection of Aichi virus in Hungary. A total of 65 stool samples were tested retrospectively, collected from children with diarrhea, by reverse transcription-polymerase chain reaction. One (1.5%) sample from a 3-year-old girl was positive. Besides diarrhea, fever, purulent conjunctivitis and respiratory symptoms were also present at the same time with virus shedding. The genotype A virus, Kobuvirus/human/Szigetvar-HUN298/2000/Hungary (FJ225407), has 96% nucleotide identity to Aichi virus.

[First gastroenteritis outbreak caused by sapovirus (GI2) in Hungary - part of an international epidemic?]

Sapovirus belonging to Caliciviridae is one of the known pathogen of sporadic gastroenteritis infections in infants, children and rarely in elderly. Since the beginning of molecular monitoring of caliciviruses (mid 1990's) sapovirus was described rarely, once in approx. 5 years, as source of an outbreak. Circulation of caliciviruses has been monitored with molecular epidemiological methods by authors for 10 years in Hungary. Sapovirus has not been detected yet in the approximately 800 examined non-bacterial gastroenteritis outbreak. Based on the informal data supported by the international calicivirus surveillance study group, the number of outbreaks caused by sapovirus was increasing in Europe in 2008. Supposedly these outbreaks can be linked to genotype GI2 sapovirus.

AIMS

To describe the first verified detection and molecular epidemiological description of a gastroenteritis outbreak caused by sapovirus in Hungary.

MATERIALS AND METHODS

Stool samples originated from Bács-Kiskun County, from a mental deficiency day care center, where a gastroenteritis outbreak occurred in September, 2008. Amplification of the RNA polymerase gene of sapovirus was performed by RT-PCR method and the product was directly sequenced and phylogenetically analyzed. Clinical and epidemiological data were collected by epidemiological investigation.

RESULTS

17 of the 135 exposed people (12.6%) had gastroenteritis with vomiting and diarrhea in the period of September 11-22, 2008. Bacterial pathogens, rotavirus, adenovirus and norovirus were not detected, but sapovirus could be identified in 1 out of the 4 (25%) stool samples. The source of the outbreak was presumably the ill nurse and the virus spread with direct contact among the mentally deficient patients. Based on the RNA polymerase gene region the virus belongs to genotype GI2 sapovirus.

CONCLUSIONS

This study reports on the first detection of sapovirus from gastroenteritis outbreak in Hungary. Epidemiologic and clinical characteristics of the outbreak in the mental deficiency day care center are described in details to prove that not every case is "calicivirus" infection and epidemic is caused by the norovirus, which is another calicivirus examined by diagnostic methods. The outbreak caused by genotype GI2 sapovirus might be the part of an international epidemic, extended into a larger geographic area.

[Detection and molecular epidemiology of respiratory syncytial virus type A and B strains in childhood respiratory infections in Hungary]

Human respiratory syncytial virus (hRSV) is one of the major causes of respiratory infection of infants and children worldwide. The molecular epidemiology of hRSV is unknown in Hungary.

AIMS

Our aims were the molecular detection and genetic analysis of hRSV from childhood respiratory infections in Hungary.

MATERIALS AND METHODS

Nasopharyngeal aspirates were collected from children under the age of 10 years with acute respiratory infections provided by the Pediatric Department of the Hospital for Chest Diseases in Mosdós. Samples were taken from 15 October to 15 May in seasons of 2005/2006 and 2006/2007. The clinical and epidemiological data were collected prospectively. The amplification of the surface fusion glycoprotein (F) and the attachment glycoprotein (G) genes of viral RNA was made by RT-PCR method. PCR-products were sequenced and analyzed by phylogenetic analysis.

RESULTS

Nasopharyngeal aspirates of 104 children were examined out of which 23 (22.1%) samples - 16 males (69.6%) and 7 females (30.4%) - (first season: 1/49, 2%; second season: 22/55, 40%) contained hRSV. The hRSV infections were taking place from December to March. The average age was 2.1 years (1 month to 8 years). The leading symptoms were dropping nose, fever, cough and wheezing. Thirty-nine point one percent of the hRSV infected children had underlying disease. Based upon the F region 22 (96%), viruses genetically belonged to type A and 1 (4%) was classified as type B hRSV. Based upon the G region, out of the 11 type A viruses 8 (72.7%) belonged to group GA5 and 3 (27.3%) to group GA2. Viral nucleotide sequence was identical in several cases.

CONCLUSIONS

To our knowledge, this is the first report on molecular detection and genetic analysis of the two types (A and B) of hRSV of children under the age of 10 with respiratory infections in Hungary. In winter and spring hRSV is an important cause of childhood respiratory infections, particularly in infants, often requiring hospitalization.

Complete nucleotide and amino acid sequences and genetic organization of porcine kobuvirus, a member of a new species in the genus Kobuvirus, family Picornaviridae

Kobuvirus is a new genus in the family Picornaviridae. Two species are currently known: Aichi virus (human kobuvirus) and Bovine kobuvirus (U-1). In this study, the complete nucleotide and amino acid sequences and genetic organization of porcine kobuvirus (Kobuvirus/swine/S-1-HUN/2007/Hungary, EU787450) were determined. The structure of the S-1-HUN genome, VPg-5'UTR-leader protein-structural proteins (VP0, VP3, VP1)-non-structural proteins (2A-2C, 3A-3D)-3'UTR-poly(A) tail, was found to be typical of picornavirus. The 8210-nucleotide (nt)-long RNA genome contains a large open reading frame (7467 nt) encoding a potential polyprotein precursor of 2488 amino acids (aa) that has 57/56% and 63/64% nt/aa identity with Aichi virus and U-1, respectively. The 5'UTR contains a hepacivirus/pestivirus-like internal ribosomal entry site (IRES type IV group-B-like) with conserved pseudoknot, II and IIIa-f domains. A tandem repeat (a 30-amino-acid-long motif) was detected in 2B. Thirty-nine (65%) of the 60 fecal samples from pigs under the age of 6 months at the tested farm were positive (the incidence was 90% under the age of 3 weeks). Porcine kobuvirus belongs to a potential new species-the third-in the genus Kobuvirus.

Genetic drift of norovirus genotype GII-4 in seven consecutive epidemic seasons in Hungary

BACKGROUND

Noroviruses are common pathogens in human gastroenteritis outbreaks worldwide. They belong to a genetically diverse group of RNA viruses with multiple genogroups (G) and genotypes. Genotype GII-4 norovirus (Lordsdale) is the predominant agent in epidemics.

OBJECTIVES

To investigate the genetic variation in GII-4 strains isolated during seven epidemic seasons in Hungary from November 2000 to June 2007.

STUDY DESIGN

Using the prospective epidemiological surveillance of norovirus outbreaks in Hungary, GII-4 strains were selected for further genetic analysis. After phylogenetic analysis, RNA-polymerase (open reading frame 1; ORF1), capsid (ORF2) and the ORF1/ORF2 junction were analysed by RT-PCR and sequencing.

RESULTS

Three hundred and seventy-seven (76.8%) of 491 confirmed norovirus outbreaks were caused by genotype GII-4. GII-4 was the predominant genotype in six of the seven epidemic seasons. Four main GII-4 variants--epidemic point mutants--(GII-4-2000, GII-4-2002, GII-4-2004 and GII-4-2006b) were detected, with each variant predominating in two consecutive epidemic seasons.

CONCLUSIONS

Genotype GII-4 was confirmed as the predominant genetic type in epidemic norovirus seasons in Hungary. Genetic drift successfully promotes the re-emergence of GII-4 variants in the population. The elevated number of norovirus outbreaks in the population predicts the emergence of new GII-4 genetic variants as part of an international epidemic.

[Hepatitis A outbreak in Transdanubia (Hungary): molecular connections and epidemiological conclusions - 2006]

INTRODUCTION

Hepatitis A virus (HAV) is one of the most important cause of fecally transmitted acute infectious hepatitis worldwide. In Hungary, beside the sporadic HAV infections, outbreaks also occur, particularly in Northeast part of the country where the subgenotype IA is endemic. The reported number of HAV cases was less than 10 per year in Southwest Hungary.

AIMS

A part of the European HAV surveillance, the author's aims were to follow and to analyze the outbreak of hepatitis A in Transdanubia (Southwest Hungary) in 2006 by molecular epidemiological methods.

MATERIALS AND METHODS

Sera samples from symptomatic patients were tested prospectively by enzyme-immunoassay (EIA) and reverse transcription-polymerase chain reaction (RT-PCR) followed by sequence- and phylogenetic analysis.

RESULTS

Between June and December 2006, a total of 115 serum samples were positive for HAV IgM antibody in Southwest Hungary. Thirty (76.9%) of the 39 samples were RT-PCR-positive and contain genetically identical subgenotype IB hepatitis A virus (HAV/Transdanubia/2006/HUN) which has 100% nucleotide identity to strain IT-MAR-02 from Italy in 2002. Until now, approximately 1200-1300 persons have been infected with the probably imported strain. The average age of patients was 18 years (years 1 to 80). In this study, detailed clinical and epidemiological data of the outbreak are presented.

CONCLUSIONS

Only a prospective molecular epidemiological study could verify the connection between the first sporadic HAV cases in June, the outbreak in August and the endemic spread of the virus since September in Southwest Hungary. This epidemic calls attention to how a hepatitis A outbreak can develop anywhere and at any time in Hungary and to the importance of active HAV immunization in the primary prevention.