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Park S, Inaba Y, Tsuruta K, Sugiura K. Hand-foot-and-mouth disease in an elderly adult caused by coxsackievirus A4. J Dermatol 2024; 51:e239-e240. [PMID: 38345303 DOI: 10.1111/1346-8138.17148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Sunyoung Park
- Department of Dermatology, Daido Hospital, Nagoya, Japan
| | - Yasuko Inaba
- Department of Dermatology, Daido Hospital, Nagoya, Japan
| | - Kyoko Tsuruta
- Department of Dermatology, Daido Hospital, Nagoya, Japan
| | - Kazumitsu Sugiura
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
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2
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Yan R, He J, Liu G, Zhong J, Xu J, Zheng K, Ren Z, He Z, Zhu Q. Drug Repositioning for Hand, Foot, and Mouth Disease. Viruses 2022; 15:75. [PMID: 36680115 PMCID: PMC9861398 DOI: 10.3390/v15010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is a highly contagious disease in children caused by a group of enteroviruses. HFMD currently presents a major threat to infants and young children because of a lack of antiviral drugs in clinical practice. Drug repositioning is an attractive drug discovery strategy aimed at identifying and developing new drugs for diseases. Notably, repositioning of well-characterized therapeutics, including either approved or investigational drugs, is becoming a potential strategy to identify new treatments for virus infections. Various types of drugs, including antibacterial, cardiovascular, and anticancer agents, have been studied in relation to their therapeutic potential to treat HFMD. In this review, we summarize the major outbreaks of HFMD and the progress in drug repositioning to treat this disease. We also discuss the structural features and mode of action of these repositioned drugs and highlight the opportunities and challenges of drug repositioning for HFMD.
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Affiliation(s)
- Ran Yan
- School of Pharmaceutical Sciences, Shenzhen University, Shenzhen 518060, China
- College of Pharmacy, Shenzhen Technology University, Shenzhen 518118, China
| | - Jiahao He
- School of Pharmaceutical Sciences, Shenzhen University, Shenzhen 518060, China
| | - Ge Liu
- College of Pharmacy, Shenzhen Technology University, Shenzhen 518118, China
| | - Jianfeng Zhong
- School of Pharmaceutical Sciences, Shenzhen University, Shenzhen 518060, China
| | - Jiapeng Xu
- College of Pharmacy, Shenzhen Technology University, Shenzhen 518118, China
| | - Kai Zheng
- School of Pharmaceutical Sciences, Shenzhen University, Shenzhen 518060, China
| | - Zhe Ren
- Institute of Biomedicine, College of Life Science and Technology, Jinan University, Guangzhou 510632, China
- National Engineering Research Center of Genetic Medicine, Guangzhou 510632, China
| | - Zhendan He
- School of Pharmaceutical Sciences, Shenzhen University, Shenzhen 518060, China
| | - Qinchang Zhu
- College of Pharmacy, Shenzhen Technology University, Shenzhen 518118, China
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3
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Li J, Ni N, Cui Y, Zong S, Yao X, Hu T, Cao M, Zhang Y, Hou P, Carr MJ, Xing W, Zhou H, Shi W. An outbreak of a novel recombinant Coxsackievirus A4 in a kindergarten, Shandong Province, China, 2021. Emerg Microbes Infect 2022; 11:2207-2210. [PMID: 35993324 PMCID: PMC9518300 DOI: 10.1080/22221751.2022.2114855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In 2021, twenty children exhibiting influenza-like illnesses were reported from a kindergarten in Shandong Province, China. Eleven genomes of Coxsackievirus A4 (CV-A4) were obtained from the pediatric cases, sharing <93% genome sequence identities with known CV-A4 strains. Further analyses suggested potential genetic recombination in the P3 region of the novel strains.
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Affiliation(s)
- Juan Li
- Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Nan Ni
- Taian Center for Disease Control and Prevention, Taian, China
| | - Yanan Cui
- Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Shuai Zong
- Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Xue Yao
- Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Tao Hu
- Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Mengyuan Cao
- Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Yong Zhang
- Taishan District Center for Disease Control and Prevention, Taian, China
| | - Peiqiang Hou
- Taian Center for Disease Control and Prevention, Taian, China
| | - Michael J. Carr
- National Virus Reference Laboratory, School of Medicine, University College Dublin, Dublin 4, Ireland
- International Collaboration Unit, Research Center for Zoonosis Control, Hokkaido University, N20 W10 Kita-ku, Sapporo, 001-0020, Japan
| | - Weijia Xing
- Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Hong Zhou
- Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
| | - Weifeng Shi
- Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
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4
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Genetic characterization of VP1 of coxsackieviruses A2, A4, and A10 associated with hand, foot, and mouth disease in Vietnam in 2012-2017: endemic circulation and emergence of new HFMD-causing lineages. Arch Virol 2020; 165:823-834. [PMID: 32008121 DOI: 10.1007/s00705-020-04536-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/23/2019] [Indexed: 12/15/2022]
Abstract
While conducting sentinel surveillance of hand, foot, and mouth disease (HFMD) in Vietnam, we found a sudden increase in the prevalence of coxsackievirus A10 (CV-A10) in 2016 and CV-A2 and CV-A4 in 2017, the emergence of which has been reported recently to be associated with various clinical manifestations in other countries. However, there have been only a limited number of molecular studies on those serotypes, with none being conducted in Vietnam. Therefore, we sequenced the entire VP1 genes of CV-A10, CV-A4, and CV-A2 strains associated with HFMD in Vietnam between 2012 and 2017. Phylogenetic analysis revealed a trend of endemic circulation of Vietnamese CV-A10, CV-A4, and CV-A2 strains and the emergence of thus-far undescribed HFMD-causing lineages of CV-A4 and CV-A2. The Vietnamese CV-A10 strains belonged to a genotype comprising isolates from patients with HFMD from several other countries; however, most of the Vietnamese strains were grouped into a local lineage. Recently, emerging CV-A4 strains in Vietnam were grouped into a unique lineage within a genotype comprising strains isolated from patients with acute flaccid paralysis from various countries. New substitutions were detected in the putative BC and HI loops in the Vietnamese CV-A4 strains. Except for one strain, Vietnamese CV-A2 isolates were grouped into a unique lineage of a genotype that includes strains from various countries that are associated with other clinical manifestations. Enhanced surveillance is required to monitor their spread and to specify their roles as etiological agents of HFMD or "HFMD-like" diseases, especially for CV-A4 and CV-A2. Further studies including whole-genome sequencing should be conducted to fully understand the evolutionary changes occurring in these newly emerging strains.
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5
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Ji T, Guo Y, Lv L, Wang J, Shi Y, Yu Q, Zhang F, Tong W, Ma J, Zeng H, Zhao H, Zhang Y, Han T, Song Y, Yan D, Yang Q, Zhu S, Zhang Y, Xu W. Emerging recombination of the C2 sub-genotype of HFMD-associated CV-A4 is persistently and extensively circulating in China. Sci Rep 2019; 9:13668. [PMID: 31541120 PMCID: PMC6754396 DOI: 10.1038/s41598-019-49859-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/23/2019] [Indexed: 12/31/2022] Open
Abstract
Sporadic outbreaks caused by coxsackievirus A4 (CV-A4) have been reported worldwide. To further elucidate the detailed genetic characteristics and evolutionary recombination events of CV-A4, virus samples from nationwide hand, foot and mouth disease (HFMD) surveillance, encompassing 27 out of the 31 provinces in China, were investigated. Comprehensive and systematic phylogenetic analyses were performed by using 29 complete genomes, 142 complete CV-A4 VP1 sequences. Four genotypes (A, B, C and D) and five sub-genotypes (C1-C5) were re-identified based on the complete VP1 sequences. C2 is the predominant sub-genotype of CV-A4 associated with HFMD and has evolved into 3 clusters. Cluster 1 is a major cluster that has been persistently and extensively circulating in China since 2006 and has been associated with all severe cases. All the sequences showed high homology with the CV-A4 prototype in the P1 region, while higher identities with CV-A5, CV-14 and CV-16 in the P2 and P3 regions. Recombination analysis revealed that C2 had two specific genetic recombination patterns with other EV-A prototypes in the 5'-UTR and 3D region compared with C5. These recombination patterns might be associated with the increased transmissibility of C2 viruses, which were obtained due to their persistent and extensive circulation in populations.
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Affiliation(s)
- Tianjiao Ji
- NHC Key Laboratory of Medical Virology and Viral Diseases (National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention), Beijing, People's Republic of China
| | - Yue Guo
- NHC Key Laboratory of Medical Virology and Viral Diseases (National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention), Beijing, People's Republic of China
| | - Likun Lv
- Tianjin Municipal Center for Disease Control and Prevention, Tianjin Municipal, People's Republic of China
| | - Jianxing Wang
- Shandong Center for Disease Control and Prevention, Shandong Province, People's Republic of China
| | - Yong Shi
- Jiangxi Center for Disease Control and Prevention, Nanchang, Jiangxi Province, People's Republic of China
| | - Qiuli Yu
- Hebei Center for Disease Control and Prevention, Shijiazhuang, Hebei Province, People's Republic of China
| | - Fan Zhang
- Hunan Center for Disease Control and Prevention, Changsha, Hunan Province, People's Republic of China
| | - Wenbin Tong
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan Province, People's Republic of China
| | - Jiangtao Ma
- Ningxia Center for Disease Control and Prevention, Yinchuan, Ningxia Province, People's Republic of China
| | - Hanri Zeng
- Guangdong Center for Disease Control and Prevention, Guangzhou, Guangdong Province, People's Republic of China
| | - Hua Zhao
- Chongqing Center for Disease Control and Prevention, Chongqing Municipal, People's Republic of China
| | - Yong Zhang
- NHC Key Laboratory of Medical Virology and Viral Diseases (National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention), Beijing, People's Republic of China
| | - Taoli Han
- NHC Key Laboratory of Medical Virology and Viral Diseases (National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention), Beijing, People's Republic of China
| | - Yang Song
- NHC Key Laboratory of Medical Virology and Viral Diseases (National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention), Beijing, People's Republic of China
| | - Dongmei Yan
- NHC Key Laboratory of Medical Virology and Viral Diseases (National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention), Beijing, People's Republic of China
| | - Qian Yang
- NHC Key Laboratory of Medical Virology and Viral Diseases (National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention), Beijing, People's Republic of China
| | - Shuangli Zhu
- NHC Key Laboratory of Medical Virology and Viral Diseases (National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention), Beijing, People's Republic of China
| | - Yan Zhang
- NHC Key Laboratory of Medical Virology and Viral Diseases (National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention), Beijing, People's Republic of China.
| | - Wenbo Xu
- NHC Key Laboratory of Medical Virology and Viral Diseases (National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention), Beijing, People's Republic of China.
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Wang M, Li J, Yao MX, Zhang YW, Hu T, Carr MJ, Duchêne S, Zhang XC, Zhang ZJ, Zhou H, Tong YG, Ding SJ, Wang XJ, Shi WF. Genome Analysis of Coxsackievirus A4 Isolates From Hand, Foot, and Mouth Disease Cases in Shandong, China. Front Microbiol 2019; 10:1001. [PMID: 31134033 PMCID: PMC6513881 DOI: 10.3389/fmicb.2019.01001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/18/2019] [Indexed: 01/12/2023] Open
Abstract
Coxsackievirus A4 (CVA4) is one of the most prevalent pathogens associated with hand, foot and mouth disease (HFMD), an acute febrile illness in children, and is also associated with acute localized exanthema, myocarditis, hepatitis and pancreatitis. Despite this, limited CVA4 genome sequences are currently available. Herein, complete genome sequences from CVA4 strains (n = 21), isolated from patients with HFMD in Shandong province, China between 2014 and 2016, were determined and phylogenetically characterized. Phylogenetic analysis of the VP1 gene from a larger CVA4 collection (n = 175) showed that CVA4 has evolved into four separable genotypes: A, B, C, and D; and genotype D could be further classified in to two sub-genotypes: D1 and D2. Each of the 21 newly described genomes derived from isolates that segregated with sub-genotype D2. The CVA4 genomes displayed significant intra-genotypic genetic diversity with frequent synonymous substitutions occurring at the third codon positions, particularly within the P2 region. However, VP1 was relatively stable and therefore represents a potential target for molecular diagnostics assays and also for the rational design of vaccine epitopes. The substitution rate of VP1 was estimated to be 5.12 × 10-3 substitutions/site/year, indicative of ongoing CVA4 evolution. Mutations at amino acid residue 169 in VP1 gene may be responsible for differing virulence of CVA4 strains. Bayesian skyline plot analysis showed that the population size of CVA4 has experienced several dynamic fluctuations since 1948. In summary, we describe the phylogenetic and molecular characterization of 21 complete genomes from CVA4 isolates which greatly enriches the known genomic diversity of CVA4 and underscores the need for further surveillance of CVA4 in China.
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Affiliation(s)
- Min Wang
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Juan Li
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Ming-Xiao Yao
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Institute for Viral Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Ya-Wei Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Tao Hu
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Michael J Carr
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan.,National Virus Reference Laboratory, School of Medicine, University College Dublin, Dublin, Ireland
| | - Sebastián Duchêne
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC, Australia
| | - Xing-Cheng Zhang
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Zhen-Jie Zhang
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Hong Zhou
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Yi-Gang Tong
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Shu-Jun Ding
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Institute for Viral Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Xian-Jun Wang
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Institute for Viral Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Wei-Feng Shi
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
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7
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Chen P, Wang H, Tao Z, Xu A, Lin X, Zhou N, Wang P, Wang Q. Multiple transmission chains of coxsackievirus A4 co-circulating in China and neighboring countries in recent years: Phylogenetic and spatiotemporal analyses based on virological surveillance. Mol Phylogenet Evol 2017; 118:23-31. [PMID: 28942015 DOI: 10.1016/j.ympev.2017.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/30/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
Coxsackievirus A4 (CV-A4) has been reported frequently in association with many infectious diseases and cases of hand, foot, and mouth disease potentially associated with CV-A4 infection are also identified. This study summarized the Shandong CV-A4 strains isolated from 25years acute flaccid paralysis surveillance, with an emphasis on exploring the phylogenetic analyses and spatiotemporal dynamics of CV-A4 at the global scale. We sampled 43 CV-A4 isolates and utilized VP1 gene to construct phylogenetic trees. Further extensive Bayesian phylogeographic analysis was carried out to investigate the evolution of CV-A4 and understand the spatiotemporal diffusion around the world using BEAST and SPREAD software. Phylogenetic trees showed that CV-A4 emerged to be more active in recent decades and multiple transmission chains were co-circulating. The molecular clock analysis estimated a mean evolutionary rate of 6.4×10-3 substitutions/site/year, and the estimated origin of CV-A4 around 1944. The phylogeographic analyses suggested the origin of CV-A4 could be in the USA, however regional dissemination was mainly located around the Asia-Europe region. The spatiotemporal dynamics of CV-A4 exhibited frequent viral traffic among localities, and virus from Shandong province seemed to have played a central role in spreading around China and neighboring countries. Our phylogenetic description and phylogeographic analyses indicate the importance of large spatial- and temporal-scale studies in understanding epidemiological dynamics of CV-A4, particularly the diffusion routes will be of great importance to global control efforts.
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Affiliation(s)
- Peng Chen
- Department of Epidemiology, School of Public Health, Shandong University, No. 44 Wenhuaxi Road, Jinan 250012, People's Republic of China
| | - Haiyan Wang
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, No. 16992 Jingshi Road, Jinan 250014, People's Republic of China
| | - Zexin Tao
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, No. 16992 Jingshi Road, Jinan 250014, People's Republic of China
| | - Aiqiang Xu
- Department of Epidemiology, School of Public Health, Shandong University, No. 44 Wenhuaxi Road, Jinan 250012, People's Republic of China; Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, No. 16992 Jingshi Road, Jinan 250014, People's Republic of China.
| | - Xiaojuan Lin
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, No. 16992 Jingshi Road, Jinan 250014, People's Republic of China
| | - Nan Zhou
- Department of Epidemiology, School of Public Health, Shandong University, No. 44 Wenhuaxi Road, Jinan 250012, People's Republic of China
| | - Pei Wang
- Department of Epidemiology, School of Public Health, Shandong University, No. 44 Wenhuaxi Road, Jinan 250012, People's Republic of China
| | - Qian Wang
- Department of Epidemiology, School of Public Health, Shandong University, No. 44 Wenhuaxi Road, Jinan 250012, People's Republic of China
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High prevalence of coxsackievirus A2 in children with herpangina in Thailand in 2015. Virusdisease 2017; 28:111-114. [PMID: 28466062 DOI: 10.1007/s13337-017-0366-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/02/2017] [Indexed: 10/20/2022] Open
Abstract
Coxsackievirus (CV) is a member of the genus Enterovirus and the family Picornaviridae. CV infection can cause herpangina, a disease characterized by multiple ulcers on the tonsils and soft palate affecting mostly young children. CV strains are categorized by serotypes. Unfortunately, serotypes responsible for infections in patients are often undetermined. This knowledge gap partly contributes to the ineffective prevention and control of CV-associated herpangina in Southeast Asia. To characterize the viral etiology of children presented with herpangina, 295 throat swabs were tested for human enterovirus infection. Using RT-PCR specific for the viral 5'UTR/VP2 and the VP1 regions, two most frequent CV types found in these samples were CV-A2 (33.33%, 40/120) and CV-A4 (15.8%, 19/120). Phylogenetic analysis of the VP1 gene demonstrated that the CV-A2 strains in this study not only were closely related to those previously identified in Asia and Europe, but the majority clustered into a distinct group. Thus, infection predominantly by CV-A2 and CV-A4 caused herpangina in 2015 in Thailand.
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Yen YC, Chu PH, Lu PL, Lin YC, Shi YY, Chou LC, Wang CF, Lin YY, Su HJ, Lin CC, Zeng JY, Tyan YC, Ke GM, Chu PY. Phylodynamic Characterization of an Ocular-Tropism Coxsackievirus A24 Variant. PLoS One 2016; 11:e0160672. [PMID: 27529556 PMCID: PMC4987047 DOI: 10.1371/journal.pone.0160672] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 06/13/2016] [Indexed: 01/22/2023] Open
Abstract
Recent phylodynamic studies have focused on using tree topology patterns to elucidate interactions among the epidemiological, evolutionary, and demographic characteristics of infectious agents. However, because studies of viral phylodynamics tend to focus on epidemic outbreaks, tree topology signatures of tissue-tropism pathogens might not be clearly identified. Therefore, this study used a novel Bayesian evolutionary approach to analyze the A24 variant of coxsackievirus (CV-A24v), an ocular-tropism agent of acute hemorrhagic conjunctivitis. Analyses of the 915-nucleotide VP1 and 690-nt 3Dpol regions of 21 strains isolated in Taiwan and worldwide during 1985-2010 revealed a clear chronological trend in both the VP1 and 3Dpol phylogenetic trees: the emergence of a single dominant cluster in each outbreak. The VP1 sequences included three genotypes: GI (prototype), GIII (isolated 1985-1999), and GIV (isolated after 2000); no VP1 sequences from GII strains have been deposited in GenBank. Another five genotypes identified in the 3Dpol region had support values >0.9. Geographic and demographic transitions among CV-A24v clusters were clearly identified by Bayes algorithm. The transmission route was mapped from India to China and then to Taiwan, and each prevalent viral population declined before new clusters emerged. Notably, the VP1 and 3Dpol genes had high nucleotide sequence similarities (94.1% and 95.2%, respectively). The lack of co-circulating lineages and narrow tissue tropism affected the CV-A24v gene pool.
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Affiliation(s)
- Yung-Chang Yen
- Department of Ophthalmology, Chi Mei Medical Center, Liou-Ying, Tainan, Taiwan
- Department of Nursing, Min Hwei College of Health Care Management, Tainan, Taiwan
| | - Pei-Huan Chu
- Division of Cardiology, Department of Medicine, Wei Gong Memorial Hospital, Miaoli, Taiwan
| | - Po-Liang Lu
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yung-Cheng Lin
- Institute of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung, Taiwan
| | - Yong-Ying Shi
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Chiu Chou
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chu-Feng Wang
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Ying Lin
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hui-Ju Su
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chien-Ching Lin
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jing-Yun Zeng
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Chang Tyan
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan
- Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Guan-Ming Ke
- Graduate Institute of Animal Vaccine Technology, College of Veterinary Medicine, National Pingtung University of Science and Technology, Neipu, Pingtung, Taiwan
| | - Pei-Yu Chu
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
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10
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Huang HW, Chen YS, Chen JYF, Lu PL, Lin YC, Chen BC, Chou LC, Wang CF, Su HJ, Huang YC, Shi YY, Chen HL, Sanno-Duanda B, Huang TS, Lin KH, Tyan YC, Chu PY. Phylodynamic reconstruction of the spatiotemporal transmission and demographic history of coxsackievirus B2. BMC Bioinformatics 2015; 16:302. [PMID: 26390997 PMCID: PMC4578604 DOI: 10.1186/s12859-015-0738-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 09/11/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Studies regarding coxsackievirus (CV) tend to focus on epidemic outbreaks, an imbalanced topology is considered to be an indication of acute infection with partial cross-immunity. In enteroviruses, a clear understanding of the characteristics of tree topology, transmission, and its demographic dynamics in viral succession and circulation are essential for identifying prevalence trends in endemic pathogens such as coxsackievirus B2 (CV-B2). This study applied a novel Bayesian evolutionary approach to elucidate the phylodynamic characteristics of CV-B2. A dataset containing 51 VP1 sequences and a dataset containing 34 partial 3D(pol) sequencing were analyzed, where each dataset included Taiwan sequences isolated during 1988-2013. RESULTS Four and five genotypes were determined based on the 846-nucleotide VP1 and 441-nucleotide 3D(pol) (6641-7087) regions, respectively, with spatiotemporally structured topologies in both trees. Some strains with tree discordance indicated the occurrence of recombination in the region between the VP1 and 3D(pol) genes. The similarities of VP1 and 3D(pol) gene were 80.0%-96.8% and 74.7%-91.9%, respectively. Analyses of population dynamics using VP1 dataset indicated that the endemic CV-B2 has a small effective population size. The balance indices, high similarity, and low evolutionary rate in the VP1 region indicated mild herd immunity selection in the major capsid region. CONCLUSIONS Phylodynamic analysis can reveal demographic trends and herd immunity in endemic pathogens.
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Affiliation(s)
- Hui-Wen Huang
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, ROC, Taiwan. .,Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, ROC, Taiwan.
| | - Yao-Shen Chen
- Division of Infectious Diseases, Kaohsiung Veterans General Hospital, Kaohsiung, ROC, Taiwan. .,Division of Microbiology, Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, ROC, Taiwan. .,Department of Internal Medicine, National Yang-Ming Medical University, Taipei, ROC, Taiwan.
| | - Jeff Yi-Fu Chen
- Department of Biotechnology, Kaohsiung Medical University, Kaohsiung, ROC, Taiwan.
| | - Po-Liang Lu
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, ROC, Taiwan. .,Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, ROC, Taiwan.
| | - Yung-Cheng Lin
- Institute of Bioscience and Biotechnology, National Taiwan Ocean University, Keelung, ROC, Taiwan.
| | - Bao-Chen Chen
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, ROC, Taiwan.
| | - Li-Chiu Chou
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, ROC, Taiwan.
| | - Chu-Feng Wang
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, ROC, Taiwan.
| | - Hui-Ju Su
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, ROC, Taiwan.
| | - Yi-Chien Huang
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, ROC, Taiwan.
| | - Yong-Ying Shi
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, ROC, Taiwan.
| | - Hsiu-Lin Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, ROC, Taiwan. .,Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, ROC, Taiwan.
| | - Bintou Sanno-Duanda
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, ROC, Taiwan. .,Department of laboratory medicine, Edward Francis Small Teaching Hospital, Banjul, Gambia.
| | - Tsi-Shu Huang
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, ROC, Taiwan.
| | - Kuei-Hsiang Lin
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, ROC, Taiwan.
| | - Yu-Chang Tyan
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Pei-Yu Chu
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, ROC, Taiwan. .,Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, ROC, Taiwan.
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11
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Molecular epidemiology of coxsackievirus type B1. Arch Virol 2015; 160:2815-21. [PMID: 26243282 DOI: 10.1007/s00705-015-2561-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
Abstract
Coxsackievirus type B1 (CVB1) has emerged globally as the predominant enterovirus serotype and is associated with epidemics of meningitis and chronic diseases. In this report, the phylogeny of CVB1 was studied based on the VP1 sequences of 11 North African isolates and 81 published sequences. All CVB1 isolates segregated into four distinct genogroups and 10 genotypes. Most of the identified genotypes of circulating CVB1 strains appear to have a strict geographical specificity. The North African strains were of a single genotype and probably evolved distinctly. Using a relaxed molecular clock model and three different population models (constant population, exponential growth and Bayesian skyline demographic models) in coalescent analysis using the BEAST program, the substitution rate in CVB1 varied between 6.95 × 10(-3) and 7.37 × 10(-3) substitutions/site/year in the VP1 region. This study permits better identification of circulating CVB1, which has become one of the most predominant enterovirus serotypes in humans.
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12
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Li JS, Dong XG, Qin M, Xie ZP, Gao HC, Yang JY, Yang XX, Li DD, Li J, Duan ZJ. Outbreak of febrile illness caused by coxsackievirus A4 in a nursery school in Beijing, China. Virol J 2015; 12:92. [PMID: 26084565 PMCID: PMC4495935 DOI: 10.1186/s12985-015-0325-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 06/15/2015] [Indexed: 11/13/2022] Open
Abstract
Background Coxsackievirus A4 (CV-A4) is classified as human enterovirus A according to its serotype. CV-A4, an etiological agent of hand, foot, and mouth disease, affects children worldwide and can circulate in closed environments such as schools and hospitals for long periods. Findings An outbreak of febrile illness at a nursery school in Beijing, China, was confirmed to be caused by CV-A4. Phylogenetic analysis of the complete genome of the isolated strain showed that the virus belongs to the same cluster as the predominant CV-A4 strain in China. This outbreak was controlled by effective measures. Conclusions The early identification of the pathogen and timely intervention may be the most critical factors in controlling an outbreak caused by CV-A4 in a preschool.
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Affiliation(s)
- Jin-Song Li
- National Institute for Viral Disease Control and Prevention, China CDC, 100 Ying-Xin St., Xuan-Wu District, Beijing, 100052, China.
| | - Xiao-Gen Dong
- Fengtai District Center for Disease Control and Prevention of Beijing, 3 Xi An St., Feng-Tai District, Beijing, 100071, China.
| | - Meng Qin
- Fengtai District Center for Disease Control and Prevention of Beijing, 3 Xi An St., Feng-Tai District, Beijing, 100071, China.
| | - Zhi-Ping Xie
- National Institute for Viral Disease Control and Prevention, China CDC, 100 Ying-Xin St., Xuan-Wu District, Beijing, 100052, China.
| | - Han-Chun Gao
- National Institute for Viral Disease Control and Prevention, China CDC, 100 Ying-Xin St., Xuan-Wu District, Beijing, 100052, China.
| | - Jun-Yong Yang
- Fengtai District Center for Disease Control and Prevention of Beijing, 3 Xi An St., Feng-Tai District, Beijing, 100071, China.
| | - Xiao-Xin Yang
- Fengtai District Center for Disease Control and Prevention of Beijing, 3 Xi An St., Feng-Tai District, Beijing, 100071, China.
| | - Dan-Di Li
- National Institute for Viral Disease Control and Prevention, China CDC, 100 Ying-Xin St., Xuan-Wu District, Beijing, 100052, China.
| | - Jie Li
- Fengtai District Center for Disease Control and Prevention of Beijing, 3 Xi An St., Feng-Tai District, Beijing, 100071, China.
| | - Zhao-Jun Duan
- National Institute for Viral Disease Control and Prevention, China CDC, 100 Ying-Xin St., Xuan-Wu District, Beijing, 100052, China.
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13
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Chu PY, Tyan YC, Chen YS, Chen HL, Lu PL, Chen YH, Chen BC, Huang TS, Wang CF, Su HJ, Shi YY, Sanno-Duanda B, Lin KH, Motomura K. Transmission and Demographic Dynamics of Coxsackievirus B1. PLoS One 2015; 10:e0129272. [PMID: 26053872 PMCID: PMC4460132 DOI: 10.1371/journal.pone.0129272] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 05/06/2015] [Indexed: 11/19/2022] Open
Abstract
The infectious activity of coxsackievirus B1 (CV-B1) in Taiwan was high from 2008 to 2010, following an alarming increase in severe neonate disease in the United States (US). To examine the relationship between CV-B1 strains isolated in Taiwan and those from other parts of the world, we performed a phylodynamic study using VP1 and partial 3Dpol (414 nt) sequences from 22 strains of CV-B1 isolated in Taiwan (1989-2010) and compared them to sequences from strains isolated worldwide. Phylogenetic trees were constructed by neighbor-joining, maximum likelihood, and Bayesian Monte Carlo Markov Chain methods. Four genotypes (GI-IV) in the VP1 region of CV-B1 and three genotypes (GA-C) in the 3Dpol region of enterovirus B were identified and had high support values. The phylogenetic analysis indicates that the GI and GIII strains in VP1 were geographically distributed in Taiwan (1993-1994) and in India (2007-2009). On the other hand, the GII and GIV strains appear to have a wider spatiotemporal distribution and ladder-like topology A stair-like phylogeny was observed in the VP1 region indicating that the phylogeny of the virus may be affected by different selection pressures in the specified regions. Further, most of the GI and GII strains in the VP1 tree were clustered together in GA in the 3D tree, while the GIV strains diverged into GB and GC. Taken together, these data provide important insights into the population dynamics of CV-B1 and indicate that incongruencies in specific gene regions may contribute to spatiotemporal patterns of epidemicity for this virus.
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Affiliation(s)
- Pei-Yu Chu
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
- * E-mail: (PYC); (KM)
| | - Yu-Chang Tyan
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Translational Research Center, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- National Sun Yat-Sen University-Kaohsiung Medical University Joint Research Center, Kaohsiung 804, Taiwan
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung 804, Taiwan
| | - Yao-Shen Chen
- Division of Infectious Diseases, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
- Department of Internal Medicine, National Yang-Ming Medical University, Taipei, Taiwan, ROC
| | - Hsiu-Lin Chen
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Liang Lu
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
- Department of Laboratory Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
| | - Yu-Hsien Chen
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Bao-Chen Chen
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Tsi-Shu Huang
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Chu-Feng Wang
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Hui-Ju Su
- Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, ROC
| | - Yong-Ying Shi
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Bintou Sanno-Duanda
- Department of Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
- Edward Francis Small Teaching Hospital, Banjul, Gambia
| | - Kuei-Hsiang Lin
- Department of Laboratory Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan
| | - Kazushi Motomura
- Pathogen Genomics Center, National Institute of Infectious Diseases, Tokyo, Japan
- Thailand-Japan Research Collaboration Center on Emerging and Re-emerging Infections, Research Institute of Microbial Diseases, Osaka University, Nonthaburi, Thailand
- * E-mail: (PYC); (KM)
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14
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Kyriakopoulou Z, Bletsa M, Tsakogiannis D, Dimitriou TG, Amoutzias GD, Gartzonika C, Levidiotou-Stefanou S, Markoulatos P. Molecular epidemiology and evolutionary dynamics of Echovirus 3 serotype. INFECTION GENETICS AND EVOLUTION 2015; 32:305-12. [DOI: 10.1016/j.meegid.2015.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 02/25/2015] [Accepted: 03/09/2015] [Indexed: 01/06/2023]
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15
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The evolution of Vp1 gene in enterovirus C species sub-group that contains types CVA-21, CVA-24, EV-C95, EV-C96 and EV-C99. PLoS One 2014; 9:e93737. [PMID: 24695547 PMCID: PMC3973639 DOI: 10.1371/journal.pone.0093737] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 03/07/2014] [Indexed: 12/17/2022] Open
Abstract
Genus Enterovirus (Family Picornaviridae,) consists of twelve species divided into genetically diverse types by their capsid protein VP1 coding sequences. Each enterovirus type can further be divided into intra-typic sub-clusters (genotypes). The aim of this study was to elucidate what leads to the emergence of novel enterovirus clades (types and genotypes). An evolutionary analysis was conducted for a sub-group of Enterovirus C species that contains types Coxsackievirus A21 (CVA-21), CVA-24, Enterovirus C95 (EV-C95), EV-C96 and EV-C99. VP1 gene datasets were collected and analysed to infer the phylogeny, rate of evolution, nucleotide and amino acid substitution patterns and signs of selection. In VP1 coding gene, high intra-typic sequence diversities and robust grouping into distinct genotypes within each type were detected. Within each type the majority of nucleotide substitutions were synonymous and the non-synonymous substitutions tended to cluster in distinct highly polymorphic sites. Signs of positive selection were detected in some of these highly polymorphic sites, while strong negative selection was indicated in most of the codons. Despite robust clustering to intra-typic genotypes, only few genotype-specific ‘signature’ amino acids were detected. In contrast, when different enterovirus types were compared, there was a clear tendency towards fixation of type-specific ‘signature’ amino acids. The results suggest that permanent fixation of type-specific amino acids is a hallmark associated with evolution of different enterovirus types, whereas neutral evolution and/or (frequency-dependent) positive selection in few highly polymorphic amino acid sites are the dominant forms of evolution when strains within an enterovirus type are compared.
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16
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Emergence, circulation, and spatiotemporal phylogenetic analysis of coxsackievirus a6- and coxsackievirus a10-associated hand, foot, and mouth disease infections from 2008 to 2012 in Shenzhen, China. J Clin Microbiol 2013; 51:3560-6. [PMID: 23966496 DOI: 10.1128/jcm.01231-13] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Sporadic hand, foot, and mouth disease (HFMD) outbreaks and other infectious diseases in recent years have frequently been associated with certain human enterovirus (HEV) serotypes. This study explored the prevalences and genetic characteristics of non-HEV71 and non-coxsackievirus A16 (CV-A16) human enterovirus-associated HFMD infections in Shenzhen, China. A total of 2,411 clinical stool specimens were collected from hospital-based surveillance for HFMD from 2008 to 2012. The detection of HEV was performed by real-time reverse transcription-PCR (RT-PCR) and RT-seminested PCR, and spatiotemporal phylogenetic analysis was performed based on the VP1 genes. A total of 1,803 (74.8%) strains comprising 28 different serotypes were detected. In the past 5 years, the predominant serotypes were HEV71 (60.0%), followed by CV-A16 (21.2%) and two uncommon serotypes, CV-A6 (13.0%) and CV-A10 (3.3%). However, CV-A6 replaced CV-A16 as the second most common serotype between 2010 and 2012. As an emerging pathogen, CV-A6 became as common a causative agent of HFMD as HEV71 in Shenzhen in 2012. Phylogenetic analysis revealed that little variation occurred in the Chinese HEV71 and CV-A16 strains. The genetic characteristics of the Chinese CV-A6 and CV-A10 strains displayed geographic differences. The CV-A6 and CV-A10 strains circulating in Shenzhen likely originated in Europe. It was found that human enteroviruses have a high mutation rate due to evolutionary pressure and frequent recombination (3.2 × 10(-3) to 6.4 ×10(-3) substitutions per site per year for HEV71, CV-A6, CV-A16, and CV-A10). Since certain serotypes are potential threats to the public health, this study provides further insights into the significance of the epidemiological surveillance of HFMD.
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