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Sasidharan A, Harrison CJ, Selvarangan R. Diagnosis, management, and outcomes of parechovirus infections in infants: an overview. J Clin Microbiol 2024; 62:e0113923. [PMID: 38647282 PMCID: PMC11237800 DOI: 10.1128/jcm.01139-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Parechovirus A (PeV-A) infections have been detected with increasing frequency in US infants under 6 months of age, leading to a Centers for Disease Control and Prevention (CDC) health advisory in July 2022. Clinicians are advised to consider PeV-A laboratory testing of blood and cerebrospinal fluid when infants present with unexplained fever, sepsis-like illness, or neurological issues. Clinical laboratories are encouraged to offer in-house molecular testing for PeV-A to avoid diagnostic delays, unnecessary use of antibiotics, and prolonged hospitalization of infants presenting with sepsis-like illness. While data are evolving on potential neurodevelopmental sequelae after PeV-A infant central nervous system infections, most infected infants return to baseline health for age. This review examines the PeV-A literature with a focus on PeV-A3, including aspects of epidemiology, clinical presentations/management, laboratory diagnostics, genotyping, and post-infectious sequelae related to PeV-A infections in infants.
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Affiliation(s)
- Anjana Sasidharan
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
| | | | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
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2
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Kamga Njile D, Mugyia EA, Endegue-Zanga MC, Kfutwah JA, Djoumetio MD, Onana B, Diop OM, Njouom R, Sadeuh-Mba SA. Detection and genetic diversity of parechoviruses in children with acute flaccid paralysis in Cameroon. PLoS One 2024; 19:e0301771. [PMID: 38809876 PMCID: PMC11135751 DOI: 10.1371/journal.pone.0301771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/21/2024] [Indexed: 05/31/2024] Open
Abstract
Human Parechoviruses (HPeVs) have rarely been considered in the virological investigation of Acute Flacid Paralysis (AFP) cases in Africa, where enteric infections are very common. This study investigated the prevalence and genetic diversity of HPeV in 200 children aged ≤ 15 years with AFP in Cameroon from 2018 to 2019. HPeVs were detected in their faecal RNA using 5'-untranslated real-time RT-PCR. Detected HPeVs were typed by phylogenetic comparison with homologous sequences from homotypic reference strains. Overall, HPeV RNA was detected in 11.0% (22/200) of the 200 stool samples tested. Twelve HPeVs were successfully sequenced and reliably assigned to HPeV-A1, A4, A5, A10, A14, A15, A17 and A18 genotypes. Phylogenetic analyses revealed a high genetic variability among the studied HPeVs, as well as between the studied HPeVs and their previously reported counterparts from Cameroon in 2014. These findings suggest that different HPeV genotypes co-circulate in Cameroon without documented epidemics.
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Affiliation(s)
- Daniel Kamga Njile
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- Faculty of Sciences, Department of Microbiology, University of Yaoundé 1, Yaounde, Cameroon
| | - Emmanuel Akongnwi Mugyia
- Faculty of Science, Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | | | | | | | - Boyomo Onana
- Faculty of Sciences, Department of Microbiology, University of Yaoundé 1, Yaounde, Cameroon
| | - Ousmane Madiagne Diop
- Global Polio Eradication Initiative (GPEI), World Health Organization, Geneva, Switzerland
| | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
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3
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Kuba Y, Nidaira M, Maeshiro N, Komase K, Kamiya H, Kyan H. Analysis of Suspected Measles Cases with Discrepant Measles-Specific IgM and rRT-PCR Test Results, Japan. Emerg Infect Dis 2024; 30:926-933. [PMID: 38579738 PMCID: PMC11060445 DOI: 10.3201/eid3005.231757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
We investigated clinically suspected measles cases that had discrepant real-time reverse transcription PCR (rRT-PCR) and measles-specific IgM test results to determine diagnoses. We performed rRT-PCR and measles-specific IgM testing on samples from 541 suspected measles cases. Of the 24 IgM-positive and rRT-PCR--negative cases, 20 were among children who received a measles-containing vaccine within the previous 6 months; most had low IgG relative avidity indexes (RAIs). The other 4 cases were among adults who had an unknown previous measles history, unknown vaccination status, and high RAIs. We detected viral nucleic acid for viruses other than measles in 15 (62.5%) of the 24 cases with discrepant rRT-PCR and IgM test results. Measles vaccination, measles history, and contact history should be considered in suspected measles cases with discrepant rRT-PCR and IgM test results. If in doubt, measles IgG avidity and PCR testing for other febrile exanthematous viruses can help confirm or refute the diagnosis.
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Affiliation(s)
| | - Minoru Nidaira
- Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan (Y. Kuba, M. Nidaira, N. Maeshiro, H. Kyan)
- National Institute of Infectious Diseases, Tokyo, Japan (K. Komase, H. Kamiya)
| | - Noriyuki Maeshiro
- Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan (Y. Kuba, M. Nidaira, N. Maeshiro, H. Kyan)
- National Institute of Infectious Diseases, Tokyo, Japan (K. Komase, H. Kamiya)
| | - Katsuhiro Komase
- Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan (Y. Kuba, M. Nidaira, N. Maeshiro, H. Kyan)
- National Institute of Infectious Diseases, Tokyo, Japan (K. Komase, H. Kamiya)
| | - Hajime Kamiya
- Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan (Y. Kuba, M. Nidaira, N. Maeshiro, H. Kyan)
- National Institute of Infectious Diseases, Tokyo, Japan (K. Komase, H. Kamiya)
| | - Hisako Kyan
- Okinawa Prefectural Institute of Health and Environment, Okinawa, Japan (Y. Kuba, M. Nidaira, N. Maeshiro, H. Kyan)
- National Institute of Infectious Diseases, Tokyo, Japan (K. Komase, H. Kamiya)
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4
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Boers SA, van Houdt R, van Sorge NM, Groot J, van Aarle Y, van Bussel MJAWM, Smit LFE, Wessels E, Claas ECJ. A multicenter evaluation of the QIAstat-Dx meningitis-encephalitis syndromic test kit as compared to the conventional diagnostic microbiology workflow. Eur J Clin Microbiol Infect Dis 2024; 43:511-516. [PMID: 38206519 PMCID: PMC10917839 DOI: 10.1007/s10096-024-04751-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
PURPOSE Rapid diagnosis and treatment of infectious meningitis and encephalitis (ME) is critical to minimize morbidity and mortality. Recently, Qiagen introduced the CE-IVD QIAstat-Dx ME panel (QS-ME) for syndromic diagnostic testing of meningitis and encephalitis. Some data on the performance of the QS-ME in comparison to the BioFire FilmArray ME panel are available. In this study, the performance of the QS-ME is compared to the current diagnostic workflow in two academic medical centers in the Netherlands. METHODS A total of 110 cerebrospinal fluid samples were retrospectively tested with the QS-ME. The results obtained were compared to the results of laboratory-developed real-time PCR assays (LDTs), IS-pro, bacterial culture, and cryptococcal antigen (CrAg) testing. In addition, the accuracy of the QS-ME was also investigated using an external quality assessment (EQA) panel consisting of ten samples. RESULTS Four of the 110 samples tested failed to produce a valid QS-ME result. In the remaining 106 samples, the QS-ME detected 53/53 viral targets, 38/40 bacterial targets, and 7/13 Cryptococcus neoformans targets. The discrepant bacterial results consisted of two samples that were previously tested positive for Listeria monocytogenes (CT 35.8) and Streptococcus pneumoniae (CT 40), respectively. The QS-ME detected one additional result, consisting of a varicella-zoster virus signal (CT 35.9), in a sample in which both techniques detected Streptococcus pyogenes. Finally, 100% concordance was achieved in testing a blinded bacterial ME EQA panel. CONCLUSION The QS-ME is a relevant addition to the syndromic testing landscape to assist in diagnosing infectious ME.
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Affiliation(s)
- Stefan A Boers
- Dept. Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Robin van Houdt
- Dept. Medical Microbiology and Infection prevention, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Nina M van Sorge
- Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam UMC location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jelle Groot
- Dept. Medical Microbiology and Infection prevention, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Yvette van Aarle
- Dept. Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Mario J A W M van Bussel
- Dept. Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Louise F E Smit
- Dept. Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Els Wessels
- Dept. Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Eric C J Claas
- Dept. Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Schmitz D, Zwagemaker F, van der Veer B, Vennema H, Laros JFJ, Koopmans MPG, De Graaf M, Kroneman A. Metagenomic Surveillance of Viral Gastroenteritis in a Public Health Setting. Microbiol Spectr 2023; 11:e0502222. [PMID: 37432120 PMCID: PMC10434279 DOI: 10.1128/spectrum.05022-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 06/06/2023] [Indexed: 07/12/2023] Open
Abstract
Norovirus is the primary cause of viral gastroenteritis (GE). To investigate norovirus epidemiology, there is a need for whole-genome sequencing and reference sets consisting of complete genomes. To investigate the potential of shotgun metagenomic sequencing on the Illumina platform for whole-genome sequencing, 71 reverse transcriptase quantitative PCR (RT-qPCR) norovirus positive-feces (threshold cycle [CT], <30) samples from norovirus surveillance within The Netherlands were subjected to metagenomic sequencing. Data were analyzed through an in-house next-generation sequencing (NGS) analysis workflow. Additionally, we assessed the potential of metagenomic sequencing for the surveillance of off-target viruses that are of importance for public health, e.g., sapovirus, rotavirus A, enterovirus, parechovirus, aichivirus, adenovirus, and bocaparvovirus. A total of 60 complete and 10 partial norovirus genomes were generated, representing 7 genogroup I capsid genotypes and 12 genogroup II capsid genotypes. In addition to the norovirus genomes, the metagenomic approach yielded partial or complete genomes of other viruses for 39% of samples from children and 6.7% of samples from adults, including adenovirus 41 (N = 1); aichivirus 1 (N = 1); coxsackievirus A2 (N = 2), A4 (N = 2), A5 (N = 1), and A16 (N = 1); bocaparvovirus 1 (N = 1) and 3 (N = 1); human parechovirus 1 (N = 2) and 3 (N = 1); Rotavirus A (N = 1); and a sapovirus GI.7 (N = 1). The sapovirus GI.7 was initially not detected through RT-qPCR and warranted an update of the primer and probe set. Metagenomic sequencing on the Illumina platform robustly determines complete norovirus genomes and may be used to broaden gastroenteritis surveillance by capturing off-target enteric viruses. IMPORTANCE Viral gastroenteritis results in significant morbidity and mortality in vulnerable individuals and is primarily caused by norovirus. To investigate norovirus epidemiology, there is a need for whole-genome sequencing and reference sets consisting of full genomes. Using surveillance samples sent to the Dutch National Institute for Public Health and the Environment (RIVM), we compared metagenomics against conventional techniques, such as RT-qPCR and Sanger-sequencing, with norovirus as the target pathogen. We determined that metagenomics is a robust method to generate complete norovirus genomes, in parallel to many off-target pathogenic enteric virus genomes, thereby broadening our surveillance efforts. Moreover, we detected a sapovirus that was not detected by our validated gastroenteritis RT-qPCR panel, which exemplifies the strength of metagenomics. Our study shows that metagenomics can be used for public health gastroenteritis surveillance, the generation of reference-sets for molecular epidemiology, and how it compares to current surveillance strategies.
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Affiliation(s)
- Dennis Schmitz
- National Institute of Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, The Netherlands
- Erasmus Medical Center, Viroscience, Rotterdam, The Netherlands
| | - Florian Zwagemaker
- National Institute of Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, The Netherlands
| | - Bas van der Veer
- National Institute of Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, The Netherlands
| | - Harry Vennema
- National Institute of Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, The Netherlands
| | - Jeroen F. J. Laros
- National Institute of Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, The Netherlands
- Leiden University Medical Center, Department of Human Genetics, Leiden, The Netherlands
| | | | | | - Annelies Kroneman
- National Institute of Public Health and the Environment, Center for Infectious Disease Control, Bilthoven, The Netherlands
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García-Rodríguez I, van Eijk H, Koen G, Pajkrt D, Sridhar A, Wolthers KC. Parechovirus A Infection of the Intestinal Epithelium: Differences Between Genotypes A1 and A3. Front Cell Infect Microbiol 2021; 11:740662. [PMID: 34790587 PMCID: PMC8591172 DOI: 10.3389/fcimb.2021.740662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Human parechovirus (PeV-A), one of the species within the Picornaviridae family, is known to cause disease in humans. The most commonly detected genotypes are PeV-A1, associated with mild gastrointestinal disease in young children, and PeV-A3, linked to severe disease with neurological symptoms in neonates. As PeV-A are detectable in stool and nasopharyngeal samples, entry is speculated to occur via the respiratory and gastro-intestinal routes. In this study, we characterized PeV-A1 and PeV-A3 replication and tropism in the intestinal epithelium using a primary 2D model based on human fetal enteroids. This model was permissive to infection with lab-adapted strains and clinical isolates of PeV-A1, but for PeV-A3, infection could only be established with clinical isolates. Replication was highest with infection established from the basolateral side with apical shedding for both genotypes. Compared to PeV-A1, replication kinetics of PeV-A3 were slower. Interestingly, there was a difference in cell tropism with PeV-A1 infecting both Paneth cells and enterocytes, while PeV-A3 infected mainly goblet cells. This difference in cell tropism may explain the difference in replication kinetics and associated disease in humans.
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Affiliation(s)
- Inés García-Rodríguez
- OrganoVIR Labs, Department of Medical Microbiology, Amsterdam University Medical Centers (UMC), location Academic Medical Center, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, Netherlands.,Emma Children's Hospital Department of Pediatrics Infectious Diseases, Amsterdam University Medical Centers (UMC), location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Hetty van Eijk
- OrganoVIR Labs, Department of Medical Microbiology, Amsterdam University Medical Centers (UMC), location Academic Medical Center, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, Netherlands
| | - Gerrit Koen
- OrganoVIR Labs, Department of Medical Microbiology, Amsterdam University Medical Centers (UMC), location Academic Medical Center, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, Netherlands
| | - Dasja Pajkrt
- OrganoVIR Labs, Department of Medical Microbiology, Amsterdam University Medical Centers (UMC), location Academic Medical Center, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, Netherlands.,Emma Children's Hospital Department of Pediatrics Infectious Diseases, Amsterdam University Medical Centers (UMC), location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Adithya Sridhar
- OrganoVIR Labs, Department of Medical Microbiology, Amsterdam University Medical Centers (UMC), location Academic Medical Center, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, Netherlands.,Emma Children's Hospital Department of Pediatrics Infectious Diseases, Amsterdam University Medical Centers (UMC), location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Katja C Wolthers
- OrganoVIR Labs, Department of Medical Microbiology, Amsterdam University Medical Centers (UMC), location Academic Medical Center, Amsterdam Institute for Infection and Immunity, University of Amsterdam, Amsterdam, Netherlands
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7
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Nouri R, Jiang Y, Tang Z, Lian XL, Guan W. Detection of SARS-CoV-2 with Solid-State CRISPR-Cas12a-Assisted Nanopores. NANO LETTERS 2021; 21:8393-8400. [PMID: 34542296 PMCID: PMC8491552 DOI: 10.1021/acs.nanolett.1c02974] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/16/2021] [Indexed: 05/12/2023]
Abstract
The outbreak of the SARS-CoV-2 caused the disease COVID-19 to spread globally. Specific and sensitive detection of SARS-CoV-2 facilitates early intervention and prevents the disease from spreading. Here, we present a solid-state CRISPR-Cas12a-assisted nanopore (SCAN) sensing strategy for the specific detection of SARS-CoV-2. We introduced a nanopore-sized counting method to measure the cleavage ratio of reporters, which is used as a criterion for positive/negative classification. A kinetic cleavage model was developed and validated to predict the reporter size distributions. The model revealed the trade-offs between sensitivity, turnaround time, and false-positive rate of the SARS-CoV-2 SCAN. With preamplification and a 30 min CRISPR Cas12a assay, we achieved excellent specificity against other common human coronaviruses and a limit of detection of 13.5 copies/μL (22.5 aM) of viral RNA at a confidence level of 95%. These results suggested that the SCAN could provide a rapid, sensitive, and specific analysis of SARS-CoV-2.
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Affiliation(s)
- Reza Nouri
- Department of Electrical Engineering,
Pennsylvania State University, University Park, Pennsylvania
16802, United States
| | - Yuqian Jiang
- Department of Biomedical Engineering,
Pennsylvania State University, University Park, Pennsylvania
16802, United States
- Huck Institutes of the Life Sciences,
Pennsylvania State University, University Park, Pennsylvania
16802, United States
| | - Zifan Tang
- Department of Electrical Engineering,
Pennsylvania State University, University Park, Pennsylvania
16802, United States
| | - Xiaojun Lance Lian
- Department of Biomedical Engineering,
Pennsylvania State University, University Park, Pennsylvania
16802, United States
- Huck Institutes of the Life Sciences,
Pennsylvania State University, University Park, Pennsylvania
16802, United States
- Department of Biology, Pennsylvania State
University, University Park, Pennsylvania 16802, United
States
| | - Weihua Guan
- Department of Electrical Engineering,
Pennsylvania State University, University Park, Pennsylvania
16802, United States
- Department of Biomedical Engineering,
Pennsylvania State University, University Park, Pennsylvania
16802, United States
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8
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Zhang XA, Zhao RQ, Chen JJ, Yuan Y, Tang X, Zhou ZW, Ren L, Lu QB, Wang YN, Zhang HY, Zhang PH, Fang LQ, Zhou HS, Liu EM, Xu HM, Liu W. The Identification and Genetic Characterization of Parechovirus Infection Among Pediatric Patients With Wide Clinical Spectrum in Chongqing, China. Front Microbiol 2021; 12:709849. [PMID: 34594310 PMCID: PMC8477803 DOI: 10.3389/fmicb.2021.709849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/05/2021] [Indexed: 12/03/2022] Open
Abstract
Human parechoviruses (HPeVs) are important causes of infection in children. However, without a comprehensive and persistent surveillance, the epidemiology and clinical features of HPeV infection remain ambiguous. We performed a hospital-based surveillance study among three groups of pediatric patients with acute respiratory infection (Group 1), acute diarrhea (Group 2), and hand, foot and mouth disease (Group 3) in Chongqing, China, from 2009 to 2015. Among 10,212 tested patients, 707 (6.92%) were positive for HPeV, with the positive rates differing significantly among three groups (Group 1, 3.43%; Group 2, 14.94%; Group 3, 3.55%; P < 0.001). The co-infection with other pathogens was detected in 75.2% (531/707) of HPeV-positive patients. Significant negative interaction between HPeV and Parainfluenza virus (PIV) (P = 0.046, OR = 0.59, 95% CI = 0.34–0.98) and positive interactions between HPeV and Enterovirus (EV) (P = 0.015, OR = 2.28, 95% CI = 1.23–4.73) were identified. Among 707 HPeV-positive patients, 592 (83.73%) were successfully sequenced, and 10 genotypes were identified, with HPeV1 (n = 396), HPeV4 (n = 86), and HPeV3 (n = 46) as the most frequently seen. The proportion of genotypes differed among three groups (P < 0.001), with HPeV1 and HPeV4 overrepresented in Group 2 and HPeV6 overrepresented in Group 3. The spatial patterns of HPeV genotypes disclosed more close clustering of the currently sequenced strains than those from other countries/regions, although they were indeed mixed. Three main genotypes (HPeV1, HPeV3, and HPeV4) had shown distinct seasonal peaks, highlighting a bi-annual cycle of all HpeV and two genotypes (HPeV 1 and HPeV 4) with peaks in odd-numbered years and with peaks in even-numbered years HPeV3. Significantly higher HPeV1 viral loads were associated with severe diarrhea in Group 2 (P = 0.044), while associated with HPeV single infection than HPeV-EV coinfection among HFMD patients (P = 0.001). It’s concluded that HPeV infection was correlated with wide clinical spectrum in pediatric patients with a high variety of genotypes determined. Still no clinical significance can be confirmed, which warranted more molecular surveillance in the future.
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Affiliation(s)
- Xiao-Ai Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Rui-Qiu Zhao
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jin-Jin Chen
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Yang Yuan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Xiang Tang
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zi-Wei Zhou
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Luo Ren
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qin-Bin Lu
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China
| | - Yu-Na Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Hai-Yang Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Pan-He Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Li-Qun Fang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Hai-Sheng Zhou
- Key Laboratory of Dermatology, Anhui Medical University, Hefei, China.,Department of Biochemistry and Molecular Biology, Anhui Medical University, Hefei, China
| | - En-Mei Liu
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hong-Mei Xu
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.,Beijing Key Laboratory of Vector Borne and Natural Focus Infectious Diseases, Beijing, China
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9
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Evolutionary Relationships of Ljungan Virus Variants Circulating in Multi-Host Systems across Europe. Viruses 2021; 13:v13071317. [PMID: 34372523 PMCID: PMC8310206 DOI: 10.3390/v13071317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 12/12/2022] Open
Abstract
The picornavirus named 'Ljungan virus' (LV, species Parechovirus B) has been detected in a dozen small mammal species from across Europe, but detailed information on its genetic diversity and host specificity is lacking. Here, we analyze the evolutionary relationships of LV variants circulating in free-living mammal populations by comparing the phylogenetics of the VP1 region (encoding the capsid protein and associated with LV serotype) and the 3Dpol region (encoding the RNA polymerase) from 24 LV RNA-positive animals and a fragment of the 5' untranslated region (UTR) sequence (used for defining strains) in sympatric small mammals. We define three new VP1 genotypes: two in bank voles (Myodes glareolus) (genotype 8 from Finland, Sweden, France, and Italy, and genotype 9 from France and Italy) and one in field voles (Microtus arvalis) (genotype 7 from Finland). There are several other indications that LV variants are host-specific, at least in parts of their range. Our results suggest that LV evolution is rapid, ongoing and affected by genetic drift, purifying selection, spillover and host evolutionary history. Although recent studies suggest that LV does not have zoonotic potential, its widespread geographical and host distribution in natural populations of well-characterized small mammals could make it useful as a model for studying RNA virus evolution and transmission.
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10
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Benschop KSM, Broberg EK, Hodcroft E, Schmitz D, Albert J, Baicus A, Bailly JL, Baldvinsdottir G, Berginc N, Blomqvist S, Böttcher S, Brytting M, Bujaki E, Cabrerizo M, Celma C, Cinek O, Claas ECJ, Cremer J, Dean J, Dembinski JL, Demchyshyna I, Diedrich S, Dudman S, Dunning J, Dyrdak R, Emmanouil M, Farkas A, De Gascun C, Fournier G, Georgieva I, Gonzalez-Sanz R, van Hooydonk-Elving J, Jääskeläinen AJ, Jancauskaite R, Keeren K, Fischer TK, Krokstad S, Nikolaeva-Glomb L, Novakova L, Midgley SE, Mirand A, Molenkamp R, Morley U, Mossong J, Muralyte S, Murk JL, Nguyen T, Nordbø SA, Österback R, Pas S, Pellegrinelli L, Pogka V, Prochazka B, Rainetova P, Van Ranst M, Roorda L, Schuffenecker I, Schuurman R, Stoyanova A, Templeton K, Verweij JJ, Voulgari-Kokota A, Vuorinen T, Wollants E, Wolthers KC, Zakikhany K, Neher R, Harvala H, Simmonds P. Molecular Epidemiology and Evolutionary Trajectory of Emerging Echovirus 30, Europe. Emerg Infect Dis 2021; 27:1616-1626. [PMID: 34013874 PMCID: PMC8153861 DOI: 10.3201/eid2706.203096] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
In 2018, an upsurge in echovirus 30 (E30) infections was reported in Europe. We conducted a large-scale epidemiologic and evolutionary study of 1,329 E30 strains collected in 22 countries in Europe during 2016-2018. Most E30 cases affected persons 0-4 years of age (29%) and 25-34 years of age (27%). Sequences were divided into 6 genetic clades (G1-G6). Most (53%) sequences belonged to G1, followed by G6 (23%), G2 (17%), G4 (4%), G3 (0.3%), and G5 (0.2%). Each clade encompassed unique individual recombinant forms; G1 and G4 displayed >2 unique recombinant forms. Rapid turnover of new clades and recombinant forms occurred over time. Clades G1 and G6 dominated in 2018, suggesting the E30 upsurge was caused by emergence of 2 distinct clades circulating in Europe. Investigation into the mechanisms behind the rapid turnover of E30 is crucial for clarifying the epidemiology and evolution of these enterovirus infections.
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11
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Tripathi L, Hietanen E, Merilahti P, Teixido L, Sanchez-Alberola N, Tauriainen S, Susi P. Monoclonal antibody against VP0 recognizes a broad range of human parechoviruses. J Virol Methods 2021; 293:114167. [PMID: 33894205 DOI: 10.1016/j.jviromet.2021.114167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/17/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
Parechoviruses (PeVs) are common viruses that cause mild gastrointestinal or respiratory symptoms to severe central nervous system infections. In infants, parechovirus infection is one of the leading causes of life-threatening viral disease. High-quality antibodies with broad binding specificities are essential to improve accurate parechovirus diagnosis in diagnostic laboratories. Such antibodies have potential in the development of rapid antigen detection assay against PeVs. In the present study, VP4 and VP2 genes from human parechovirus A1 (PeV-A1) were cloned and VP0 fusion protein produced to develop monoclonal antibodies against PeVs. Two pan-parechovirus antibodies, one IgG and one IgM isotype, were isolated. The properties of IgG1/κ monoclonal (designated as Mab-PAR-1) was studied further. Mab-PAR-1 was shown to be functional in western blot against denatured recombinant protein and viral particles. In immunofluorescence assay, the antibody tested positive for nineteen PeV-A1 isolates while showing no cross-reactivity to fourteen entero- and rhinovirus types. In addition, Mab-PAR-1 showed positive reactivity against five other cultivable parechovirus types 2-6. A unique Mab-PAR-1 epitope located in the junction of the three capsid proteins VP0, VP1, and VP3 was identified using a peptide library screen. This study demonstrates that PeV-A1-VP0 protein is functional antigen for developing monoclonal antibody for diagnosis of broad range of parechovirus infections.
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Affiliation(s)
- Lav Tripathi
- Institute of Biomedicine, University of Turku, Turku, Finland.
| | - Eero Hietanen
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Pirjo Merilahti
- Institute of Biomedicine, University of Turku, Turku, Finland
| | | | | | | | - Petri Susi
- Institute of Biomedicine, University of Turku, Turku, Finland
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12
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Wang CYT, Ware RS, Lambert SB, Mhango LP, Tozer S, Day R, Grimwood K, Bialasiewicz S. Parechovirus A Infections in Healthy Australian Children During the First 2 Years of Life: A Community-based Longitudinal Birth Cohort Study. Clin Infect Dis 2021; 71:116-127. [PMID: 31406985 PMCID: PMC7108192 DOI: 10.1093/cid/ciz761] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/07/2019] [Indexed: 12/13/2022] Open
Abstract
Background Hospital-based studies identify parechovirus (PeV), primarily PeV-A3, as an important cause of severe infections in young children. However, few community-based studies have been published and the true PeV infection burden is unknown. We investigated PeV epidemiology in healthy children participating in a community-based, longitudinal birth cohort study. Methods Australian children (n = 158) enrolled in the Observational Research in Childhood Infectious Diseases (ORChID) study were followed from birth until their second birthday. Weekly stool and nasal swabs and daily symptom diaries were collected. Swabs were tested for PeV by reverse-transcription polymerase chain reaction and genotypes determined by subgenomic sequencing. Incidence rate, infection characteristics, clinical associations, and virus codetections were investigated. Results PeV was detected in 1423 of 11 124 (12.8%) and 17 of 8100 (0.2%) stool and nasal swabs, respectively. Major genotypes among the 306 infection episodes identified were PeV-A1 (47.9%), PeV-A6 (20.1%), and PeV-A3 (18.3%). The incidence rate was 144 episodes (95% confidence interval, 128–160) per 100 child-years. First infections appeared at a median age of 8 (interquartile range, 6.0–11.7) months. Annual seasonal peaks changing from PeV-A1 to PeV-A3 were observed. Infection was positively associated with age ≥6 months, summer season, nonexclusive breastfeeding at age <3 months, and formal childcare attendance before age 12 months. Sole PeV infections were either asymptomatic (38.4%) or mild (32.7%), while codetection with other viruses in stool swabs was common (64.4%). Conclusions In contrast with hospital-based studies, this study showed that diverse and dynamically changing PeV genotypes circulate in the community causing mild or subclinical infections in children. Parechovirus can cause severe illnesses in children. However, studies focus mainly on hospitalized populations. True disease burden in the community remains largely unknown. From our community-based cohort, we found diverse parechovirus genotypes in the community, causing mild or subclinical infections in children.
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Affiliation(s)
- Claire Y T Wang
- Centre for Children's Health Research, Queensland Children's Hospital Brisbane, Brisbane, Australia.,Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Stephen B Lambert
- Centre for Children's Health Research, Queensland Children's Hospital Brisbane, Brisbane, Australia.,Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Lebogang P Mhango
- Centre for Children's Health Research, Queensland Children's Hospital Brisbane, Brisbane, Australia.,Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Sarah Tozer
- Centre for Children's Health Research, Queensland Children's Hospital Brisbane, Brisbane, Australia.,Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Rebecca Day
- Centre for Children's Health Research, Queensland Children's Hospital Brisbane, Brisbane, Australia.,Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, Australia
| | - Seweryn Bialasiewicz
- Centre for Children's Health Research, Queensland Children's Hospital Brisbane, Brisbane, Australia.,Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
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13
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Carbo EC, Buddingh EP, Karelioti E, Sidorov IA, Feltkamp MC, Borne PAVD, Verschuuren JJ, Kroes AC, Claas EC, de Vries JJ. Improved diagnosis of viral encephalitis in adult and pediatric hematological patients using viral metagenomics. J Clin Virol 2020; 130:104566. [DOI: 10.1016/j.jcv.2020.104566] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 02/06/2023]
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14
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Hayes A, Nguyen D, Andersson M, Antón A, Bailly J, Beard S, Benschop KSM, Berginc N, Blomqvist S, Cunningham E, Davis D, Dembinski JL, Diedrich S, Dudman SG, Dyrdak R, Eltringham GJA, Gonzales‐Goggia S, Gunson R, Howson‐Wells HC, Jääskeläinen AJ, López‐Labrador FX, Maier M, Majumdar M, Midgley S, Mirand A, Morley U, Nordbø SA, Oikarinen S, Osman H, Papa A, Pellegrinelli L, Piralla A, Rabella N, Richter J, Smith M, Söderlund Strand A, Templeton K, Vipond B, Vuorinen T, Williams C, Wollants E, Zakikhany K, Fischer TK, Harvala H, Simmonds P. A European multicentre evaluation of detection and typing methods for human enteroviruses and parechoviruses using RNA transcripts. J Med Virol 2020; 92:1065-1074. [PMID: 31883139 PMCID: PMC7496258 DOI: 10.1002/jmv.25659] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 12/24/2019] [Indexed: 12/28/2022]
Abstract
Polymerase chain reaction (PCR) detection has become the gold standard for diagnosis and typing of enterovirus (EV) and human parechovirus (HPeV) infections. Its effectiveness depends critically on using the appropriate sample types and high assay sensitivity as viral loads in cerebrospinal fluid samples from meningitis and sepsis clinical presentation can be extremely low. This study evaluated the sensitivity and specificity of currently used commercial and in-house diagnostic and typing assays. Accurately quantified RNA transcript controls were distributed to 27 diagnostic and 12 reference laboratories in 17 European countries for blinded testing. Transcripts represented the four human EV species (EV-A71, echovirus 30, coxsackie A virus 21, and EV-D68), HPeV3, and specificity controls. Reported results from 48 in-house and 15 commercial assays showed 98% detection frequencies of high copy (1000 RNA copies/5 µL) transcripts. In-house assays showed significantly greater detection frequencies of the low copy (10 copies/5 µL) EV and HPeV transcripts (81% and 86%, respectively) compared with commercial assays (56%, 50%; P = 7 × 10-5 ). EV-specific PCRs showed low cross-reactivity with human rhinovirus C (3 of 42 tests) and infrequent positivity in the negative control (2 of 63 tests). Most or all high copy EV and HPeV controls were successfully typed (88%, 100%) by reference laboratories, but showed reduced effectiveness for low copy controls (41%, 67%). Stabilized RNA transcripts provide an effective, logistically simple and inexpensive reagent for evaluation of diagnostic assay performance. The study provides reassurance of the performance of the many in-house assay formats used across Europe. However, it identified often substantially reduced sensitivities of commercial assays often used as point-of-care tests.
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Affiliation(s)
- A. Hayes
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - D. Nguyen
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - M. Andersson
- Microbiology Laboratory, John Radcliffe Hospital, Headley Way, HeadingtonOxfordUK
| | - A. Antón
- Respiratory Viruses Unit, Virology Section, Microbiology DepartmentHospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d'HebronBarcelonaSpain
| | - J.‐L. Bailly
- Université Clermont Auvergne, LMGE UMR CNRS, UFR MédecineClermont‐FerrandFrance
- CHU Clermont‐Ferrand, National Reference Center for EV and Parechovirus‐Associated LaboratoryClermont‐FerrandFrance
| | - S. Beard
- Enteric Virus Unit, Virus Reference DepartmentNational Infection Service, Public Health EnglandLondonUK
| | - K. S. M. Benschop
- National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - N. Berginc
- Department for Public Health VirologyNational Laboratory of Health, Environment and FoodLjubljanaSlovenia
| | - S. Blomqvist
- National Institute for Health and Welfare, MannerheimintieHelsinkiFinland
| | - E. Cunningham
- Viapath Infection Sciences, St. Thomas' HospitalLondonUK
| | - D. Davis
- Microbiology, Virology and infection Prevention & ControlGreat Ormond Street Hospital for Children NHS Foundation TrustLondonUK
| | - J. L. Dembinski
- Department of VirologyNorwegian Institute of Public HealthOsloNorway
| | - S. Diedrich
- National Reference Center for Poliomyelitis and Enteroviruses, Robert Koch InstituteBerlinGermany
| | - S. G. Dudman
- Department of MicrobiologyOslo University Hospital Rikshospitalet, Inst. Clinical Medicine, University of OsloOsloNorway
| | - R. Dyrdak
- Department of Clinical MicrobiologyKarolinska University HospitalStockholmSweden
- Department of Microbiology, Tumor and Cell BiologyKarolinska InstituteStockholmSweden
| | - G. J. A. Eltringham
- Molecular Diagnostics Laboratory, Microbiology, Freeman HospitalNewcastle Upon TyneUK
| | - S. Gonzales‐Goggia
- Public Health England Poliovirus Reference Laboratory, National Infection Service, Public Health EnglandLondonUK
| | - R. Gunson
- West of Scotland Specialist Virology CentreGlasgow Royal InfirmaryGlasgowUK
| | - H. C. Howson‐Wells
- Nottingham University Hospitals NHS Trust, Clinical Microbiology, Queens Medical CentreNottinghamUK
| | - A. J. Jääskeläinen
- University of Helsinki and Helsinki University Hospital, HUSLAB, Virology and ImmunologyHelsinkiFinland
| | - F. X. López‐Labrador
- Virology Laboratory, Joint Units in Genomics and Health and Infection and Health, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO‐Public Health)/Universitat de València, Av. CatalunyaValènciaSpain
- CIBEResp, Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Instituto de Salud Carlos IIIMadridSpain
| | - M. Maier
- Institute of VirologyLeipzig University HospitalLeipzigGermany
| | - M. Majumdar
- The National Institute for Biological Standards and ControlHertfordshireUK
| | - S. Midgley
- Department of Virus and Special Microbiological DiagnosticsVirus Surveillance and Research Section, Statens Serum InstitutCopenhagenDenmark
| | - A. Mirand
- CHU Clermont‐Ferrand, Laboratoire de Virologie—Centre National de Référence des Entérovirus et Parechovirus, Laboratoire Associé—Clermont‐FerrandFrance
| | - U. Morley
- UCD National Virus Reference LaboratoryUniversity College Dublin, BelfieldDublinIreland
| | - S. A. Nordbø
- Department of Medical MicrobiologySt. Olavs University HospitalTrondheimNorway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - S. Oikarinen
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - H. Osman
- Public Health England Birmingham Public Health Laboratory, Heartlands HospitalBirminghamUK
| | - A. Papa
- Department of MicrobiologyMedical School, Aristotle University of ThessalonikiThessalonikiGreece
| | - L. Pellegrinelli
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
| | - A. Piralla
- Molecular Virology Unit, Microbiology and Virology DepartmentFondazione IRCCS Policlinico San MatteoPaviaItaly
| | - N. Rabella
- Virology Section, Santa Creu i Sant Pau University HospitalBarcelonaSpain
| | - J. Richter
- Department of Molecular VirologyCyprus Institute of Neurology and GeneticsNicosiaCyprus
| | - M. Smith
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
- King's College Hospital, Bessemer Wing, Denmark HillLondonUK
| | - A. Söderlund Strand
- Laboratory Medicine, Department of Clinical MicrobiologyLund University Hospital, SölvegatanLundSweden
| | - K. Templeton
- Edinburgh Specialist Virology, Royal Infirmary of EdinburghEdinburghUK
| | - B. Vipond
- Public Health England, South West Regional Laboratory, Pathology Sciences Building, Science QuarterSouthmead HospitalBristolUK
| | - T. Vuorinen
- Clinical MicrobiologyTurku University Hospital and Institute of Biomedicine University of TurkuTurkuFinland
| | | | - E. Wollants
- Clinical and Epidemiological Virology, KU Leuven, REGA Institute, Clinical and Epidemiological VirologyLeuvenBelgium
| | - K. Zakikhany
- Katherina Zakikhany‐Gilg, Public Health Agency of Sweden, Department of MicrobiologyUnit of Laboratory Surveillance of Viral Pathogens and Vaccine Preventable DiseasesStockholmSweden
| | - T. K. Fischer
- CIBEResp, Centro de Investigación Biomédica en Red en Epidemiología y Salud Pública, Instituto de Salud Carlos IIIMadridSpain
- Department of Virus and Special Microbiological DiagnosticsVirus Surveillance and Research Section, Statens Serum InstitutCopenhagenDenmark
| | - H. Harvala
- NHS Blood and Transplant, ColindaleLondonUK
| | - P. Simmonds
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
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15
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Smura T, Blomqvist S, Kolehmainen P, Schuffenecker I, Lina B, Böttcher S, Diedrich S, Löve A, Brytting M, Hauzenberger E, Dudman S, Ivanova O, Lukasev A, Fischer TK, Midgley S, Susi P, Savolainen-Kopra C, Lappalainen M, Jääskeläinen AJ. Aseptic meningitis outbreak associated with echovirus 4 in Northern Europe in 2013-2014. J Clin Virol 2020; 129:104535. [PMID: 32652478 DOI: 10.1016/j.jcv.2020.104535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 01/23/2023]
Abstract
Picornaviruses (family Picornaviridae) are small, nonenveloped, positive-sense, single-stranded RNA viruses. The members of this family are currently classified into 47 genera and 110 species. Of picornaviruses, entero- and parechoviruses are associated with aseptic meningitis. They are transmitted via fecal-oral and respiratory routes, and occasionally, these viruses may cause a brief viremia and gain access to central nervous system (CNS). During the diagnostic screening of entero- and parechovirus types in Finland in year 2013-14, we detected a cluster of echovirus 4 (E4) infections in young adults and adolescents. As E4 is infrequently detected in Finland, we contacted several Northern and Central European laboratories that conduct routine surveillance for enteroviruses and, for those who have had E4 cases, we send a query for E4 sequences and data. Here we report CNS infections caused by E4 in Finland, Sweden, Norway, Denmark, Iceland and Germany in 2013 and 2014, and show that the E4 detected in these countries form a single lineage. In contrast, E4 strains circulating in these countries preceding the year 2013, and those circulating elsewhere in Europe during 2013-2014, formed several independent clusters.
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Affiliation(s)
- Teemu Smura
- University of Helsinki and Helsinki University Hospital, Virology and Immunology, Helsinki, Finland
| | - Soile Blomqvist
- National Institute for Health and Welfare (THL), Department of Health Security, Helsinki, Finland
| | | | - Isabelle Schuffenecker
- Institut des Agents infectieux des HCL, CNR des enterovirus, Hôpital de la Croix-Rousse & Université de Lyon, CIRI INSERM U1111, UCBL, Lyon, France
| | - Bruno Lina
- Institut des Agents infectieux des HCL, CNR des enterovirus, Hôpital de la Croix-Rousse & Université de Lyon, CIRI INSERM U1111, UCBL, Lyon, France
| | | | | | - Arthur Löve
- Landspitali, National University Hospital, Reykjavik, Iceland
| | - Mia Brytting
- Folkhälsomyndigheten, Public Health Agency of Sweden, Solna, Sweden
| | | | | | - Olga Ivanova
- Chumakov Federal Scientific Center for Research and Development, Moscow, Russia; Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Alexander Lukasev
- Chumakov Federal Scientific Center for Research and Development, Moscow, Russia; Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | | | | | - Petri Susi
- University of Turku, Institute of Biomedicine, Turku, Finland
| | - Carita Savolainen-Kopra
- National Institute for Health and Welfare (THL), Department of Health Security, Helsinki, Finland
| | - Maija Lappalainen
- University of Helsinki and Helsinki University Hospital, Virology and Immunology, Helsinki, Finland
| | - Anne J Jääskeläinen
- University of Helsinki and Helsinki University Hospital, Virology and Immunology, Helsinki, Finland.
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S1 guidelines "lumbar puncture and cerebrospinal fluid analysis" (abridged and translated version). Neurol Res Pract 2020; 2:8. [PMID: 33324914 PMCID: PMC7650145 DOI: 10.1186/s42466-020-0051-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/03/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction Cerebrospinal fluid (CSF) analysis is important for detecting inflammation of the nervous system and the meninges, bleeding in the area of the subarachnoid space that may not be visualized by imaging, and the spread of malignant diseases to the CSF space. In the diagnosis and differential diagnosis of neurodegenerative diseases, the importance of CSF analysis is increasing. Measuring the opening pressure of CSF in idiopathic intracranial hypertension and at spinal tap in normal pressure hydrocephalus constitute diagnostic examination procedures with therapeutic benefits.Recommendations (most important 3-5 recommendations on a glimpse): The indications and contraindications must be checked before lumbar puncture (LP) is performed, and sampling CSF requires the consent of the patient.Puncture with an atraumatic needle is associated with a lower incidence of postpuncture discomfort. The frequency of postpuncture syndrome correlates inversely with age and body mass index, and it is more common in women and patients with a history of headache. The sharp needle is preferably used in older or obese patients, also in punctures expected to be difficult.In order to avoid repeating LP, a sufficient quantity of CSF (at least 10 ml) should be collected. The CSF sample and the serum sample taken at the same time should be sent to a specialized laboratory immediately so that the emergency and basic CSF analysis program can be carried out within 2 h.The indication for LP in anticoagulant therapy should always be decided on an individual basis. The risk of interrupting anticoagulant therapy must be weighed against the increased bleeding risk of LP with anticoagulant therapy.As a quality assurance measure in CSF analysis, it is recommended that all cytological, clinical-chemical, and microbiological findings are combined in an integrated summary report and evaluated by an expert in CSF analysis. Conclusions In view of the importance and developments in CSF analysis, the S1 guideline "Lumbar puncture and cerebrospinal fluid analysis" was recently prepared by the German Society for CSF analysis and clinical neurochemistry (DGLN) and published in German in accordance with the guidelines of the AWMF (https://www.awmf.org). /uploads/tx_szleitlinien/030-141l_S1_Lumbalpunktion_und_Liquordiagnostik_2019-08.pdf). The present article is an abridged translation of the above cited guideline. The guideline has been jointly edited by the DGLN and DGN.
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Pfefferle S, Christner M, Aepfelbacher M, Lütgehetmann M, Rohde H. Implementation of the FilmArray ME panel in laboratory routine using a simple sample selection strategy for diagnosis of meningitis and encephalitis. BMC Infect Dis 2020; 20:170. [PMID: 32087681 PMCID: PMC7036261 DOI: 10.1186/s12879-020-4904-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 02/18/2020] [Indexed: 12/13/2022] Open
Abstract
Background Infectious meningitis is a serious disease and patient outcome relies on fast and reliable diagnostics. A syndromic panel testing approach like the FilmArray ME can accelerate diagnosis and therefore decrease the time to pathogen specific therapy. Yet, its clinical utility is controversial, mainly because of a remaining uncertainty in correct interpretation of results, limited data on its performance on clinical specimens and its relatively high costs. The aim of this study was to analyze clinical performance of the assay in a real life setting at a tertiary university hospital using a pragmatic and simple sample selection strategy to reduce the overall cost burden. Methods Over a period of 18 months we received 4623 CSF samples (2338 hospitalizations, 1601 individuals). FilmArray ME analysis was restricted to CSF-samples with a high pretest probability of infectious meningitis, e.g. positive Gram-stain, samples in which leukocytes and/or bacteria were evident or urgent suspicion of infection was communicated by clinicians. N = 171 samples matched to our risk criteria and were subjected to FilmArray ME analysis. Those samples were also analyzed by reference methods: culture only (n = 45), PCR only (n = 20) or both methods (n = 106). Results 56/171 (32.75%) were FilmArray ME positive. Bacterial pathogens were detected in 30/56 (53.57%), viral pathogens were detected in 27/56 (48.21%) and yeast DNA was detected in 1/56 (1.79%) of positive samples. Double detection occurred in 2/56 samples. In 52/56 (92.86%) FilmArray ME positive samples, results could be confirmed by the reference assays (sensitivity = 96.30%, specificity =96.58%). Conclusion The FilmArray ME assay is a fast and reliable diagnostic tool for the management of infectious meningitis and can easily be implemented in routine diagnostic workflows. However, correlation of test results and underlying clinical symptoms requires experienced users and the awareness of potentially false negative or false positive results. Moreover, considering the need for antimicrobial susceptibility testing, the use of molecular tests as a stand-alone diagnostic cannot be recommended.
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Affiliation(s)
- Susanne Pfefferle
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Martin Christner
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martin Aepfelbacher
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marc Lütgehetmann
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Holger Rohde
- Institut für Medizinische Mikrobiologie, Virologie und Hygiene, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Sridhar A, Karelehto E, Brouwer L, Pajkrt D, Wolthers KC. Parechovirus A Pathogenesis and the Enigma of Genotype A-3. Viruses 2019; 11:v11111062. [PMID: 31739613 PMCID: PMC6893760 DOI: 10.3390/v11111062] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 12/16/2022] Open
Abstract
Parechovirus A is a species in the Parechovirus genus within the Picornaviridae family that can cause severe disease in children. Relatively little is known on Parechovirus A epidemiology and pathogenesis. This review aims to explore the Parechovirus A literature and highlight the differences between Parechovirus A genotypes from a pathogenesis standpoint. In particular, the curious case of Parechovirus-A3 and the genotype-specific disease association will be discussed. Finally, a brief outlook on Parechovirus A research is provided.
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Affiliation(s)
- Adithya Sridhar
- Laboratory of Clinical Virology, Department of Medical Microbiology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, 1100 AZ Amsterdam, The Netherlands; (E.K.); (L.B.); (K.C.W.)
- Correspondence:
| | - Eveliina Karelehto
- Laboratory of Clinical Virology, Department of Medical Microbiology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, 1100 AZ Amsterdam, The Netherlands; (E.K.); (L.B.); (K.C.W.)
| | - Lieke Brouwer
- Laboratory of Clinical Virology, Department of Medical Microbiology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, 1100 AZ Amsterdam, The Netherlands; (E.K.); (L.B.); (K.C.W.)
| | - Dasja Pajkrt
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, 1100 AZ Amsterdam, The Netherlands;
| | - Katja C. Wolthers
- Laboratory of Clinical Virology, Department of Medical Microbiology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, 1100 AZ Amsterdam, The Netherlands; (E.K.); (L.B.); (K.C.W.)
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19
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Polymerase chain reaction for human parechovirus on blood samples improves detection of clinical infections in infants. Mol Biol Rep 2019; 47:715-720. [PMID: 31659694 DOI: 10.1007/s11033-019-05151-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 10/18/2019] [Indexed: 01/11/2023]
Abstract
Human parechovirus (HPeV) is an emerging pathogen for infants. Improved diagnostics are needed due to the non-specific clinical presentation. Real-time reverse transcription polymerase chain reaction (RT-PCR) on blood samples may be an adjunct to diagnosis. A retrospective cohort of HPeV-affected infants was used to assess sensitivity and specificity of a HPeV RT-PCR on blood and cerebrospinal fluid (CSF). As a secondary analysis, the Ct value of the PCR results was compared to clinical correlates of severity. Between 2017 and 2018 blood samples were obtained from 97 infants of whom 44 had HPeV clinical and laboratory proven infection. Eighty-three concurrent CSF samples were available. Sensitivity was 93.3% [95% CI 82-99] for blood HPeV RT-PCR and 85% [95% CI 73.9-96.1] for CSF HPeV RT-PCR. Blood HPeV RT-PCR Ct values < 25 cycles were associated with age < 28 days and < 3 days of symptoms. No statistical associations were identified between potential clinical markers of severity and Ct value. HPeV RT-PCR on blood is a valuable adjunct to diagnostic testing for acute HPeV-related illness in infants. Results can be expected to be robust until at least day 5 of symptoms, with optimal sampling occurring close to onset of symptoms.
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20
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Cremer J, Morley U, Pas S, Wolthers K, Vennema H, Duizer E, Benschop K. Highly sensitive parechovirus CODEHOP PCR amplification of the complete VP1 gene for typing directly from clinical specimens and correct typing based on phylogenetic clustering. J Med Microbiol 2019; 68:1194-1203. [PMID: 31050627 DOI: 10.1099/jmm.0.000974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Human parechoviruses (HPeVs), particularly type 3, can cause severe neurological disease and neonatal sepsis in infants. HPeV3 lacks the receptor-binding motif arginine-glycine aspartic acid (RGD), and is proposed to use a different receptor associated with severe disease. In contrast, HPeV1, which contains the RGD motif, is associated with mild disease. Rapid characterization of the presence/absence of this motif is essential for understanding their epidemiology and differential disease profiles. Current HPeV typing assays are based on partial capsid genes and often do not encompass the C-terminus where the RGD region is localized/absent. In addition, these assays lack sensitivity to enable characterization within low viral-load samples, such as cerebral spinal fluid. METHODOLOGY We developed a highly sensitive HPeV CODEHOP PCR, which enables typing of parechoviruses directly from clinical samples while generating a complete VP1 gene, including the C-terminus. RESULTS The assay was HPeV-specific and has a sensitivity of 6.3 TCID50 ml-1 for HPeV1 and 0.63 TCID50 ml-1 for HPeV3. Analysis of the complete VP1 gene in comparison to partial VP1 fragments generated by previously published PCRs showed homologous clustering for most types. However, phylogenetic analysis of partial VP1 fragments showed incongruent typing based on the 75 % homology classification rule. In particular, the strains designated as type 17 were found to be either type 3 or 4 when using the (near-) complete VP1 fragment. CONCLUSION While enabling sensitive characterization of HPeVs directly from clinical samples, the HPeV CODEHOP PCR enables the characterization of RGD and non-RGD strains and correct HPeV typing based on the complete VP1.
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Affiliation(s)
- Jeroen Cremer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Ursula Morley
- National Virus Reference Laboratory, University College Dublin (UCD), Belfield, Dublin, Ireland
| | - Suzan Pas
- Erasmus Medical Center (EMC), Rotterdam, The Netherlands.,Present address: Microvida, Roosendaal, The Netherlands
| | - Katja Wolthers
- University Medical Centers Amsterdam-AMC, Amsterdam, The Netherlands
| | - Harry Vennema
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Erwin Duizer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Kimberley Benschop
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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21
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Abstract
BACKGROUND Human parechovirus particularly genotype 3 (HPeV3) is an emerging infection affecting predominantly young infants. The potential for neurologic sequelae in a vulnerable subset is increasingly apparent. A review of 2 epidemics of human parechovirus (HpeV) infection in 2013 and in 2015 in Queensland, Australia, was undertaken, with an emphasis on identifying adverse neurodevelopmental outcome. METHODS All hospitalized cases with laboratory-confirmed HPeV infection between October 2013 June 2016 were identified. Clinical, demographic, laboratory and imaging data were collected and correlated with reported developmental outcome. RESULTS Laboratory-confirmed HPeV infections were identified in 202 patients across 25 hospitals; 86.6% (n = 175) were younger than 3 months 16.3% (n = 33) received intensive care admission. Of 142 cerebrospinal fluid samples which were HPeV polymerase chain reaction positive, all 89 isolates successfully genotyped were HPeV3. Clinical information was available for 145 children; 53.1% (n = 77) had follow-up from a pediatrician, of whom 14% (n = 11) had neurodevelopmental sequelae, ranging from hypotonia and gross motor delay to spastic quadriplegic cerebral palsy and cortical visual impairment. Of 15 children with initially abnormal brain magnetic resonance imaging, 47% (n = 7) had neurodevelopmental concerns, the remainder had normal development at follow-up between 6 and 15 months of age. CONCLUSIONS This is the largest cohort of HPeV3 cases with clinical data and pediatrician-assessed neurodevelopmental follow-up to date. Developmental concerns were identified in 11 children at early follow-up. Abnormal magnetic resonance imaging during acute infection did not specifically predict poor neurodevelopmental in short-term follow-up. Continued follow-up of infants and further imaging correlation is needed to explore predictors of long-term morbidity.
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22
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Chen BC, Chang JT, Huang TS, Chen JJ, Chen YS, Jan MW, Chang TH. Parechovirus A Detection by a Comprehensive Approach in a Clinical Laboratory. Viruses 2018; 10:v10120711. [PMID: 30545147 PMCID: PMC6316871 DOI: 10.3390/v10120711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 12/15/2022] Open
Abstract
Parechovirus A (Human parechovirus, HPeV) causes symptoms ranging from severe neonatal infection to mild gastrointestinal and respiratory disease. Use of molecular approaches with RT-PCR and genotyping has improved the detection rate of HPeV. Conventional methods, such as viral culture and immunofluorescence assay, together with molecular methods facilitate comprehensive viral diagnosis. To establish the HPeV immunofluorescence assay, an antibody against HPeV capsid protein VP0 was generated by using antigenic epitope prediction data. The specificity of the anti-HPeV VP0 antibody was demonstrated on immunofluorescence assay, showing that this antibody was specific for HPeV but not enteroviruses. A total of 74 HPeV isolates, 7 non–polio-enteroviruses and 12 HPeV negative cell culture supernatant were used for evaluating the efficiency of the anti-HPeV VP0 antibody. The sensitivity of HPeV detection by the anti-HPeV VP0 antibody was consistent with 5′untranslated region (UTR) RT-PCR analysis. This study established comprehensive methods for HPeV detection that include viral culture and observation of cytopathic effect, immunofluorescence assay, RT-PCR and genotyping. The methods were incorporated into our routine clinical practice for viral diagnosis. In conclusion, this study established a protocol for enterovirus and HPeV virus identification that combines conventional and molecular methods and would be beneficial for HPeV diagnosis.
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Affiliation(s)
- Bao-Chen Chen
- Department of Microbiology, Kaohsiung Veterans General Hospital, Kaohsiung81362, Taiwan.
| | - Jenn-Tzong Chang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
| | - Tsi-Shu Huang
- Department of Microbiology, Kaohsiung Veterans General Hospital, Kaohsiung81362, Taiwan.
| | - Jih-Jung Chen
- Faculty of Pharmacy, School of Pharmaceutical Sciences, National Yang-Ming University, Taipei 112, Taiwan.
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 404, Taiwan.
| | - Yao-Shen Chen
- Department of Infectious Diseases, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
| | - Ming-Wei Jan
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
| | - Tsung-Hsien Chang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
- Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan 717, Taiwan.
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23
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Karelehto E, Cristella C, Yu X, Sridhar A, Hulsdouw R, de Haan K, van Eijk H, Koekkoek S, Pajkrt D, de Jong MD, Wolthers KC. Polarized Entry of Human Parechoviruses in the Airway Epithelium. Front Cell Infect Microbiol 2018; 8:294. [PMID: 30211126 PMCID: PMC6119779 DOI: 10.3389/fcimb.2018.00294] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 08/02/2018] [Indexed: 12/11/2022] Open
Abstract
Human parechoviruses (HPeVs), a poorly studied genus within the Picornaviridae family, are classified into 19 genotypes of which HPeV1 and HPeV3 are the most often detected. HPeV1 VP1 C terminus contains an arginine-glycine-aspartic acid (RGD) motif and has been shown to depend on the host cell surface αV integrins (αV ITGs) and heparan sulfate (HS) for entry. HPeV3 lacks this motif and the receptors remain unknown. HPeVs can be detected in patient nasopharyngeal and stool samples, and infection is presumed to occur after respiratory or gastro-intestinal transmission. HPeV pathogenesis is poorly understood as there are no animal models and previous studies have been conducted in immortalized monolayer cell cultures which do not adequately represent the characteristics of human tissues. To bridge this gap, we determined the polarity of infection, replication kinetics, and cell tropism of HPeV1 and HPeV3 in the well-differentiated human airway epithelial (HAE) model. We found the HAE cultures to be permissive for HPeVs. Both HPeV genotypes infected the HAE preferentially from the basolateral surface while the progeny virus was shed toward the apical side. Confocal microscopy revealed the target cell type to be the p63+ basal cells for both viruses, αV ITG and HS blocking had no effect on the replication of either virus, and transcriptional profiling suggested that HPeV3 infection induced stronger immune activation than HPeV1. Genotype-specific host responses may contribute to the differences in pathogenesis and clinical outcomes associated with HPeV1 and HPeV3.
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Affiliation(s)
- Eveliina Karelehto
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Cosimo Cristella
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Xiao Yu
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Adithya Sridhar
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Rens Hulsdouw
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Karen de Haan
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Hetty van Eijk
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Sylvie Koekkoek
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Academic Medical Center, Emma's Children's Hospital, Amsterdam, Netherlands
| | - Menno D de Jong
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Katja C Wolthers
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
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Josman N, Tee NWS, Maiwald M, Loo LH, Ho CKM. Pragmatic and evidence-based approach to paediatric cerebrospinal fluid reference limits for white cell count and concentrations of total protein and glucose. J Clin Pathol 2018; 71:932-935. [DOI: 10.1136/jclinpath-2018-205090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 11/04/2022]
Abstract
BackgroundIt is often impractical for each laboratory to establish its own paediatric reference intervals. This is particularly true for specimen types collected using invasive procedures, for example, cerebrospinal fluid (CSF).MethodsPublished CSF reference intervals for white cell count, and concentrations of total protein and glucose were reviewed by stakeholders in a paediatric hospital. Consensus reference intervals for the three CSF parameters were then subjected to verification using guidelines from the Clinical Laboratory Standards Institute and residual CSF specimens.ResultsConsensus paediatric reference intervals adapted from published studies with minor modifications were locally verified as follows. White cell count (x106 cells/L): 0–20 (<1 month); 0–10 (1–2 months); 0–5 (>2 months). Total protein (g/L): 0.3–1.2 (<1 month); 0.2–0.6 (1–3 months); 0.1–0.4 (>3 months). Glucose (mmol/L): 2.0–5.6 (<6 months); 2.4–4.3 (6 months or older).
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25
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Chang JT, Chen YS, Chen BC, Huang TS, Chang TH. Human Parechovirus Infection in Children in Taiwan: a Retrospective, Single-Hospital Study. Jpn J Infect Dis 2018; 71:291-297. [PMID: 29709990 DOI: 10.7883/yoken.jjid.2018.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To understand human parechovirus (HPeV) infections in Taiwanese children, we analyzed data for 112 children (age≤10 years) with HPeV infection diagnosed between July 2007 and June 2016 in a medical center in Kaohsiung, southern Taiwan. The patients were infected with HPeV1 (n=94), HPeV3 (n=3), HPeV4 (n=3), HPeV6 (n=1) and non-typeable HPeV (n=11). We compared the clinical implications for children younger than 3 months (n=56) and 3 months and older (n=31), excluding 25 children with concomitant infections. Fever was noted in almost half of the children younger than 3 months but was more frequent in older than in younger children (83.9% vs 46.4%). As compared with older children, children younger than 3 months had a lower incidence of respiratory symptoms (30.1% vs 83.9%), more frequently required intensive care unit admission (28.6% vs 3.2%), and had longer hospital stays (mean 10.95 vs 5.13 days). Importantly, about one-third of the children were suspected to have hospital-acquired or cluster infections in the environment of medical institutions, with a significantly high proportion of 42.9% (24/56) in younger infants. Hospital-acquired infections might play a key role in the spread of HPeV, especially in children younger than 3 months.
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Affiliation(s)
- Jenn-Tzong Chang
- Department of Pediatrics, Kaohsiung Veterans General Hospital.,Department of Nursing, Shu-Zen Junior College of Medicine and Management
| | - Yao-Shen Chen
- Department of Infectious Diseases, Kaohsiung Veterans General Hospital.,Department of Nursing, Shu-Zen Junior College of Medicine and Management
| | - Bao-Chen Chen
- Department of Microbiology, Kaohsiung Veterans General Hospital
| | - Tsi-Shu Huang
- Department of Microbiology, Kaohsiung Veterans General Hospital
| | - Tsung-Hsien Chang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital.,Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology
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26
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Olijve L, Jennings L, Walls T. Human Parechovirus: an Increasingly Recognized Cause of Sepsis-Like Illness in Young Infants. Clin Microbiol Rev 2018; 31:e00047-17. [PMID: 29142080 PMCID: PMC5740974 DOI: 10.1128/cmr.00047-17] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Human parechovirus (HPeV) is increasingly being recognized as a potentially severe viral infection in neonates and young infants. HPeV belongs to the family Picornaviridae and is currently divided into 19 genotypes. HPeV-1 is the most prevalent genotype and most commonly causes gastrointestinal and respiratory disease. HPeV-3 is clinically the most important genotype due to its association with severe disease in younger infants, which may partly be explained by its distinct virological properties. In young infants, the typical clinical presentation includes fever, severe irritability, and rash, often leading to descriptions of "hot, red, angry babies." Infants with severe central nervous system (CNS) infections are at an increased risk of long-term sequelae. Considering the importance of HPeV as a cause of severe viral infections in young infants, we recommend that molecular diagnostic techniques for early detection be included in the standard practice for the investigation of sepsis-like illnesses and CNS infections in this age group.
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Affiliation(s)
- Laudi Olijve
- Department of Paediatrics, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
| | - Lance Jennings
- Canterbury Health Laboratories, Christchurch, New Zealand
| | - Tony Walls
- Department of Paediatrics, University of Otago, Christchurch School of Medicine, Christchurch, New Zealand
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27
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Strain-dependent neutralization reveals antigenic variation of human parechovirus 3. Sci Rep 2017; 7:12075. [PMID: 28935894 PMCID: PMC5608956 DOI: 10.1038/s41598-017-12458-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/08/2017] [Indexed: 11/09/2022] Open
Abstract
Human parechovirus 3 (HPeV3), a member of the Picornavirus family, is frequently detected worldwide. However, the observed seropositivity rates for HPeV3 neutralizing antibodies (nAbs) vary from high in Japan to low in the Netherlands and Finland. To study if this can be explained by technical differences or antigenic diversity among HPeV3 strains included in the serological studies, we determined the neutralizing activity of Japanese and Dutch intravenous immunoglobulin batches (IVIG), a rabbit HPeV3 hyperimmune polyclonal serum, and a human HPeV3-specific monoclonal antibody (mAb) AT12-015, against the HPeV3 A308/99 prototype strain and clinical isolates from Japan, the Netherlands and Australia, collected between 1989 and 2015. The rabbit antiserum neutralized all HPeV3 isolates whereas the neutralization capacity of the IVIG batches varied, and the mAb exclusively neutralized the A308/99 strain. Mapping of the amino acid variation among a subset of the HPeV3 strains on an HPeV3 capsid structure revealed that the majority of the surface-exposed amino acid variation was located in the VP1. Furthermore, amino acid mutations in a mAb AT12-015-resistant HPeV3 A308/99 variant indicated the location for potential antigenic determinants. Virus aggregation and the observed antigenic diversity in HPeV3 can explain the varying levels of nAb seropositivity reported in previous studies.
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28
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Benschop KSM, Rahamat-Langendoen JC, van der Avoort HGAM, Claas ECJ, Pas SD, Schuurman R, Verweij JJ, Wolthers KC, Niesters HGM, Koopmans MPG. VIRO-TypeNed, systematic molecular surveillance of enteroviruses in the Netherlands between 2010 and 2014. ACTA ACUST UNITED AC 2017; 21:30352. [PMID: 27719752 PMCID: PMC5069426 DOI: 10.2807/1560-7917.es.2016.21.39.30352] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/23/2016] [Indexed: 12/29/2022]
Abstract
VIRO-TypeNed is a collaborative molecular surveillance platform facilitated through a web-based database. Genetic data in combination with epidemiological, clinical and patient data are shared between clinical and public health laboratories, as part of the surveillance underpinning poliovirus eradication. We analysed the combination of data submitted from 2010 to 2014 to understand circulation patterns of non-polio enteroviruses (NPEV) of public health relevance. Two epidemiological patterns were observed based on VIRO-TypeNed data and classical surveillance data dating back to 1996: (i) endemic cyclic, characterised by predictable upsurges/outbreaks every two to four years, and (ii) epidemic, where rare virus types caused upsurges/outbreaks. Genetic analysis suggests continuous temporal displacement of virus lineages due to the accumulation of (silent) genetic changes. Non-synonymous changes in the antigenic B/C loop suggest antigenic diversification, which may affect population susceptibility. Infections were frequently detected at an age under three months and at an older, parenting age (25–49 years) pointing to a distinct role of immunity in the circulation patterns. Upsurges were detected in the summer and winter which can promote increased transmissibility underlying new (cyclic) upsurges and requires close monitoring. The combination of data provide a better understanding of NPEV circulation required to control and curtail upsurges and outbreaks.
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Affiliation(s)
- Kimberley S M Benschop
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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29
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Shakeel S, Dykeman EC, White SJ, Ora A, Cockburn JJB, Butcher SJ, Stockley PG, Twarock R. Genomic RNA folding mediates assembly of human parechovirus. Nat Commun 2017; 8:5. [PMID: 28232749 PMCID: PMC5431903 DOI: 10.1038/s41467-016-0011-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/16/2016] [Indexed: 01/04/2023] Open
Abstract
Assembly of the major viral pathogens of the Picornaviridae family is poorly understood. Human parechovirus 1 is an example of such viruses that contains 60 short regions of ordered RNA density making identical contacts with the protein shell. We show here via a combination of RNA-based systematic evolution of ligands by exponential enrichment, bioinformatics analysis and reverse genetics that these RNA segments are bound to the coat proteins in a sequence-specific manner. Disruption of either the RNA coat protein recognition motif or its contact amino acid residues is deleterious for viral assembly. The data are consistent with RNA packaging signals playing essential roles in virion assembly. Their binding sites on the coat proteins are evolutionarily conserved across the Parechovirus genus, suggesting that they represent potential broad-spectrum anti-viral targets.The mechanism underlying packaging of genomic RNA into viral particles is not well understood for human parechoviruses. Here the authors identify short RNA motifs in the parechovirus genome that bind capsid proteins, providing approximately 60 specific interactions for virion assembly.
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Affiliation(s)
- Shabih Shakeel
- Institute of Biotechnology and Department of Biosciences, University of Helsinki, Helsinki, 00790, Finland
| | - Eric C Dykeman
- Departments of Mathematics and Biology and York Centre for Complex Systems Analysis, University of York, York, YO10 5DD, UK
| | - Simon J White
- Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, LS2 9JT, UK
| | - Ari Ora
- Institute of Biotechnology and Department of Biosciences, University of Helsinki, Helsinki, 00790, Finland
- Department of Applied Physics and Department of Biotechnology and Chemical Technology, Aalto University, Espoo, 02150, Finland
| | - Joseph J B Cockburn
- Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, LS2 9JT, UK
| | - Sarah J Butcher
- Institute of Biotechnology and Department of Biosciences, University of Helsinki, Helsinki, 00790, Finland.
| | - Peter G Stockley
- Astbury Centre for Structural Molecular Biology, University of Leeds, Leeds, LS2 9JT, UK.
| | - Reidun Twarock
- Departments of Mathematics and Biology and York Centre for Complex Systems Analysis, University of York, York, YO10 5DD, UK.
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30
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de Crom SCM, Rossen JWA, van Furth AM, Obihara CC. Enterovirus and parechovirus infection in children: a brief overview. Eur J Pediatr 2016; 175:1023-9. [PMID: 27156106 PMCID: PMC4930465 DOI: 10.1007/s00431-016-2725-7] [Citation(s) in RCA: 111] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/25/2016] [Accepted: 04/18/2016] [Indexed: 02/07/2023]
Abstract
UNLABELLED Enterovirus and parechovirus are a frequent cause of infection in children. This review is an overview of what is known from enterovirus and parechovirus infection in children and contains information about the epidemiology, pathogenesis, clinical presentation, diagnosis, treatment, and prognosis of enterovirus and parechovirus infection in children. CONCLUSIONS EV and HPeV infections are a frequent cause of infection in childhood. The clinical presentation is diverse. RT-qPCR is the best way to detect an EV or HPeV. Cerebrospinal fluid, blood and feces have the highest sensitivity for detecting an EV or HPeV. There is no treatment for EV and HPeV infections. Two vaccines against EV 71 are just licensed in China and will be available on the private market. Little is known about the prognosis of EV and HPeV infections. WHAT IS KNOWN •EV and HPeV are a frequent cause of infection in children. What is new: •This review gives a brief overview over EV and HPeV infection in children.
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Affiliation(s)
- S C M de Crom
- Department of Pediatrics, St. Elisabeth Hospital, Tilburg, The Netherlands.
- Department of Pediatrics, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - J W A Rossen
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A M van Furth
- Department of Pediatric Infectious Diseases Immunology and Rheumatology, VU Medical Centre, Amsterdam, The Netherlands
| | - C C Obihara
- Department of Pediatrics, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
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31
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Prevalence of rhinoviruses in young children of an unselected birth cohort from the Netherlands. Clin Microbiol Infect 2016; 22:736.e9-736.e15. [PMID: 27265373 PMCID: PMC7128250 DOI: 10.1016/j.cmi.2016.05.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/18/2016] [Accepted: 05/22/2016] [Indexed: 12/21/2022]
Abstract
Rhinovirus (RV) is a frequent pathogen in young children, eliciting symptoms ranging from common colds to wheezing illnesses and lower respiratory tract infections. The recently identified RV-C seems to be associated with asthma exacerbations and more severe disease, but results vary. We studied the prevalence and severity of infection with RV in an unselected birth cohort. Children with respiratory symptoms entered the symptomatic arm of the cohort and were compared with asymptomatic children. Severity of wheezing and other respiratory symptoms was registered. Respiratory viruses were evaluated using throat and nasopharyngeal swabs on first presentation and after recovery (wheezing children). RV genotyping was performed on RV-PCR positive samples. RV was the most prevalent respiratory virus and was found in 58/140 symptomatic children (41%), 24/96 (25%) control children and 19/74 (26%) wheezing symptomatic children after recovery (p <0.05) and did not differ between wheezing and non-wheezing symptomatic children—respectively, 42% (38/90) and 40% (20/50). RV-A was the most commonly detected species (40/68, 59%), followed by RV-C (22/68, 32%) and RV-B (6/68, 9%). RV-B was more frequently detected in asymptomatic children (5/6, p <0.05). There was no significant difference in the frequency of RV species between wheezing and non-wheezing symptomatic children. Children with RV mono-infection had more severe symptoms, but no association between RV species and severity of disease was seen. In an unselected birth cohort from the Netherlands with mild respiratory disease RV was the most prevalent respiratory virus. RV(-C) infection was not associated with more severe disease or wheezing.
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Abstract
After symptomatic human parechovirus (HPeV) infection in infants, the duration of (mostly asymptomatic) shedding in feces was 2-24 weeks (median 58 days). HPeV cycle threshold value could neither differentiate between symptomatic disease and asymptomatic shedding nor between severe and mild disease as high cycle threshold values (indicating low viral loads) were observed in HPeV3-infected children with severe disease.
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Britton PN, Dale RC, Nissen MD, Crawford N, Elliott E, Macartney K, Khandaker G, Booy R, Jones CA. Parechovirus Encephalitis and Neurodevelopmental Outcomes. Pediatrics 2016; 137:e20152848. [PMID: 26791970 DOI: 10.1542/peds.2015-2848] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We aimed to describe the clinical features and outcome of human parechovirus (HPeV) encephalitis cases identified by the Australian Childhood Encephalitis (ACE) study. METHODS Infants with suspected encephalitis were prospectively identified in 5 hospitals through the (ACE) study. Cases of confirmed HPeV infection had comprehensive demographic, clinical, laboratory, imaging, and outcome at discharge data reviewed by an expert panel and were categorized by using predetermined case definitions. Twelve months after discharge, neurodevelopment was assessed by using the Ages and Stages Questionnaire (ASQ). RESULTS We identified thirteen cases of suspected encephalitis with HPeV infection between May 2013 and December 2014. Nine infants had confirmed encephalitis; median age was 13 days, including a twin pair. All had HPeV detected in cerebrospinal fluid with absent pleocytosis. Most were girls (7), admitted to ICU (8), and had seizures (8). Many were born preterm (5). Seven patients had white matter diffusion restriction on MRI; 3 with normal cranial ultrasounds. At discharge, 3 of 9 were assessed to have sequelae; however, at 12 months' follow-up, by using the ASQ, 5 of 8 infants showed neurodevelopmental sequelae: 3 severe (2 cerebral palsy, 1 central visual impairment). A further 2 showed concern in gross motor development. CONCLUSIONS Children with HPeV encephalitis were predominantly young, female infants with seizures and diffusion restriction on MRI. Cranial ultrasound is inadequately sensitive. HPeV encephalitis is associated with neurodevelopmental sequelae despite reassuring short-term outcomes. Given the absent cerebrospinal fluid pleocytosis and need for specific testing, HPeV could be missed as a cause of neonatal encephalopathy and subsequent cerebral palsy.
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Affiliation(s)
- Philip N Britton
- Sydney Medical School, Sydney, Australia; Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia; Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia;
| | - Russell C Dale
- Sydney Medical School, Sydney, Australia; Department of Neurology, The Children's Hospital at Westmead, Sydney, Australia
| | - Michael D Nissen
- Department of Infectious Diseases, Royal Children's Hospital, Brisbane, Australia
| | - Nigel Crawford
- SAEFVIC, Murdoch Children's Research Institute, Melbourne, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Elizabeth Elliott
- Sydney Medical School, Sydney, Australia; Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia; Australian Paediatric Surveillance Unit, Sydney, Australia; and
| | - Kristine Macartney
- Sydney Medical School, Sydney, Australia; Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia; National Centre for Immunization Research and Surveillance, Sydney, Australia
| | - Gulam Khandaker
- Sydney Medical School, Sydney, Australia; National Centre for Immunization Research and Surveillance, Sydney, Australia
| | - Robert Booy
- Sydney Medical School, Sydney, Australia; Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia; Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia; National Centre for Immunization Research and Surveillance, Sydney, Australia
| | - Cheryl A Jones
- Sydney Medical School, Sydney, Australia; Marie Bashir Institute of Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia; Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia
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Abstract
BACKGROUND Acute disseminated encephalomyelitis (ADEM) is an inflammatory, demyelinating disease occurring several weeks after viral infection. Enteroviruses have been described as potential triggers of ADEM, but the closely related parechoviruses have not. The objective of the study is to assess the prevalence and disease presentation of ADEM after parechovirus infection in a syndromic surveillance program for pediatric infection/inflammation of the central nervous system (CNS). METHODS The surveillance was conducted at the Charité Department of Pediatrics in Berlin, Germany, from November 2010 to November 2014. All hospitalized children meeting predefined case criteria underwent highly standardized prospective clinical assessments based on the published case definitions, including for ADEM. Stool samples were independently analyzed by enterovirus and parechovirus real-time polymerase chain reaction at the Robert Koch Institute. RESULTS Of 105,557 patients screened, 774 (0.7%) fulfilled entry criteria for CNS infection/inflammation, with 114 cases ascertained as ADEM. Parechoviruses were detected in 2.5% of patients with CNS infection/inflammation, including 1 case fulfilling ADEM case criteria with the highest level of diagnostic certainty. CONCLUSIONS We report a first case of ADEM after parechovirus infection in a 5-year-old female presenting with acute hemiparesis 2 weeks after a respiratory illness. Parechovirus disease should be included in the differential diagnosis of ADEM.
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Wertheim HFL, Nadjm B, Thomas S, Agustiningsih, Malik S, Nguyen DNT, Vu DVT, Van Nguyen K, Van Nguyen CV, Nguyen LT, Tran ST, Phung TBT, Nguyen TV, Hien TT, Nguyen UH, Taylor W, Truong KH, Ha TM, Chokephaibulkit K, Farrar J, Wolbers M, de Jong MD, van Doorn HR, Puthavathana P. Viral and atypical bacterial aetiologies of infection in hospitalised patients admitted with clinical suspicion of influenza in Thailand, Vietnam and Indonesia. Influenza Other Respir Viruses 2015; 9:315-322. [PMID: 25980749 PMCID: PMC4605413 DOI: 10.1111/irv.12326] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2015] [Indexed: 01/15/2023] Open
Abstract
Background Influenza constitutes a leading cause of morbidity and mortality worldwide. There is limited information about the aetiology of infection presenting clinically as influenza in hospitalised adults and children in South-East Asia. Such data are important for future management of respiratory infections. Objectives To describe the aetiology of infection presenting clinically as influenza in those hospitalised in South-East Asia. Methods Respiratory specimens archived from July 2008 to June 2009 from patients hospitalised with suspected influenza from Indonesia, Thailand and Vietnam were tested for respiratory viruses and atypical bacteria by polymerase chain reaction. Results A total of 1222 patients’ samples were tested. Of 1222, 776 patients (63·5%) were under the age of 5. Viruses detected included rhinoviruses in 229 of 1222 patients (18·7%), bocaviruses in 200 (16·4%), respiratory syncytial viruses in 144 (11·8%), parainfluenza viruses in 140 (11·5%; PIV1: 32; PIV2: 12; PIV3: 71; PIV4: 25), adenovirus in 102 (8·4%), influenza viruses in 93 (7·6%; influenza A: 77; influenza B: 16) and coronaviruses in 23 (1·8%; OC43: 14; E229: 9). Bacterial pathogens were Mycoplasma pneumoniae (n = 33, 2·7%), Chlamydophila psittaci (n = 2), C. pneumoniae (n = 1), Bordetella pertussis (n = 1) and Legionella pneumophila (n = 2). Overall, in-hospital case fatality rate was 29 of 1222 (2·4%). Conclusion Respiratory viruses were the most commonly detected pathogens in patients hospitalised with a clinical suspicion of influenza. Rhinovirus was the most frequently detected virus, and M. pneumoniae, the most common atypical bacterium. The low number of detected influenza viruses demonstrates a low benefit for empirical oseltamivir therapy, unless during an influenza outbreak.
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Affiliation(s)
- Heiman F L Wertheim
- Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Behzad Nadjm
- Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Sherine Thomas
- Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam
| | - Agustiningsih
- National Institute of Health Research and Development, Jakarta, Indonesia
| | - Suhud Malik
- National Institute of Health Research and Development, Jakarta, Indonesia
| | - Diep Ngoc Thi Nguyen
- Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam
| | - Dung Viet Tien Vu
- Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam
| | | | | | | | | | | | | | - Tran Tinh Hien
- Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Uyen Hanh Nguyen
- Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam
| | - Walter Taylor
- Mahidol Oxford University Clinical Research Unit, Bangkok, Thailand
| | | | - Tuan Manh Ha
- Children's Hospital No 2, Ho Chi Minh City, Vietnam
| | | | - Jeremy Farrar
- Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Marcel Wolbers
- Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
| | - Menno D de Jong
- Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.,Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - H Rogier van Doorn
- Wellcome Trust Major Overseas Program, Oxford University Clinical Research Unit, Hanoi, Ho Chi Minh City, Vietnam.,Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, UK
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Human Parechovirus 3: The Most Common Viral Cause of Meningoencephalitis in Young Infants. Infect Dis Clin North Am 2015; 29:415-28. [PMID: 26188604 DOI: 10.1016/j.idc.2015.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Human parechoviruses (HPeVs) were initially classified as echoviruses. HPeVs occur worldwide, comprising up to 17 genotypes. HPeV1 and HPeV3 are most common. Clinical disease varies somewhat among genotypes. HPeV1 causes mostly gastrointestinal infections. HPeV3's prominence is due to its causing sepsis syndromes and central nervous system (CNS) infections in young infants. Currently, HPeV3 is the most common single cause of aseptic meningitis/meningoencephalitis in infants less than 90 days old in North America, usually with biannual summer-fall seasonality. HPeV3 CNS infections usually lack cerebrospinal fluid pleocytosis. Mortality and sequelae are uncommon, usually accompanying initially severe or neurologically complicated acute illnesses.
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Jain S, Patel B, Bhatt GC. Enteroviral encephalitis in children: clinical features, pathophysiology, and treatment advances. Pathog Glob Health 2015; 108:216-22. [PMID: 25175874 DOI: 10.1179/2047773214y.0000000145] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Enteroviruses (EVs) have emerged as one of the important etiological agents as a causative organism for encephalitis, especially in children and adults. After the first report of EV encephalitis cases in 1950s, there have been increasing reports of regular outbreaks of EV encephalitis worldwide. Enteroviruses are RNA viruses of the family Picornaviridae that consists of more than 100 serotypes, which are characterized by a single positive-strand genomic RNA. The clinical features are pleomorphic and can be accompanied by mucocutaneous manifestations or isolated encephalitis only. The incidence of encephalitis in EV infection is reported to be about 3% and is associated with high mortality and morbidity. A number of newer therapeutic agents have been used in EV encephalitis with variable results. This review will focus on clinical features, pathophysiology, and newer treatment modality in EV encephalitis.
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38
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Cordey S, L'Huillier AG, Turin L, Gervaix A, Posfay Barbe K, Kaiser L. Enterovirus and Parechovirus viraemia in young children presenting to the emergency room: Unrecognised and frequent. J Clin Virol 2015; 68:69-72. [PMID: 26071339 DOI: 10.1016/j.jcv.2015.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/28/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Human Enterovirus (EV) and Parechovirus (HPeV) are well recognised as agents causing disease in neonates, but their importance is poorly described in the general paediatric population consulting with a suspicion of infection. OBJECTIVE We investigated the prevalence of EV- or HPeV-associated infections in children presenting to a paediatric emergency department with a suspicion of infection. STUDY DESIGN Plasma specimens collected in our paediatric emergency room for clinical reasons were screened by specific real-time RT-PCR for the presence of EV and HPeV. RESULTS Based on an analyses of 233 plasma specimens, up to 6.9% and 2.6% were positive for EV and HPeV, respectively. Amongst the population <3y.o, prevalence of EV and HPeV viraemia was 11% and 3.7%, respectively. Importantly, 56.3% of positive EV specimens were detected in infants >3 months of age. CONCLUSION The prevalence of EV and HPeV viraemia in children <3 years old is largely underestimated. Our results confirm that EV should be suspected and included in the work-up in children >3 months of age and not restricted to neonates.
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Affiliation(s)
- S Cordey
- Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland.
| | - A G L'Huillier
- University of Geneva Medical School, Geneva, Switzerland; Paediatric Infectious Diseases Unit, Division of General Paediatrics, Department of Paediatrics, University Hospitals of Geneva, Switzerland
| | - L Turin
- Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
| | - A Gervaix
- University of Geneva Medical School, Geneva, Switzerland; Paediatric Emergency Division, University Hospitals of Geneva, Geneva, Switzerland
| | - K Posfay Barbe
- University of Geneva Medical School, Geneva, Switzerland; Paediatric Infectious Diseases Unit, Division of General Paediatrics, Department of Paediatrics, University Hospitals of Geneva, Switzerland
| | - L Kaiser
- Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, Geneva, Switzerland; University of Geneva Medical School, Geneva, Switzerland
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Human Memory B Cells Producing Potent Cross-Neutralizing Antibodies against Human Parechovirus: Implications for Prevalence, Treatment, and Diagnosis. J Virol 2015; 89:7457-64. [PMID: 25948742 DOI: 10.1128/jvi.01079-15] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 04/28/2015] [Indexed: 01/08/2023] Open
Abstract
UNLABELLED The family Picornaviridae is a large and diverse group of positive-sense RNA viruses, including human enteroviruses (EVs) and human parechoviruses (HPeVs). The human immune response against EVs and HPeVs is thought to be mainly humoral, and an insufficient neutralizing antibody (Ab) response during infection is a risk factor and can ultimately be life threatening. The accessibility of different antigenic sites and observed cross-reactivity make HPeVs a good target for development of therapeutic human monoclonal antibodies (MAbs). In this study, we generated two different human MAbs specific for HPeV by screening culture supernatants of Ab-producing human B cell cultures for direct neutralization of HPeV1. Both MAbs showed HPeV1-specific neutralization as well as neutralization of HPeV2. One antibody, AM18, cross-neutralized HPeV4, -5, and -6 and coxsackievirus A9 (CV-A9). VP1 capsid protein-specific assays confirmed that AM18 bound VP1 of HPeV1, -2, and -4 with high affinity (11.5 pM). In contrast, the HPeV1-specific MAb AM28, which neutralized HPeV1 even more efficiently than did AM18, showed no cross-reactivity with HPeV3 to -6 or other EVs and did not bind any of the capsid proteins, suggesting that AM28 is specific for a conformation-dependent, nonlinear epitope on the virus. The discovery of MAbs that are cross-reactive between HPeVs may help development of HPeV treatment options with antibodies and vaccine design based on epitopes recognized by these antibodies. IMPORTANCE HPeV infections are widespread among young children and adults, causing a broad range of disease. Infections can be severe and life threatening, while no antiviral treatment is available. Given that the absence of neutralizing Abs is a risk factor for severe disease in infants, treatment of picornavirus infections with MAbs would be a therapeutic option. To study antibody neutralization of HPeV in more detail, we generated two different HPeV1-specific human MAbs. Both MAbs show HPeV1-specific neutralization and cross-neutralized HPeV2. One MAb also cross-neutralized other HPeVs. Surprisingly, this MAb also neutralized CV-A9. These MAbs provide a unique tool for further research and for the diagnosis (antigen detection) and possible treatment of HPeV infections.
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Chang JT, Yang CS, Chen YS, Chen BC, Chiang AJ, Chang YH, Tsai WL, Lin YS, Chao D, Chang TH. Genome and infection characteristics of human parechovirus type 1: the interplay between viral infection and type I interferon antiviral system. PLoS One 2015; 10:e0116158. [PMID: 25646764 PMCID: PMC4380134 DOI: 10.1371/journal.pone.0116158] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/02/2014] [Indexed: 01/05/2023] Open
Abstract
Human parechoviruses (HPeVs), members of the family
Picornaviridae, are associated with severe human clinical
conditions such as gastrointestinal disease, encephalitis, meningitis,
respiratory disease and neonatal sepsis. A new contemporary strain of HPeV1,
KVP6 (accession no. KC769584), was isolated from a clinical specimen.
Full-genome alignment revealed that HPeV1 KVP6 shares high genome homology with
the German strain of HPeV1, 7555312 (accession no. FM178558) and could be
classified in the clade 1B group. An intertypic recombination was shown within
the P2-P3 genome regions of HPeV1. Cell-type tropism test showed that T84 cells
(colon carcinoma cells), A549 cells (lung carcinoma cells) and DBTRG-5MG cells
(glioblastoma cells) were susceptible to HPeV1 infection, which might be
relevant clinically. A facilitated cytopathic effect and increased viral titers
were reached after serial viral passages in Vero cells, with viral genome
mutation found in later passages. HPeV1 is sensitive to elevated temperature
because 39°C incubation impaired virion production. HPeV1 induced innate
immunity with phosphorylation of interferon (IFN) regulatory transcription
factor 3 and production of type I IFN in A549 but not T84 cells. Furthermore,
type I IFN inhibited HPeV1 production in A549 cells but not T84 cells; T84 cells
may be less responsive to type I IFN stimulation. Moreover, HPeV1-infected cells
showed downregulated type I IFN activation, which indicated a type I IFN evasion
mechanism. The characterization of the complete genome and infection features of
HPeV1 provide comprehensive information about this newly isolated HPeV1 for
further diagnosis, prevention or treatment strategies.
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Affiliation(s)
- Jenn-Tzong Chang
- Department of Biological Sciences, National Sun Yat-Sen University,
Kaohsiung, Taiwan
- Department of Medical Education and Research, Kaohsiung Veterans General
Hospital, Kaohsiung, Taiwan
- Department of Pediatrics; Kaohsiung Veterans General Hospital, Kaohsiung,
Taiwan
| | - Chih-Shiang Yang
- Department of Medical Education and Research, Kaohsiung Veterans General
Hospital, Kaohsiung, Taiwan
| | - Yao-Shen Chen
- Department of Infectious Diseases, Kaohsiung Veterans General Hospital,
Kaohsiung, Taiwan
| | - Bao-Chen Chen
- Department of Microbiology, Kaohsiung Veterans General Hospital,
Kaohsiung, Taiwan
| | - An-Jen Chiang
- Department of Biological Sciences, National Sun Yat-Sen University,
Kaohsiung, Taiwan
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General
Hospital, Kaohsiung, Taiwan
| | - Yu-Hsiang Chang
- Department of Pediatrics; Kaohsiung Veterans General Hospital, Kaohsiung,
Taiwan
| | - Wei-Lun Tsai
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung
Veterans General Hospital, Kaohsiung, Taiwan
| | - You-Sheng Lin
- Department of Medical Education and Research, Kaohsiung Veterans General
Hospital, Kaohsiung, Taiwan
| | - David Chao
- Department of Biological Sciences, National Sun Yat-Sen University,
Kaohsiung, Taiwan
| | - Tsung-Hsien Chang
- Department of Medical Education and Research, Kaohsiung Veterans General
Hospital, Kaohsiung, Taiwan
- Department of Pharmacy and Graduate Institute of Pharmaceutical
Technology, Tajen University, Pingtung, Taiwan
- * E-mail:
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41
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Janes VA, Minnaar R, Koen G, van Eijk H, Dijkman-de Haan K, Pajkrt D, Wolthers KC, Benschop KS. Presence of human non-polio enterovirus and parechovirus genotypes in an Amsterdam hospital in 2007 to 2011 compared to national and international published surveillance data: a comprehensive review. ACTA ACUST UNITED AC 2014; 19. [PMID: 25425513 DOI: 10.2807/1560-7917.es2014.19.46.20964] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Enteroviruses (EV) and human parechoviruses (HPeV) are endemic worldwide. These infections are a constant cause of hospitalisation and severe disease, predominantly in young children and infants. Coordinated monitoring and surveillance are crucial to control these infections. We have monitored EV and HPeV epidemiology in Amsterdam from 2007 to 2011 with real-time RT-PCR and direct genotyping, facilitating highly sensitive surveillance. Moreover, we conducted a literature survey of existing surveillance data for comparison. Only 14 studies were identified. While HPeV1 was most frequently detected in Amsterdam, EV-B viruses dominated nationally and internationally. Furthermore, the top 10 strains detected differed yearly and per study. However, detection and typing methods were too varied to allow direct comparison and comprehension of the worldwide distribution and circulation patterns of the different genotypes. This limited a direct response to anticipate peaks. Uniform European monitoring programmes are essential to aid prediction of outbreaks and disease management.
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Affiliation(s)
- V A Janes
- Emma Children s Hospital, Department of Paediatric Haematology, Immunology and Infectious Diseases, Academic Medical Center, Amsterdam, the Netherlands
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42
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Benschop KSM, Wildenbeest JG, Koen G, Minnaar RP, van Hemert FJ, Westerhuis BM, Pajkrt D, van den Broek PJ, Vossen ACTM, Wolthers KC. Genetic and antigenic structural characterization for resistance of echovirus 11 to pleconaril in an immunocompromised patient. J Gen Virol 2014; 96:571-579. [PMID: 25395595 DOI: 10.1099/vir.0.069773-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Pleconaril is a capsid inhibitor used previously to treat enterovirus infections. A pleconaril-resistant echovirus 11 (E11) strain was identified before pleconaril treatment was given in an immunocompromised patient. The patient was also treated with intravenous Ig (IVIg) for a long period but remained unresponsive. The pleconaril-resistant strains could not be neutralized in vitro, confirming IVIg treatment failure. To identify the basis of pleconaril resistance, genetic and structural analyses were conducted. Analysis of a modelled viral capsid indicated conformational changes in the hydrophobic pocket that could prevent pleconaril docking. Substitutions (V117I, V119M and I188L) in the pleconaril-resistant viruses were found in the pocket region of VP1. Modelling suggested that V119M could confer resistance, most probably due to the protruding sulfate side chain of methionine. Although pleconaril resistance induced in vitro in a susceptible E11 clinical isolate was characterized by a different substitution (I183M), resistance was suggested to also result from a similar mechanism, i.e. due to a protruding sulfate side chain of methionine. Our results showed that resistant strains that arise in vivo display different markers from those identified in vitro and suggest that multiple factors may play a role in pleconaril resistance in patient strains. Based on IVIg treatment failure, we predict that one of these factors could be immune related. Thus, both IVIg and capsid inhibitors target the viral capsid and can induce mutations that can be cross-reactive, enabling escape from both IVIg and the drug. This could limit treatment options and should be investigated further.
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Affiliation(s)
- K S M Benschop
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - J G Wildenbeest
- Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - G Koen
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - R P Minnaar
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - F J van Hemert
- Laboratory of Experimental Virology, Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - B M Westerhuis
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - D Pajkrt
- Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - P J van den Broek
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - A C T M Vossen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - K C Wolthers
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
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43
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Abstract
BACKGROUND The symptoms observed in children with human parechovirus (HPeV) infection vary widely from asymptomatic or mild gastrointestinal infections to more severe central nervous system infections and sepsis-like disease. Many of the disease associations are, however, only suggestive. In this study, we examined the connection between HPeV and acute otitis media, lower respiratory infections and suspected central nervous system infections. METHODS An HPeV specific real-time reverese transcriptase polymerase chain reaction was used to detect HPeV RNA. We analyzed altogether 200 middle-ear fluid samples, 192 nasopharyngeal aspirates, 79 cerebrospinal fluid specimens and 50 serum and 5 fecal or fecal culture samples. Positive samples were typed by sequencing the VP1 region. RESULTS Seven (8%) of 85 children with suspected central nervous system infections were positive for HPeV. Of these, 4 (all in autumn 2012 and from children <3 months of age) were typed to be HPeV4, whereas 1 child had HPeV3. HPeV4 was detected from stool, serum and cerebrospinal fluid. The children with acute otitis media tested HPeV positive in 2.5% episodes. In the lower respiratory cases, HPeV was absent. CONCLUSIONS The findings reported in this study suggest that HPeV4 can cause sepsis-like disease in young infants and be present in cerebrospinal fluid. Furthermore, this report shows that HPeV findings in children with more severe symptoms occur also in Finland.
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The particulars on parechovirus. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2014; 25:186-8. [PMID: 25285119 PMCID: PMC4173935 DOI: 10.1155/2014/602501] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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45
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Wildenbeest J, Wildenbeest J, Benschop K, Minnaar R, Bouma-de Jongh S, Wolthers K, Pajkrt D, Benschop K, Minnaar R, Bouma-de Jongh S, Wolthers K, Pajkrt D. Clinical relevance of positive human parechovirus type 1 and 3 PCR in stool samples. Clin Microbiol Infect 2014; 20:O640-7. [DOI: 10.1111/1469-0691.12542] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 12/19/2013] [Accepted: 01/13/2014] [Indexed: 11/29/2022]
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Chen HF, Zheng XY, Chen XM, Shi TL, Yao YX, Yuan Q, Chen Q, Yu SY. Diversity and recombination of human parechovirus in children with acute gastroenteritis in Guangzhou, China. J Med Virol 2014; 87:296-302. [DOI: 10.1002/jmv.24030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Hui-fang Chen
- Department of Epidemiology; School of Public Health and Tropical Medicine; Southern Medical University; Guangzhou China
- Songgang Health Inspection and Prevention Institute; Shenzhen China
| | - Xue-yan Zheng
- Department of Epidemiology; School of Public Health and Tropical Medicine; Southern Medical University; Guangzhou China
| | - Xia-ming Chen
- Songgang Health Inspection and Prevention Institute; Shenzhen China
| | - Ting-li Shi
- Department of Epidemiology; School of Public Health and Tropical Medicine; Southern Medical University; Guangzhou China
| | - Yue-xian Yao
- Department of Epidemiology; School of Public Health and Tropical Medicine; Southern Medical University; Guangzhou China
| | - Qing Yuan
- Songgang Health Inspection and Prevention Institute; Shenzhen China
| | - Qing Chen
- Department of Epidemiology; School of Public Health and Tropical Medicine; Southern Medical University; Guangzhou China
| | - Shou-yi Yu
- Department of Epidemiology; School of Public Health and Tropical Medicine; Southern Medical University; Guangzhou China
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Abstract
Early-onset sepsis remains a common and serious problem for neonates, especially preterm infants. Group B streptococcus (GBS) is the most common etiologic agent, while Escherichia coli is the most common cause of mortality. Current efforts toward maternal intrapartum antimicrobial prophylaxis have significantly reduced the rates of GBS disease but have been associated with increased rates of Gram-negative infections, especially among very-low-birth-weight infants. The diagnosis of neonatal sepsis is based on a combination of clinical presentation; the use of nonspecific markers, including C-reactive protein and procalcitonin (where available); blood cultures; and the use of molecular methods, including PCR. Cytokines, including interleukin 6 (IL-6), interleukin 8 (IL-8), gamma interferon (IFN-γ), and tumor necrosis factor alpha (TNF-α), and cell surface antigens, including soluble intercellular adhesion molecule (sICAM) and CD64, are also being increasingly examined for use as nonspecific screening measures for neonatal sepsis. Viruses, in particular enteroviruses, parechoviruses, and herpes simplex virus (HSV), should be considered in the differential diagnosis. Empirical treatment should be based on local patterns of antimicrobial resistance but typically consists of the use of ampicillin and gentamicin, or ampicillin and cefotaxime if meningitis is suspected, until the etiologic agent has been identified. Current research is focused primarily on development of vaccines against GBS.
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Infection sévère à paréchovirus de type 3 chez un nourrisson de 6semaines. Arch Pediatr 2014; 21:399-401. [DOI: 10.1016/j.arcped.2014.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/25/2013] [Accepted: 01/19/2014] [Indexed: 11/17/2022]
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Abstract
BACKGROUND Human parechoviruses (hPeV) are increasingly recognized as significant etiological agents for meningoencephalitis especially in young children, but testing of cerebrospinal fluid (CSF) for hPeV by PCR is not routinely performed. METHODS We used real-time reverse transcriptase PCR for detection of serotypes 1-6 in CSF samples of 440 children who underwent a lumbar puncture to exclude an infectious etiology of their clinical presentation. We then compared the prevalence and clinical presentation of children with hPeV-positive CSF with that of children with enterovirus (EV)-positive CSF. RESULTS HPeV was detected in 2.7% and EV in 10.7% of CSF samples. Many hPeV-positive patients were <3 months of age and usually had CSF parameters within the age-adjusted normal range. However, children with hPeV-positive CSF presented with neurologic symptoms more frequently than those with EV-positive CSF. CONCLUSIONS HPeV infections of the central nervous system occurred mainly in young infants and were more commonly associated with neurologic symptoms at presentation, despite the fact that CSF findings were within the normal range in the vast majority of these cases. HPeV should be included in the differential diagnosis of young children with central nervous system symptoms and sepsis-like illness, even in the presence of normal CSF parameters.
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Rahimi P, Naser HM, Siadat SD, Sohrabi A, Mostafavi E, Motamedirad M, Bahramali G, Sadat SM, Ardestani MS. Genotyping of human parechoviruses in Iranian young children with aseptic meningitis and sepsis-like illness. J Neurovirol 2013; 19:595-600. [PMID: 24277440 DOI: 10.1007/s13365-013-0221-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/16/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
Abstract
Human parechoviruses (HPeV) are classified into 14 genotypes. HPeV1 and HPeV2 are the most prevalent genotypes in young children, which have been associated with mild to severe diseases. This study was conducted to investigate the involvement of HPeVs in aseptic meningitis and sepsis-like illness in Iran. Viral RNA was extracted from 148 cerebrospinal fluid samples from children <8 years old with primary diagnosis of aseptic meningitis and/or sepsis-like illness. Specific HPeV, HEV real-time PCR and HPeV typing were done to identify the infection rate of these viruses. HPeV and HEV were detected in 64 (43.24 %), 31 (20.94 %) of 148 patients with 10 (6.75 %) coinfection. VP1/VP3 junction region was successfully sequenced from 12 of the HPeV-positive specimens, and all of them were identified as HPeV1. HPeV was more prevalent than HEV in both aseptic meningitis and sepsis-like illness, so further studies are needed to understand the disease burden of HPeV infections, and clinical manifestations especially in specific illnesses of possible viral etiology. Direct detection of these viruses leads to reduce hospitalization and use of antibiotic, which are often followed by other complications in neonates and young children.
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Affiliation(s)
- Pooneh Rahimi
- Department of Hepatitis and AIDS, Pasteur Institute of Iran, Enghelab Square, 12 Faravrdin Ave, Tehran, Iran,
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