1
|
Recent advances in anti-coxsackievirus A16 viral drug research. Future Med Chem 2023; 15:97-117. [PMID: 36538291 DOI: 10.4155/fmc-2022-0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Hand, foot and mouth disease, a childhood disorder caused by enteroviruses, is intermittently endemic in the Asia-Pacific region and endangers the lives of many infants and young children. Coxsackievirus A16 (CV-A16) is one of the major pathogens causing hand, foot, and mouth disease on occasion, resulting in catastrophic neurological sequelae and patient death. Currently, no clinical interventions are available that completely block the CV-A16 infection. Therefore, research on anti-CV-A16 treatment continues to be a significant focus of interest. This report provides a detailed background on and an introduction to CV-A16; a description of the viral gene and protein structures and a summary of the current advances in pharmaceutical targets, drug research and other related areas.
Collapse
|
2
|
Bandara HMHN, Samaranayake LP. Viral, bacterial, and fungal infections of the oral mucosa: Types, incidence, predisposing factors, diagnostic algorithms, and management. Periodontol 2000 2019; 80:148-176. [PMID: 31090135 DOI: 10.1111/prd.12273] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
For millions of years, microbiota residing within us, including those in the oral cavity, coexisted in a harmonious symbiotic fashion that provided a quintessential foundation for human health. It is now clear that disruption of such a healthy relationship leading to microbial dysbiosis causes a wide array of infections, ranging from localized, mild, superficial infections to deep, disseminated life-threatening diseases. With recent advances in research, diagnostics, and improved surveillance we are witnessing an array of emerging and re-emerging oral infections and orofacial manifestations of systemic infections. Orofacial infections may cause significant discomfort to the patients and unnecessary economic burden. Thus, the early recognition of such infections is paramount for holistic patient management, and oral clinicians have a critical role in recognizing, diagnosing, managing, and preventing either new or old orofacial infections. This paper aims to provide an update on current understanding of well-established and emerging viral, bacterial, and fungal infections manifesting in the human oral cavity.
Collapse
Affiliation(s)
| | - Lakshman P Samaranayake
- Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| |
Collapse
|
3
|
Yin D, Zhu Y, Wang K, Wang J, Zhang X, Han M, He Y, Chen Q, Hu G. Development and evaluation of a rapid recombinase polymerase amplification assay for the detection of human enterovirus 71. Arch Virol 2018; 163:2459-2463. [PMID: 29767300 DOI: 10.1007/s00705-018-3859-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 04/21/2018] [Indexed: 10/16/2022]
Abstract
Enterovirus 71 (EV71) is one of the most common pathogens of hand, foot, and mouth disease (HFMD). A rapid reverse transcription recombinase polymerase amplification (RT-RPA) assay was established to detect EV71 subgenotype C4 (EV71-C4). The 95% detection limit of the RT-RPA was 3.767 log10 genomic copies (LGC)/reaction. The specificity was 100%. In a clinical sample evaluation, this approach demonstrated sufficient clinical performance when compared with a commercial RT-qPCR diagnostic kit. Thus, the RT-RPA assay may be a promising alternative for the detection of EV71-C4.
Collapse
Affiliation(s)
- Dan Yin
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Yanan Zhu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Kaifeng Wang
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jing Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Xiru Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Min Han
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Yaqing He
- Shenzhen Center for Disease Control and Prevention, Shenzhen, 518055, Guangdong, China
| | - Qing Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Guifang Hu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
| |
Collapse
|
4
|
Abstract
Infections with enteroviruses and human parechoviruses are highly prevalent, particularly in neonates, where they may cause substantial morbidity and mortality. Individuals with B-cell-related immunodeficiencies are at risk for severe enteroviral infections, usually a chronic and fatal meningoencephalitis. In transplant recipients and patients with malignancy, enterovirus infections typically involve the respiratory tract, but cases of severe, disseminated infection have been described. The mainstay of diagnosis for enterovirus and human parechovirus infections involves the use of molecular diagnostic techniques. However, routine nucleic acid-detection methods for enteroviruses will not detect human parechoviruses. Laboratory diagnosis of these viral infections is important in determining a patient's prognosis and guiding clinical management.
Collapse
|
5
|
Teo FMS, Chu JJH. Diagnosis of human enteroviruses that cause hand, foot and mouth disease. Expert Rev Anti Infect Ther 2016; 14:443-5. [PMID: 27042876 DOI: 10.1586/14787210.2016.1173543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Fiona Mei Shan Teo
- a Collaborative and Translation Unit for HFMD , Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR) , Singapore
| | - Justin Jang Hann Chu
- a Collaborative and Translation Unit for HFMD , Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR) , Singapore.,b Laboratory of Molecular RNA Virology and Antiviral Strategies, Department of Microbiology, Yong Loo Lin School of Medicine , National University of Singapore , Singapore
| |
Collapse
|
6
|
Development of a Specific Latex Agglutination Test to Detect Antibodies of Enterovirus 71. Arch Med Res 2015; 46:580-7. [DOI: 10.1016/j.arcmed.2015.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022]
|
7
|
Dubot-Pérès A, Tan CYQ, de Chesse R, Sibounheuang B, Vongsouvath M, Phommasone K, Bessaud M, Gazin C, Thirion L, Phetsouvanh R, Newton PN, de Lamballerie X. SYBR green real-time PCR for the detection of all enterovirus-A71 genogroups. PLoS One 2014; 9:e89963. [PMID: 24651608 PMCID: PMC3961242 DOI: 10.1371/journal.pone.0089963] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/21/2014] [Indexed: 11/18/2022] Open
Abstract
Enterovirus A71 (EV-A71) has recently become an important public health threat, especially in South-East Asia, where it has caused massive outbreaks of Hand, Foot and Mouth disease every year, resulting in significant mortality. Rapid detection of EV-A71 early in outbreaks would facilitate implementation of prevention and control measures to limit spread. Real-time RT-PCR is the technique of choice for the rapid diagnosis of EV-A71 infection and several systems have been developed to detect circulating strains. Although eight genogroups have been described globally, none of these PCR techniques detect all eight. We describe, for the first time, a SYBR Green real-time RT-PCR system validated to detect all 8 EV-A71 genogroups. This tool could permit the early detection and shift in genogroup circulation and the standardization of HFMD virological diagnosis, facilitating networking of laboratories working on EV-A71 in different regions.
Collapse
Affiliation(s)
- Audrey Dubot-Pérès
- Unité Mixte de Recherche_D 190 “Emergence des Pathologies Virales” (Aix-Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health), Marseille, France
- Lao-Oxford-Mahosot Hospital–Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom
- * E-mail:
| | - Charlene Y. Q. Tan
- Unité Mixte de Recherche_D 190 “Emergence des Pathologies Virales” (Aix-Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health), Marseille, France
| | - Reine de Chesse
- Unité Mixte de Recherche_D 190 “Emergence des Pathologies Virales” (Aix-Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health), Marseille, France
| | - Bountoy Sibounheuang
- Lao-Oxford-Mahosot Hospital–Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital–Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
| | - Koukeo Phommasone
- Lao-Oxford-Mahosot Hospital–Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom
| | - Maël Bessaud
- Unité Mixte de Recherche_D 190 “Emergence des Pathologies Virales” (Aix-Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health), Marseille, France
| | - Céline Gazin
- Laboratory of Clinical Microbiology, AP-HM Timone, University Hospital Institute for Infectious Disease and Tropical Medicine, Marseille, France
| | - Laurence Thirion
- Unité Mixte de Recherche_D 190 “Emergence des Pathologies Virales” (Aix-Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health), Marseille, France
| | - Rattanaphone Phetsouvanh
- Lao-Oxford-Mahosot Hospital–Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom
| | - Paul N. Newton
- Lao-Oxford-Mahosot Hospital–Wellcome Trust Research Unit, Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom
| | - Xavier de Lamballerie
- Unité Mixte de Recherche_D 190 “Emergence des Pathologies Virales” (Aix-Marseille University, IRD French Institute of Research for Development, EHESP French School of Public Health), Marseille, France
- Laboratory of Clinical Microbiology, AP-HM Timone, University Hospital Institute for Infectious Disease and Tropical Medicine, Marseille, France
| |
Collapse
|
8
|
Li JX, Meng FY, Liang ZL, Mao QY, Zhu FC. How to understand the efficacy measurements for enterovirus type 71 vaccine? Hum Vaccin Immunother 2013; 10:623-7. [PMID: 24280898 DOI: 10.4161/hv.27253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The choice of endpoint was most important for an efficacy vaccine trial. The objective of this paper is to gear toward answering questions about the rationality and scientificity of the primary endpoints choosing, case capturing and diagnosis strategy in our recently reported EV71 vaccine efficacy phase 3 trial. In order to obtain both high sensitivity and specificity in the case detecting, EV71-associated disease had been chosen as primary endpoint, a broad spectrum of clinical symptoms was surveyed, both the real-time RT-PCR and virus isolation were combined for the laboratory diagnosis, and serial specimens since disease onset were collected for assays. Though, the EV71 vaccine efficacy was well measured in the phase 3 trial, several potential factors could also have influences on the cases confirming. More evidence of EV71 vaccine efficacy will be demanded in post-marketing studies in the future.
Collapse
Affiliation(s)
- Jing-Xin Li
- College of Pharmacy; Third Military Medical University & National Engineering Research Center for Immunological Products; Chongqing, PR China; Jiangsu Provincial Center for Disease Control and Prevention; Nanjing, PR China
| | - Fan-Yue Meng
- Jiangsu Provincial Center for Disease Control and Prevention; Nanjing, PR China
| | - Zheng-Lun Liang
- National Institute for Food and Drug Control; Beijing, PR China
| | - Qun-Ying Mao
- National Institute for Food and Drug Control; Beijing, PR China
| | - Feng-Cai Zhu
- Jiangsu Provincial Center for Disease Control and Prevention; Nanjing, PR China
| |
Collapse
|
9
|
Huang KYA, Yang S, Tsao KC, Chen CJ, Hsieh YC, Chiu CH, Hsieh JY, Yang JY, Huang YC. Bedside immunochromatographic test for enterovirus 71 infection in children. J Clin Virol 2013; 58:548-52. [PMID: 24084600 DOI: 10.1016/j.jcv.2013.08.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 08/06/2013] [Accepted: 08/27/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Enterovirus 71 (EV71) causes frequent outbreaks worldwide, particularly in the Asia-Pacific area. Its quick spread is a critical challenge for public health and timely preventive measures and clinical management therefore rely on early detection. There is a need for a rapid, easy-to-use, and reliable method for detecting EV71 infections. OBJECTIVE The study aimed to evaluate a bedside immunochromatography (ICT) kit for diagnosing acute EV71 infection in children. STUDY DESIGN Pediatric patients with herpangina or hand-foot-mouth disease were randomly and prospectively enrolled from hospitals across Taiwan. Throat or rectal swabs were collected for viral culture and reverse-transcriptase polymerase chain reaction (RTPCR). For the ICT kit, whole blood was obtained by ear piercing, finger-sticking, or venipuncture. The results of ICT, virus isolation and RTPCR in clinical samples were compared. RESULTS Of the 156 patients enrolled, 91 (58%), 64 (41%) and 72 (46%) had positive results of the ICT kit, viral culture and RTPCR, respectively. Laboratory-confirmed infection with either positive EV71 culture or RTPCR was used as the diagnostic standard. The sensitivity and specificity of the ICT kit was 84% and 77%, respectively. The viral culture and RTPCR had relatively lower sensitivity but higher specificity. The patient's age did not affect the performance of the ICT, viral culture and RTPCR. However, a low sensitivity of ICT kit was noted before the second day of disease onset. CONCLUSIONS The ICT kit may serve as a simple, quick and reliable method for the bedside diagnosis of acute EV71 infection in children.
Collapse
Affiliation(s)
- Kuan-Ying Arthur Huang
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Wang C, You A, Tian X, Zhao M, Chen Y, Lin T, Zheng J, Xiao M, Zhang Y, Kuang L, Zhou Z, Zhu B. Analysis and solution of false-positives when testing CVA16 sera using an antibody assay against the EV71 virus. Virus Res 2013; 176:33-6. [DOI: 10.1016/j.virusres.2013.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/19/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
|
11
|
Hwang S, Kang B, Hong J, Kim A, Kim H, Kim K, Cheon DS. Development of duplex real-time RT-PCR based on Taqman technology for detecting simultaneously the genome of pan-enterovirus and enterovirus 71. J Med Virol 2013; 85:1274-9. [DOI: 10.1002/jmv.23588] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Seoyeon Hwang
- Division of Vaccine Research, Center for Infectious Diseases, National Institute of Health; Korea Centers for Disease Control and Prevention; Chungcheongbuk-do; Korea
| | - Byunghak Kang
- Division of Vaccine Research, Center for Infectious Diseases, National Institute of Health; Korea Centers for Disease Control and Prevention; Chungcheongbuk-do; Korea
| | - Jiyoung Hong
- Division of Vaccine Research, Center for Infectious Diseases, National Institute of Health; Korea Centers for Disease Control and Prevention; Chungcheongbuk-do; Korea
| | - Ahyoun Kim
- Division of Vaccine Research, Center for Infectious Diseases, National Institute of Health; Korea Centers for Disease Control and Prevention; Chungcheongbuk-do; Korea
| | - Hyejin Kim
- Division of Vaccine Research, Center for Infectious Diseases, National Institute of Health; Korea Centers for Disease Control and Prevention; Chungcheongbuk-do; Korea
| | - Kisang Kim
- Division of Vaccine Research, Center for Infectious Diseases, National Institute of Health; Korea Centers for Disease Control and Prevention; Chungcheongbuk-do; Korea
| | - Doo-Sung Cheon
- Division of Vaccine Research, Center for Infectious Diseases, National Institute of Health; Korea Centers for Disease Control and Prevention; Chungcheongbuk-do; Korea
| |
Collapse
|
12
|
The development and application of the two real-time RT-PCR assays to detect the pathogen of HFMD. PLoS One 2013; 8:e61451. [PMID: 23637836 PMCID: PMC3630163 DOI: 10.1371/journal.pone.0061451] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 03/08/2013] [Indexed: 11/19/2022] Open
Abstract
Large-scale Hand, Foot, and Mouth Disease (HFMD) outbreaks have frequently occurred in China since 2008, affecting more than one million children and causing several hundred children deaths every year. The pathogens of HFMD are mainly human enteroviruses (HEVs). Among them, human enterovirus 71 (HEV71) and coxsackievirus A16 (CVA16) are the most common pathogens of HFMD. However, other HEVs could also cause HFMD. To rapidly detect HEV71 and CVA16, and ensure detection of all HEVs causing HFMD, two real-time hybridization probe-based RT-PCR assays were developed in this study. One is a multiplex real-time RT-PCR assay, which was developed to detect and differentiate HEV71 specifically from CVA16 directly from clinical specimens within 1–2 h, and the other is a broad-spectrum real-time RT-PCR assay, which targeted almost all HEVs. The experiments confirmed that the two assays have high sensitivity and specificity, and the sensitivity was up to 0.1 TCID50/ml for detection of HEVs, HEV71, and CVA16, respectively. A total of 213 clinical specimens were simultaneously detected by three kinds of assays, including the two real-time RT-PCR assays, direct conventional RT-PCR assay, and virus isolation assay on human rhabdomyosarcoma cells (RD cells). The total positive rate of both HEV71 and CVA16 was 69.48% with real-time RT-PCR assay, 47.42% with RT-PCR assay, and 34.58% with virus isolation assay. One HFMD clinical specimen was positive for HEV, but negative for HEV71 or CVA16, which was identified as Echovirus 11 (Echo11) by virus isolation, RT-PCR, and sequencing for the VP1 gene. The two real-time RT-PCR assays had been applied in 31 provincial HFMD labs to detect the pathogens of HFMD, which has contributed to the rapid identification of the pathogens in the early stages of HFMD outbreaks, and helped to clarify the etiologic agents of HFMD in China.
Collapse
|
13
|
Yi L, Lu J, Kung HF, He ML. The virology and developments toward control of human enterovirus 71. Crit Rev Microbiol 2011; 37:313-27. [PMID: 21651436 DOI: 10.3109/1040841x.2011.580723] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Enterovirus 71 (EV71), a member of the Enterovirus genus in the Picornaviridae family, was first recognized as a dermotrophic virus that usually cause mild, self-limiting hand-foot-and-mouth disease (HFMD). However, EV71 infection can sometimes induce a variety of severe neurological complications and even death. Current large outbreaks of EV71 make this virus being a major public health issue. Intense effort has been made to address its underlying pathogenesis and to develop effective means for combating EV71 infections. Here, we aimed to provide an overview of cellular mechanisms underlying EV71 infection and to assess potential agents for prevention and treatment of EV71 infections.
Collapse
Affiliation(s)
- Lina Yi
- Stanley Ho Center for Emerging Infectious Diseases, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | | | | | | |
Collapse
|
14
|
Abstract
Enteroviruses are positive stranded RNA viruses belonging to the genus Enterovirus of the Picornaviridae family. Human enteroviruses are transmitted through the fecal-oral route and have been shown to cause mild to life-threatening diseases. Various diagnostic methods have been developed to detect enteroviruses from clinical specimens but many were impeded by requirements for special reagents, lengthy procedures, low sensitivity or cross-reactivity. This chapter describes rapid and highly sensitive methods of enteroviral detection directly from clinical specimens based on a conventional one-step Reverse Transcription polymerase chain reaction (RT-PCR) and a one-step real-time RT-PCR.
Collapse
Affiliation(s)
- Chit Laa Poh
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | |
Collapse
|
15
|
Abstract
Although poliomyelitis has been mostly eradicated worldwide, large outbreaks of the related enterovirus 71 have been seen in Asia-Pacific countries in the past 10 years. This virus mostly affects children, manifesting as hand, foot, and mouth disease, aseptic meningitis, poliomyelitis-like acute flaccid paralysis, brainstem encephalitis, and other severe systemic disorders, including especially pulmonary oedema and cardiorespiratory collapse. Clinical predictors of severe disease include high temperature and lethargy, and lumbar puncture might reveal pleocytosis. Many diagnostic tests are available, but PCR of throat swabs and vesicle fluid, if available, is among the most efficient. Features of inflammation, particularly in the anterior horns of the spinal cord, the dorsal pons, and the medulla can be clearly seen on MRI. No established antiviral treatment is available. Intravenous immunoglobulin seems to be beneficial in severe disease, perhaps through non-specific anti-inflammatory mechanisms, but has not been tested in any formal trials. Milrinone might be helpful in patients with cardiac dysfunction.
Collapse
|
16
|
Thao NTT, Ngoc NTK, Tú PV, Thúy TT, Cardosa MJ, McMinn PC, Phuektes P. Development of a multiplex polymerase chain reaction assay for simultaneous identification of human enterovirus 71 and coxsackievirus A16. J Virol Methods 2010; 170:134-9. [PMID: 20863857 PMCID: PMC2995219 DOI: 10.1016/j.jviromet.2010.09.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Revised: 09/09/2010] [Accepted: 09/13/2010] [Indexed: 11/20/2022]
Abstract
Human enterovirus 71 (HEV71) and coxsackievirus A16 (CVA16) are two major aetiological agents of hand, foot and mouth disease (HFMD) in children. Recently there have been several large outbreaks of HFMD in Vietnam and the Asia-Pacific region. In this study, a multiplex RT-PCR assay was developed in order to detect simultaneously HEV71, CVA16 and other human enteroviruses. Enterovirus detection was performed with a mixture of three pairs of oligonucleotide primers: one pair of published primers for amplifying all known enterovirus genomes and two new primer pairs specific for detection of the VP1 genes of HEV71 and CVA16. Enterovirus isolates, CVA16 and HEV71 strains identified previously from patients with HFMD were examined to evaluate the sensitivity and specificity of the multiplex RT-PCR assay. The assay was then applied to the direct detection of these viruses in clinical specimens obtained from HFMD cases identified at Children's Hospital Number 2, Ho Chi Minh City, Vietnam. The multiplex RT-PCR assay showed 100% specificity in screening for enteroviruses and in identifying HEV71 and CVA16. Similar results were obtained when using the multiplex RT-PCR assay to screen for enteroviruses and to identify HEV71 and CVA16 in clinical specimens obtained from HFMD cases identified at the hospital. This multiplex RT-PCR assay is a rapid, sensitive and specific assay for the diagnosis of HEV71 or CVA16 infection in cases of HFMD and is also potentially useful for molecular epidemiological investigations.
Collapse
Affiliation(s)
- Nguyen Thi Thanh Thao
- Pasteur Institute of Ho Chi Minh City, 167 Pasteur Street, District 3, Ho Chi Minh City, Viet Nam
| | | | | | | | | | | | | |
Collapse
|
17
|
Xu F, Yan Q, Wang H, Niu J, Li L, Zhu F, He S, Zhang S, Weng Z, Cheng T, Cai Y, He D, Chen Y, Ge S, Yeo AET, Zhang J, Ng MH, Xia N. Performance of detecting IgM antibodies against enterovirus 71 for early diagnosis. PLoS One 2010; 5:e11388. [PMID: 20613983 PMCID: PMC2894942 DOI: 10.1371/journal.pone.0011388] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 06/08/2010] [Indexed: 11/19/2022] Open
Abstract
Enterovirus 71 (EV71) infection is more likely to induce severe complications and mortality than other enteroviruses. Methods for detection of IgM antibody against EV71 had been established for years, however, the performance of the methods in the very early diagnosis of EV71 infection had not been fully evaluated, which is especially meaningful because of the short incubation period of EV71 infection. In this report, the performance of an IgM anti-EV71 assay was evaluated using acute sera collected from 165 EV71 infected patients, 165 patients infected with other enteroviruses, and more than 2,000 sera from healthy children or children with other infected diseases. The results showed a 90% sensitivity in 20 patients who were in their first illness day, and similar sensitivity remained till 4 days after onset. After then the sensitivity increased to 95% to 100% for more than one month. The specificity of the assay in non-HFMD children is 99.1% (95% CI: 98.6–99.4), similar as the 99.9% specificity in healthy adults. The cross-reaction rate in patients infected with other non-EV71 enteroviruses was 11.4%. In conclusion, the data here presented show that the detection of IgM anti-EV71 by ELISA affords a reliable, convenient, and prompt diagnosis of EV71 infection.
Collapse
Affiliation(s)
- Feihai Xu
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, Xiamen University, Xiamen, China
| | - Qiang Yan
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, Xiamen University, Xiamen, China
| | - Hua Wang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jianjun Niu
- Xiamen Center for Disease Control and Prevention, Xiamen, China
| | - Liang Li
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Fengcai Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Shuizhen He
- Xiamen Center for Disease Control and Prevention, Xiamen, China
| | - Shiyin Zhang
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, Xiamen University, Xiamen, China
| | - Zuxing Weng
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, Xiamen University, Xiamen, China
| | - Tong Cheng
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, Xiamen University, Xiamen, China
| | - Yijun Cai
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, Xiamen University, Xiamen, China
| | - Delei He
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, Xiamen University, Xiamen, China
| | - Yixin Chen
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, Xiamen University, Xiamen, China
| | - Shengxiang Ge
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, Xiamen University, Xiamen, China
| | - Anthony E. T. Yeo
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, Xiamen University, Xiamen, China
| | - Jun Zhang
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, Xiamen University, Xiamen, China
| | - Mun-Hon Ng
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, Xiamen University, Xiamen, China
| | - Ningshao Xia
- National Institute of Diagnostics and Vaccine Development in Infectious Disease, Xiamen University, Xiamen, China
- * E-mail:
| |
Collapse
|
18
|
[Identification of P-selectin glycoprotein ligand-1 as one of the cellular receptors for enterovirus 71]. Uirusu 2010; 59:195-203. [PMID: 20218328 DOI: 10.2222/jsv.59.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Enterovirus 71 (EV71) is a major causative agent of hand, foot and mouth disease (HFMD), a common febrile disease in young children. Although clinical manifestations of HFMD are usually mild and self-limiting, EV71 can cause large outbreaks of HFMD including severe neurological complications. We identified human P-selectin glycoprotein ligand-1 (PSGL-1; CD162) as a functional receptor for EV71 using an expression cloning method with a human T cell cDNA library by panning. PSGL-1 is a sialomucin membrane protein, expressed on leukocytes, that has a major role in early stages of inflammation by interacting with selections and chemokines. EV71 specifically binds to the N terminal region of PSGL-1 and the expression of human PSGL-1 allowed EV71 replication in nonsusceptible mouse cells, suggesting that PSGL-1 is a functional EV71 receptor. We found the presence of strain-specific EV71 replication in leukocytes. In addition, EV71 replicates in nonleukocyte cell lines in a PSGL-1-independent manner. Thus, further elucidation of the PSGL-1-dependent EV71 replication may provide valuable insights into the molecular basis of EV71 infection including HFMD and various neurological diseases.
Collapse
|
19
|
Kairis B, Sauter P, Goffard A, Fronval S, Sane F, Hober D. Quand un entérovirus émerge. ACTA ACUST UNITED AC 2009; 57:258-67. [DOI: 10.1016/j.patbio.2008.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Accepted: 06/13/2008] [Indexed: 11/24/2022]
|
20
|
Ortner B, Huang CW, Schmid D, Mutz I, Wewalka G, Allerberger F, Yang JY, Huemer HP. Epidemiology of enterovirus types causing neurological disease in Austria 1999-2007: detection of clusters of echovirus 30 and enterovirus 71 and analysis of prevalent genotypes. J Med Virol 2009; 81:317-24. [PMID: 19107980 DOI: 10.1002/jmv.21374] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Between 1999 and 2007 1,388 stool specimens from patients with acute flaccid paralysis or aseptic meningitis were submitted to the Austrian reference laboratory for poliomyelitis. Samples (201) yielded non-poliovirus enterovirus in culture. One hundred eighty-one viruses were available for typing and 78 isolates which remained serologically untyped were further analyzed by CODEHOP-PCR and sequencing of the VP1 gene and the 5'-untranslated region (5'-UTR). Typing revealed an Echovirus 30 outbreak in northwestern Austria in 2000, which was in accordance with the situation in Europe, and no dramatic seasonal changes of Coxsackie viruses were observed. In 2002/2003 a small outbreak of enterovirus 71 (EV71), affected 12 patients in the province of Styria. This virus was identified as genotype C1 and appeared to be genetically distinct from the isolates observed in 2001/2002 in Vienna. In 2004 two unrelated cases occurred in Lower Austria, which were identified as genotype C4, which has been described associated with high mortality most recently in China. In contrast to the situation in Asia the detected EV71 cases were not associated with hand-foot-mouth disease, but with serous meningitis only. This was surprising as a recent publication suggested a reduced neurovirulence of C1 genotype in children in Norway, presumably due to alterations in 5'-UTR and polymerase gene. However, comparing the 5'-UTR of the Austrian isolates and established virulent reference strains to the Norwegian isolate and an attenuated EV71 laboratory strain we did not find an indication that the genotype C1 possesses a RNA structure in its 5'-UTR leading to reduced neurovirulence.
Collapse
Affiliation(s)
- Birgit Ortner
- Institute for Medical Microbiology, Austrian Agency for Health & Food Safety, Vienna, Austria
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Development of multiplex real-time hybridization probe reverse transcriptase polymerase chain reaction for specific detection and differentiation of Enterovirus 71 and Coxsackievirus A16. Diagn Microbiol Infect Dis 2008; 61:294-301. [DOI: 10.1016/j.diagmicrobio.2008.02.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2007] [Revised: 01/14/2008] [Accepted: 02/13/2008] [Indexed: 11/22/2022]
|
22
|
Kusuhara K, Saito M, Sasaki Y, Hikino S, Taguchi T, Suita S, Hayashi J, Wakatsuki K, Hara T. An echovirus type 18 outbreak in a neonatal intensive care unit. Eur J Pediatr 2008; 167:587-9. [PMID: 17593390 DOI: 10.1007/s00431-007-0516-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2007] [Accepted: 05/09/2007] [Indexed: 11/28/2022]
Abstract
We describe an outbreak of echovirus type 18 infection involving 20 neonatal intensive care unit (NICU) patients and the results of virological investigations are presented. RT-PCR demonstrated a widespread transmission of the virus in NICU patients during the outbreak. Separation care and additional infection control measures seemed to be effective in preventing further spread of the virus.
Collapse
Affiliation(s)
- Koichi Kusuhara
- Department of Pediatrics, Kyushu University Hospital, Fukuoka, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Tan EL, Yong LLG, Quak SH, Yeo WCA, Chow VTK, Poh CL. Rapid detection of enterovirus 71 by real-time TaqMan RT-PCR. J Clin Virol 2008; 42:203-6. [PMID: 18304867 DOI: 10.1016/j.jcv.2008.01.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Revised: 09/25/2007] [Accepted: 01/03/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Enterovirus 71 (EV71) is the main etiological agent of Hand, Foot and Mouth Disease (HFMD) and has been associated with neurological complications which resulted in fatalities during recent outbreaks in Asia Pacific region. OBJECTIVE Develop a real-time TaqMan RT-PCR for rapid detection of EV71. STUDY DESIGN Specific primers and probe were designed based on highly conserved VP1 region of EV71. The sensitivity of the real-time RT-PCR was evaluated with 67 clinical specimens collected from pediatric patients with suspected HFMD. RESULTS Our real-time TaqMan RT-PCR showed 100% specificity in detecting EV71 and showed an analytical sensitivity of 5 viral copies. High sensitivity was also achieved in detecting EV71 directly from clinical specimens. CONCLUSIONS Real-time TaqMan RT-PCR offers a rapid and sensitive method to detect EV71 from clinical specimens, and will allow quarantine measures to be taken more effectively during outbreaks.
Collapse
Affiliation(s)
- Eng Lee Tan
- Department of Microbiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | | | | | | | | | | |
Collapse
|
24
|
Van Tu P, Thao NTT, Perera D, Truong KH, Tien NTK, Thuong TC, How OM, Cardosa MJ, McMinn PC. Epidemiologic and virologic investigation of hand, foot, and mouth disease, southern Vietnam, 2005. Emerg Infect Dis 2007; 13:1733-41. [PMID: 18217559 PMCID: PMC3375788 DOI: 10.3201/eid1311.070632] [Citation(s) in RCA: 286] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During 2005, 764 children were brought to a large children's hospital in Ho Chi Minh City, Vietnam, with a diagnosis of hand, foot, and mouth disease. All enrolled children had specimens (vesicle fluid, stool, throat swab) collected for enterovirus isolation by cell culture. An enterovirus was isolated from 411 (53.8%) of the specimens: 173 (42.1%) isolates were identified as human enterovirus 71 (HEV71) and 214 (52.1%) as coxsackievirus A16. Of the identified HEV71 infections, 51 (29.5%) were complicated by acute neurologic disease and 3 (1.7%) were fatal. HEV71 was isolated throughout the year, with a period of higher prevalence in October-November. Phylogenetic analysis of 23 HEV71 isolates showed that during the first half of 2005, viruses belonging to 3 subgenogroups, C1, C4, and a previously undescribed subgenogroup, C5, cocirculated in southern Vietnam. In the second half of the year, viruses belonging to subgenogroup C5 predominated during a period of higher HEV71 activity.
Collapse
Affiliation(s)
- Phan Van Tu
- Pasteur Institute, Ho Chi Minh City, Vietnam
| | | | - David Perera
- Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | | | | | | | | | | | | |
Collapse
|
25
|
Khetsuriani N, Lamonte A, Oberste MS, Pallansch M. Neonatal enterovirus infections reported to the national enterovirus surveillance system in the United States, 1983-2003. Pediatr Infect Dis J 2006; 25:889-93. [PMID: 17006282 DOI: 10.1097/01.inf.0000237798.07462.32] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neonatal enterovirus (EV) infections lead to a wide range of clinical manifestations, from mild febrile illness to severe, sometimes fatal, sepsislike disease. METHODS To determine the relationship of EV serotypes with the risk of neonatal infection and its fatal outcome, we analyzed data reported to the National Enterovirus Surveillance System (NESS) during 1983-2003. RESULTS Of the 26,737 EV detections reported during this period, neonates accounted for 2544 (11.4% of those with known age). Serotypes most commonly isolated from neonates included echovirus (E) 11 (14.0% of EV with known serotype), coxsackievirus (CV) B2 (8.9%), CVB5 (7.5%), E6, E9 and CVB4 (6.8% each). CVB1-4, E11, and E25 were significantly more common, whereas CVA16, E4, E9, E21, E30, and human parechovirus 1 (formerly E22) were less common among neonates than among persons aged > or =1 month. Fatal outcome was noted for 3.3% of reports, with neonates at a higher risk of death than persons aged > or =1 month (11.5% versus 2.5%; odds ratio [OR] 5.1; 95% confidence interval [CI] = 3.3-7.8). Neonates infected with CVB4 were at a higher risk of death (OR 6.5; 95% CI = 2.4-17.7) than those infected with other EV. CONCLUSION EV are important neonatal pathogens associated with high risk of infection and death. Because of the limitations of the NESS (incomplete reporting, limited clinical data, bias towards more severe and younger cases), additional studies are needed to better evaluate the role of different EV in neonatal infections.
Collapse
Affiliation(s)
- Nino Khetsuriani
- Epidemiology Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | |
Collapse
|
26
|
Fu YC, Chi CS, Lin NN, Cheng CC, Jan SL, Hwang B, Hsu SL, Gong CL, Chen YT, Chiu YT. Comparison of heart failure in children with enterovirus 71 rhombencephalitis and cats with norepinephrine cardiotoxicity. Pediatr Cardiol 2006; 27:577-84. [PMID: 16933070 DOI: 10.1007/s00246-005-0915-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The mechanism of heart failure in patients with enterovirus 71 rhombencephalitis (brain stem encephalitis) remains unknown. Our previous reports hypothesized that a catecholamine storm induced by rhombencephalitis may account for the heart failure. The aim of this study was to develop a novel feline model of norepinephrine cardiotoxicity and compare the resulting heart failure to that in children with enterovirus 71 rhombencephalitis. Nine of 75 children (12%) with enterovirus 71 rhombencephalitis (5 boys and 4 girls; age, 4-28 months; median age, 16 months) were complicated with left ventricular hypokinesia (ejection fraction, 31 +/- 9%). Six cats (weight, 3.03 +/- 0.64 kg) were administered intravenous norepinephrine 30 microg/kg/min for 3 hours. Echocardiography assessed the left ventricular diameter and function before and after the administration of norepinephrine. Pathology studies included hematoxylin and eosin stain and in situ terminal deoxyribonucleotidyl transferase-mediated dUTP nick end-labeling assay. In the feline model, norepinephrine induced significant left ventricular dilatation (end diastolic diameter from 1.18 +/- 0.19 to 1.62 +/- 0.22 cm, p = 0.001; endsystolic diameter from 0.54 +/- 0.09 to 1.36 +/- 0.32 cm, p = < 0.001) and hypokinesia (ejection fraction from 87.5 +/- 4.1 to 35.2 +/- 16.3%, p = 0.001). Heart specimens from 4 patients and six cats showed similar pathology findings, including myocardial hemorrhage, cardiomyocyte apoptosis, and coagulative myocytolysis, which is characterized by sarcoplasmic coagulation, granulation, vacuolization, myofibrillar waving, and disruption. Both groups showed no significant inflammatory reaction. In conclusion, heart failure in patients with enterovirus 71 rhombencephalitis is similar to that in cats with norepinephrine cardiotoxicity. Norepinephrine cardiotoxicity may play a role in the pathogenesis of heart failure in enterovirus 71 rhombencephalitis.
Collapse
Affiliation(s)
- Y-C Fu
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, 407 Taiwan, Republic of China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Podin Y, Gias ELM, Ong F, Leong YW, Yee SF, Yusof MA, Perera D, Teo B, Wee TY, Yao SC, Yao SK, Kiyu A, Arif MT, Cardosa MJ. Sentinel surveillance for human enterovirus 71 in Sarawak, Malaysia: lessons from the first 7 years. BMC Public Health 2006; 6:180. [PMID: 16827926 PMCID: PMC1543637 DOI: 10.1186/1471-2458-6-180] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2006] [Accepted: 07/07/2006] [Indexed: 12/17/2022] Open
Abstract
Background A major outbreak of human enterovirus 71-associated hand, foot and mouth disease in Sarawak in 1997 marked the beginning of a series of outbreaks in the Asia Pacific region. Some of these outbreaks had unusually high numbers of fatalities and this generated much fear and anxiety in the region. Methods We established a sentinel surveillance programme for hand, foot and mouth disease in Sarawak, Malaysia, in March 1998, and the observations of the first 7 years are described here. Virus isolation, serotyping and genotyping were performed on throat, rectal, vesicle and other swabs. Results During this period Sarawak had two outbreaks of human enterovirus 71, in 2000 and 2003. The predominant strains circulating in the outbreaks of 1997, 2000 and 2003 were all from genogroup B, but the strains isolated during each outbreak were genetically distinct from each other. Human enterovirus 71 outbreaks occurred in a cyclical pattern every three years and Coxsackievirus A16 co-circulated with human enterovirus 71. Although vesicles were most likely to yield an isolate, this sample was not generally available from most cases and obtaining throat swabs was thus found to be the most efficient way to obtain virological information. Conclusion Knowledge of the epidemiology of human enterovirus 71 transmission will allow public health personnel to predict when outbreaks might occur and to plan interventions in an effective manner in order to reduce the burden of disease.
Collapse
Affiliation(s)
- Yuwana Podin
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
| | - Edna LM Gias
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
| | - Flora Ong
- Sarawak Health Department, Jalan Tun Abang Haji Openg, Kuching, Sarawak, Malaysia
| | - Yee-Wei Leong
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
| | - Siew-Fung Yee
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
| | - Mohd Apandi Yusof
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
| | - David Perera
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
| | - Bibiana Teo
- B Teo's Specialist Clinic, Kuching, Sarawak, Malaysia
| | - Thian-Yew Wee
- TY Wee Specialist Clinic for Children, Kuching, Sarawak, Malaysia
| | - Sik-Chi Yao
- Sarawak Health Department, Jalan Tun Abang Haji Openg, Kuching, Sarawak, Malaysia
| | - Sik-King Yao
- Sarawak Health Department, Jalan Tun Abang Haji Openg, Kuching, Sarawak, Malaysia
| | - Andrew Kiyu
- Sarawak Health Department, Jalan Tun Abang Haji Openg, Kuching, Sarawak, Malaysia
| | - Mohd Taha Arif
- Sarawak Health Department, Jalan Tun Abang Haji Openg, Kuching, Sarawak, Malaysia
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
| | - Mary Jane Cardosa
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia
| |
Collapse
|
28
|
Tan EL, Chow VTK, Kumarasinghe G, Lin RTP, Mackay IM, Sloots TP, Poh CL. Specific detection of enterovirus 71 directly from clinical specimens using real-time RT-PCR hybridization probe assay. Mol Cell Probes 2006; 20:135-40. [PMID: 16460910 DOI: 10.1016/j.mcp.2005.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Accepted: 11/15/2005] [Indexed: 10/25/2022]
Abstract
Enterovirus 71 (EV71) is one of the main causative agents of hand, foot and mouth disease (HFMD) in young children. Infections caused by EV71 could lead to many complications, ranging from brainstem encephalitis to pulmonary oedema, resulting in high mortality. Thus, rapid detection of the virus is required to enable measures to be implemented in preventing widespread transmission. Based on primers and probes targeting at the VP1 region, a real-time reverse-transcriptase polymerase chain reaction (RT-PCR) hybridization probe assay was developed for specific detection of EV71 from clinical specimens. Quantitative analysis showed that the assay was able to detect as low as 5 EV71 viral copies and EV71 was detected from 46 of the 55 clinical specimens obtained from pediatric patients suffering from HFMD during the period from 2000 to 2003 in Singapore. This study showed that the single tube real-time RT-PCR assay developed in this study can be applied as a rapid and sensitive method for specific detection of EV71 directly from clinical specimens.
Collapse
Affiliation(s)
- Eng Lee Tan
- Department of Microbiology, Faculty of Medicine, National University of Singapore, Singapore
| | | | | | | | | | | | | |
Collapse
|
29
|
Huang Z, Buckwold VE. A TaqMan PCR assay using degenerate primers for the quantitative detection of woodchuck hepatitis virus DNA of multiple genotypes. Mol Cell Probes 2006; 19:282-9. [PMID: 16005181 DOI: 10.1016/j.mcp.2005.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2005] [Accepted: 04/11/2005] [Indexed: 11/25/2022]
Abstract
Woodchuck hepatitis virus (WHV) is a valuable animal model system for studies of hepatitis B virus infection and accurate assessments of WHV viral load are necessary in these studies. Wild-captured woodchucks that are naturally infected with WHV are sometimes used in these studies, however, the sequence variation in WHV isolates generally precludes the use of TaqMan PCR. To facilitate this, we have created a real-time TaqMan PCR assay for WHV using degenerate primers with inosine residues employed at the locations of known sequence heterogeneity. This TaqMan assay has a dynamic range of 10-10(8) genomic equivalents (ge) of WHV DNA per reaction and the assay is robust and reproducible in the 10(2)-10(7) ge WHV DNA per reaction range (intra-assay coefficient of variation (CV) <2.1%, inter-assay CV <2.9%). During our assay validation, we cloned and analyzed a series of six naturally occurring virus variants that contained sequence heterogeneity in the TaqMan primer sequence region. We showed that the presence of some of these sequence variations prevented the PCR amplification of the target when regular primer sequences were used, while degenerate primer sequences were able to efficiently amplify all tested sequences equally well.
Collapse
Affiliation(s)
- Zhuhui Huang
- Infectious Disease Research Department, Southern Research Institute, 431 Aviation Way, Frederick, MD 21701, USA
| | | |
Collapse
|
30
|
|
31
|
Castro CMO, Cruz ACR, Silva EED, Gomes MDLC. Molecular and seroepidemiologic studies of Enterovirus 71 infection in the State of Para, Brazil. Rev Inst Med Trop Sao Paulo 2005; 47:65-71. [PMID: 15880216 DOI: 10.1590/s0036-46652005000200002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In many countries, the Enterovirus 71 (EV-71) Picornaviridae family is associated to hand, foot and mouth disease in addition to acute neurological diseases while in Brazil these viruses are more closely associated to the latter group. The aim of this research was to use the first EV-71 isolate of the Northern region of Brazil in molecular and seroepidemiologic studies. Two (2.2%) out of 88 stool samples (44 cases of AFP), collected from January 1998 to December 2000 were positive for EV-71 isolation (73442/PA/99). Nucleotide sequence of the gen that codifies the VP1 protein showed that isolate 73442/PA/99 was similar to the EV-71 strains belonging to genotype B - more closely identified with EV-71 from North America. Neutralization test with 389 sera samples collected from January 1998 to November 2001, from individuals ranging from 0 to 15 years of age living in the city of Belém, State of Para showed the following results in relation to isolate 73442/PA/99 and prototype BrCr: a total of 207 individuals (53.2%) had neutralization antibodies to both viruses, 167 (42.9%) had no antibodies and 15 showed the presence of neutralizing antibodies to one of the two viruses. Only 20.2% of the children aged 0 to 3 had neutralizing antibodies to EV-71, indicating that these children were more susceptible to the infection. Both the seroprevalence study and VP1 sequencing were important to demonstrate the spread and the molecular pattern of the EV-71 circulating in the Northern Region of Brazil.
Collapse
Affiliation(s)
- Ceyla M O Castro
- Laboratório de Enterovírus, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ, Brazil
| | | | | | | |
Collapse
|
32
|
Perera D, Podin Y, Akin W, Tan CS, Cardosa MJ. Incorrect identification of recent Asian strains of Coxsackievirus A16 as human enterovirus 71: improved primers for the specific detection of human enterovirus 71 by RT PCR. BMC Infect Dis 2004; 4:11. [PMID: 15122971 PMCID: PMC415548 DOI: 10.1186/1471-2334-4-11] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 05/04/2004] [Indexed: 11/23/2022] Open
Abstract
Background Human enterovirus 71 has emerged as an important pathogen in the Asia Pacific region and it is important to be able to make a rapid and specific diagnosis for outbreak control. Recent Asian strains of Coxsackievirus A16 have changes in the VP1 gene which causes mispriming of widely used primers for human enterovirus 71 specific identification. Methods Local strains of Coxsackievirus A16 were sequenced in the VP4 and VP1 genes and using sequence alignment tools, an improved set of primers were designed for specific identification of human enterovirus 71. These primers were evaluated against virus isolates as well as primary clinical specimens. Results A total of 218 virus strains were tested. All 39 human enterovirus 71 isolates were positive and none of the 38 Coxsackievirus A16, 127 other enteroviruses and 14 prototype flaviviruses and adenoviruses were positive when tested with the new primers. When aliquots of primary specimens known to have yielded human enterovirus 71 were retrospectively tested, we found that within 2 months of collection of the specimens, greater than 90% were positive but that the success rate diminished rapidly to 18% after 2 years storage. Conclusions Our new primers will be useful in rapid diagnosis of human enterovirus 71 infection, and can also be used as a screening tool in surveillance programmes for early warning of human enterovirus 71 transmission.
Collapse
Affiliation(s)
- David Perera
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, 94300 Malaysia
| | - Yuwana Podin
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, 94300 Malaysia
| | - Winnie Akin
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, 94300 Malaysia
| | - Cheng-Siang Tan
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, 94300 Malaysia
| | - Mary Jane Cardosa
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, 94300 Malaysia
| |
Collapse
|
33
|
Fu YC, Chi CS, Chiu YT, Hsu SL, Hwang B, Jan SL, Chen PY, Huang FL, Chang Y. Cardiac complications of enterovirus rhombencephalitis. Arch Dis Child 2004; 89:368-73. [PMID: 15033850 PMCID: PMC1719879 DOI: 10.1136/adc.2003.029645] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Epidemics of enterovirus 71 infection have caused the death of many children throughout the world. Rhombencephalitis, brain stem encephalitis, and heart failure were present in all of the fatal cases. However, no evidence of myocarditis was noted in the heart specimens, and the mechanism of heart failure remains unknown. AIMS To characterise the presentation of cardiac complications in children with enterovirus rhombencephalitis and discuss its pathogenesis. METHODS Ninety one consecutive patients with enterovirus rhombencephalitis underwent echocardiography. Of these, 17 patients (nine male, eight female; median age 14 months, range 4-57 months) with left ventricular dysfunction were studied. RESULTS Tachycardia was noted in all patients and systemic hypertension in 12. Muscle-brain fraction of creatine kinase was >5% in 14 patients. Plasma norepinephrine and epinephrine levels were significantly raised in the three patients in whom these were analysed. Electrocardiographic abnormalities were noted in eight patients. Pulmonary oedema was complicated in 15 patients. The initial ejection fraction of the left ventricle was 22-58% (mean 37%, SD 11%). All patients deteriorated to hypotensive shock within 12 hours and 13 died. Heart specimens from seven patients showed no evidence of myocarditis, but significant coagulative myocytolysis, myofibrillar degeneration, and cardiomyocyte apoptosis were observed. CONCLUSIONS Acute heart failure was noted in 19% of patients with enterovirus rhombencephalitis, which had a fatality rate of 77%. It was not caused by myocarditis but possibly by neurogenic cardiac damage.
Collapse
Affiliation(s)
- Y C Fu
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Costa-Mattioli M, Napoli AD, Ferré V, Billaudel S, Perez-Bercoff R, Cristina J. Genetic variability of hepatitis A virus. J Gen Virol 2004; 84:3191-3201. [PMID: 14645901 DOI: 10.1099/vir.0.19532-0] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Knowledge of the molecular biology of hepatitis A virus (HAV) has increased exponentially since its identification. HAV exploits all known mechanisms of genetic variation to ensure survival, including mutation and genetic recombination. HAV has been characterized by the emergence of different genotypes, three human antigenic variants and only one major serotype. This paper reviews the genetic variability and molecular epidemiology of HAV. Its evolutionary mechanisms are described with particular emphasis on genetic recombination and HAV mutation rate. Genotypic classification methods are also discussed.
Collapse
Affiliation(s)
- Mauro Costa-Mattioli
- Department of Biochemistry, McGill University, McIntyre Medical Building, Montreal, Quebec, Canada H3G 1Y6
| | - Anna Di Napoli
- Laboratoire de Virologie Moléculaire et Structurale, CNRS, 1 Avenue de la Terrasse, 91198 Gif-sur-Yvette, France
| | - Virginie Ferré
- Laboratorie de Virologie UPRES-EA1156, Institut de Biologie, Centre Hospitalier Regional Universitaire de Nantes, Rue Quai Moncousu 9, 44093 Nantes, France
| | - Sylviane Billaudel
- Laboratorie de Virologie UPRES-EA1156, Institut de Biologie, Centre Hospitalier Regional Universitaire de Nantes, Rue Quai Moncousu 9, 44093 Nantes, France
| | - Raul Perez-Bercoff
- Laboratoire de Virologie Moléculaire et Structurale, CNRS, 1 Avenue de la Terrasse, 91198 Gif-sur-Yvette, France
| | - Juan Cristina
- Departamento de Técnicas Nucleares Aplicadas, Centro de Investigaciones Nucleares, Facultad de Ciencias, Universidad de la República, Igua 4225, 11400 Montevideo, Uruguay
| |
Collapse
|
35
|
Shih SR, Wang YW, Chen GW, Chang LY, Lin TY, Tseng MC, Chiang C, Tsao KC, Huang CG, Shio MR, Tai JH, Wang SH, Kuo RL, Liu WT. Serotype-specific detection of enterovirus 71 in clinical specimens by DNA microchip array. J Virol Methods 2003; 111:55-60. [PMID: 12821197 DOI: 10.1016/s0166-0934(03)00151-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Enterovirus 71 is an important pathogen that causes high morbidity and mortality in children in Taiwan. Virus isolation in cell cultures has been the standard method for enterovirus 71 identification in Clinical Virology Laboratories. However, virus isolation takes 5-10 days when using cell culture. A microchip for enterovirus 71 detection was developed as an alternative diagnostic method. The novel approach is based on hybridization of amplified DNA specimens with oligonucleotide DNA probes immobilized on a microchip. Two oligonucleotides were used as detection probes, the pan-enterovirus sequence located in the 5'-noncoding region (5'-NCR) and the enterovirus 71-specific sequence located in the VP2 region. The diagnostic procedure takes 6 h. One hundred specimens identified as enteroviruses by viral cultures were tested using this microchip, including 67 enterovirus 71 specimens. The sensitivity of the novel method is 89.6% and its specificity is 90.9%. The enterovirus 71-microchip can detect the amplicon derived from viral RNA corresponding to 1-10 virions in a clinical specimen. Microchip array is a potential diagnostic method for identification of enterovirus in the future.
Collapse
Affiliation(s)
- Shin-Ru Shih
- School of Medical Technology, Chang Gung University, 259 Wen-Hua 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan, ROC.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Fu YC, Chi CS, Jan SL, Wang TM, Chen PY, Chang Y, Chou G, Lin CC, Hwang B, Hsu SL. Pulmonary edema of enterovirus 71 encephalomyelitis is associated with left ventricular failure: implications for treatment. Pediatr Pulmonol 2003; 35:263-8. [PMID: 12629622 DOI: 10.1002/ppul.10258] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Epidemics of enterovirus 71 infections caused the rapid death of many children in Malaysia in 1997 and in Taiwan in 1998. Pulmonary edema occurred in most of the fatal cases and was considered to be neurogenic. The role of the heart was rarely investigated before. Between January 1998-January 2001, 34 consecutive patients who were admitted to the intensive care unit due to enterovirus infection were studied prospectively. Patients were divided into two groups: group I with pulmonary edema, and group II without pulmonary edema. Comparisons were made between the two groups based upon demographic, neurological, and cardiovascular manifestations. Group I consisted of 11 patients (5 boys, 6 girls; mean age, 22.8 months), and group II of 23 patients (12 boys, 11 girls; mean age, 28.8 months). There were no significant differences between the two groups in comparing sex, age, body weight, neurological severity, intracranial pressure, cell count, protein and glucose levels in cerebral spinal fluid, and blood pressure. All group I patients had left ventricular dysfunction, and their ejection fractions were significantly lower than those of patients in group II (37 +/- 11% vs. 75 +/- 6%, P < 0.001). Group I heart rates were higher than those of group II (175 +/- 24 vs. 137 +/- 25, P < 0.001). In group I, 9 patients who received conventional treatment died, and the only two survivors received left ventricular assist devices. In conclusion, the pulmonary edema of fulminant enterovirus 71 infection is associated with left ventricular failure. Left ventricular function is the major determinant of outcome. Early recognition of heart failure and aggressive cardiac intervention are life-saving. Pediatr Pulmonol. 2003; 35:263-268.
Collapse
Affiliation(s)
- Yun-Ching Fu
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Cardosa MJ, Perera D, Brown BA, Cheon D, Chan HM, Chan KP, Cho H, McMinn P. Molecular epidemiology of human enterovirus 71 strains and recent outbreaks in the Asia-Pacific region: comparative analysis of the VP1 and VP4 genes. Emerg Infect Dis 2003; 9:461-8. [PMID: 12702227 PMCID: PMC2957976 DOI: 10.3201/eid0904.020395] [Citation(s) in RCA: 218] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This study provides a comprehensive overview of the molecular epidemiology of human enterovirus 71 (HEV71) in the Asia-Pacific region from 1997 through 2002. Phylogenetic analysis of the VP4 and VP1 genes of recent HEV71 strains indicates that several genogroups of the virus have been circulating in the Asia-Pacific region since 1997. The first of these recent outbreaks, described in Sarawak (Malaysian Borneo) in 1997, was caused by genogroup B3. This outbreak was followed by large outbreaks in Taiwan in 1998, caused by genogroup C2, and in Perth (Western Australia) in 1999, where viruses belonging to genogroups B3 and C2 cocirculated. Singapore, Taiwan, and Sarawak had HEV71 epidemics in 2000, caused predominantly by viruses belonging to genogroup B4; however, large numbers of fatalities were observed only in Taiwan. HEV71 was identified during an epidemic of hand, foot and mouth disease in Korea; that epidemic was found to be due to viruses constituting a new genogroup, C3.
Collapse
|
38
|
Singh S, Poh CL, Chow VTK. Complete sequence analyses of enterovirus 71 strains from fatal and non-fatal cases of the hand, foot and mouth disease outbreak in Singapore (2000). Microbiol Immunol 2003; 46:801-8. [PMID: 12516778 DOI: 10.1111/j.1348-0421.2002.tb02767.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Enterovirus 71 (EV71) is a major aetiological agent of hand, foot and mouth disease (HFMD). In recent years, several outbreaks in East Asia were associated with neurological complications and numerous deaths. An outbreak in Singapore in October 2000 afflicted thousands of children, resulting in four fatal cases from three of whom EV71 was isolated. The genomes of two representative EV71 strains isolated from a fatal case and a surviving patient were completely sequenced, and their nucleotide and amino acid sequences compared with known EV71 strains. The two outbreak strains were classified under genogroup B, together with those previously isolated in Singapore, Malaysia and Japan. Comparative sequence analysis of the two Singapore strains revealed 99% nucleotide similarity, while their deduced amino acid sequences were almost identical except for residue 1506 in the 3A non-structural region. Given that the outbreak involved closely related genetic variants of EV71, the broad spectrum of disease severity may be attributed to critical factors such as varying viral inoculation doses or differing host immune responses following infection, but is less likely to be due to the emergence of EV71 strains with heightened virulence.
Collapse
Affiliation(s)
- Sunita Singh
- Programme in Infectious Diseases, Department of Microbiology, Faculty of Medicine, National University of Singapore, 5 Science Drive 2, Kent Ridge, Singapore 117597
| | | | | |
Collapse
|
39
|
Oberste MS, Nix WA, Kilpatrick DR, Flemister MR, Pallansch MA. Molecular epidemiology and type-specific detection of echovirus 11 isolates from the Americas, Europe, Africa, Australia, southern Asia and the Middle East. Virus Res 2003; 91:241-8. [PMID: 12573503 DOI: 10.1016/s0168-1702(02)00291-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Echovirus 11 (E11) is among the most commonly isolated human enteroviruses. To examine the range of genetic variation within the E11 serotype, we determined the complete VP1 sequences for 53 geographically dispersed E11 strains isolated in 16 countries from 1953 to 2001. E11 sequences were monophyletic with respect to all other enterovirus serotypes. The sequences clustered into four monophyletic genogroups, A-D; members of each genogroup differed from one another by <20%. Isolates in different genogroups differed from one another by 19-28%. The E11 prototype strain, USA/CA53-Gregory, was the sole member of genogroup B. All recent US isolates were members of one of two discrete lineages within genogroup D. The well-characterized E11 antigenic variant, USA/CA63-Silva, was also a member of genogroup D. Members of genogroups A and C were antigenically similar to USA/CA53-Gregory, as measured by neutralization with anti-Gregory and anti-Silva antisera. Only USA/CA63-Silva was neutralized more efficiently by the anti-Silva antiserum; other genogroup D viruses were Gregory-like or intermediate in their neutralization phenotype. Recent non-US isolates were distributed in genogroups A, C and D. Sequence similarities among genogroup D isolates from North America, Europe, Asia, Australia and North Africa demonstrate that an E11 strain can spread rapidly over a wide geographic area. The aligned sequences were used to develop an E11-specific RT-PCR assay, using degenerate, inosine-containing primers, to amplify all members of all genogroups.
Collapse
Affiliation(s)
- M Steven Oberste
- Respiratory and Enteric Viruses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop G-17, Atlanta, GA 30333, USA.
| | | | | | | | | |
Collapse
|
40
|
Fujimoto T, Chikahira M, Yoshida S, Ebira H, Hasegawa A, Totsuka A, Nishio O. Outbreak of central nervous system disease associated with hand, foot, and mouth disease in Japan during the summer of 2000: detection and molecular epidemiology of enterovirus 71. Microbiol Immunol 2003; 46:621-7. [PMID: 12437029 DOI: 10.1111/j.1348-0421.2002.tb02743.x] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Few outbreaks of the serious enterovirus 71 (EV71) infections, which affect the central nervous system (CNS), had been reported in Japan before 2000. During June through August 2000, a patient died of pulmonary edema caused by brainstem encephalitis accompanied by EV71-induced hand, foot, and mouth disease (HFMD), and many patients complicated by serious CNS disease, including paralysis, were hospitalized in a restricted area in Hyogo Prefecture, Japan (K-area). During the same period, endemics of HFMD were reported in other areas in Hyogo Prefecture, where EV71 was isolated from HFMD patients, but few patients developed aseptic meningitis. The isolations of EV71 from K-area patients were difficult with the use of Vero cells, so the strains were isolated by use of GL37 cells; Vero cells, however, could isolate EV71 strains from other areas in Hyogo Prefecture. We sequenced VP4 coding regions of these EV71 isolates and found that the isolates from K-area had the same sequence, which, except for one isolate, was different from the sequences of EV71 strains isolated from other areas of Hyogo Prefecture. Although these results were not enough to state that EV71 from K-area was a virulent strain, it seemed reasonable to conclude that serious CNS diseases in K-area were caused by EV71 because it was the only infectious agent detected in the inpatients of K-area.
Collapse
Affiliation(s)
- Tsuguto Fujimoto
- Infectious Disease Research Division, Hyogo Prefectural Institute of Public Health and Environmental Sciences, Kobe, Japan.
| | | | | | | | | | | | | |
Collapse
|
41
|
Cinque P, Bossolasco S, Lundkvist A. Molecular analysis of cerebrospinal fluid in viral diseases of the central nervous system. J Clin Virol 2003; 26:1-28. [PMID: 12589831 PMCID: PMC7128469 DOI: 10.1016/s1386-6532(02)00173-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of nucleic acid (NA) amplification techniques has transformed the diagnosis of viral infections of the central nervous system (CNS). Because of their enhanced sensitivity, these methods enable detection of even low amounts of viral genomes in cerebrospinal fluid. Following more than 10 years of experience, the polymerase chain reaction or other NA-based amplification techniques are nowadays performed in most diagnostic laboratories and have become the test of choice for the diagnosis of several viral CNS infections, such as herpes encephalitis, enterovirus meningitis and other viral infections occurring in human immunodeficiency virus-infected persons. Furthermore, they have been useful to establish a viral etiology in neurological syndromes of dubious origin and to recognise unusual or poorly characterised CNS diseases. Quantitative methods have provided a valuable additional tool for clinical management of these diseases, whereas post-amplification techniques have enabled precise genome characterisation. Current efforts are aiming at further improvement of the diagnostic efficiency of molecular techniques, their speed and standardisation, and to reduce the costs. The most relevant NA amplification strategies and clinical applications of to date will be the object of this review.
Collapse
Affiliation(s)
- Paola Cinque
- Clinic of Infectious Diseases, San Raffaele Hospital, Via Stamira d'Ancona, 20, 20127, Milan, Italy.
| | | | | |
Collapse
|
42
|
|
43
|
Tsao KC, Chan EC, Chang LY, Chang PY, Huang CG, Chen YP, Chang SC, Lin TY, Sun CF, Shih SR. Responses of IgM for enterovirus 71 infection. J Med Virol 2002; 68:574-80. [PMID: 12376966 DOI: 10.1002/jmv.10233] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A rapid serological assay was developed for detection of specific IgM to enterovirus 71, a human picornavirus that is usually associated with severe central nervous system complications. The sensitivity and specificity of this "in-house" mu-capture enzyme linked-immunosorbent assay was assessed by testing 213 serum samples. With the conventional virus culture as a standard method, the sensitivity and specificity were 91.5 and 93.1%, respectively, for this newly developed immunoassay. This method allows for detection of the IgM responses from the patients either infected by genotype B or genotype C of enterovirus 71. IgM can be detected as early as the second day from the onset of disease. IgM responses exhibit 100% positive rate from enterovirus 71-infected patients with complications, including encephalitis, meningitis, polio-like syndrome, pulmonary edema, and fatal cases. These findings suggest that detection of specific IgM by the use of enzyme linked-immunosorbent assay is a rapid and valuable way for the diagnosis of enterovirus 71 infection.
Collapse
Affiliation(s)
- Kuo-Chien Tsao
- School of Medical Technology, Chang Gung University, Tao-Yuan, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Singh S, Chow VTK, Phoon MC, Chan KP, Poh CL. Direct detection of enterovirus 71 (EV71) in clinical specimens from a hand, foot, and mouth disease outbreak in Singapore by reverse transcription-PCR with universal enterovirus and EV71-specific primers. J Clin Microbiol 2002; 40:2823-7. [PMID: 12149336 PMCID: PMC120643 DOI: 10.1128/jcm.40.8.2823-2827.2002] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A recent outbreak of hand, foot, and mouth disease in Singapore in 2000 affected several thousand children and resulted in four deaths. The aim of this study was to determine the applicability of reverse transcription-PCR (RT-PCR) with universal pan-enterovirus primers and enterovirus 71 (EV71) type-specific primers for the direct detection of enteroviruses in clinical specimens derived from this outbreak. With the universal primers, EV71 RNA sequences were successfully detected by RT-PCR and direct sequencing in 71% of positive specimens. Three pairs of EV71 type-specific primers were evaluated for rapid detection of EV71 directly from clinical specimens and cell culture isolates. By using a seminested RT-PCR strategy, specific identification of EV71 sequences directly in clinical specimens was achieved, with a detection rate of 53%. In contrast, cell culture could isolate EV71 in only 20% of positive specimens. EV71 was detected directly from brain, heart, and lung specimens of two deceased siblings. Although more than one type of enterovirus was identified in clinical specimens from this outbreak, 90% of the enteroviruses were confirmed as EV71. The data demonstrate the clinical applicability of pan-enterovirus and seminested RT-PCR for the detection of EV71 RNA directly from clinical specimens in an outbreak situation.
Collapse
Affiliation(s)
- Sunita Singh
- Programme in Infectious Diseases, Department of Microbiology, Faculty of Medicine, National University of Singapore, Singapore 117597
| | | | | | | | | |
Collapse
|
45
|
Tsao KC, Chang PY, Ning HC, Sun CF, Lin TY, Chang LY, Huang YC, Shih SR. Use of molecular assay in diagnosis of hand, foot and mouth disease caused by enterovirus 71 or coxsackievirus A 16. J Virol Methods 2002; 102:9-14. [PMID: 11879688 DOI: 10.1016/s0166-0934(01)00376-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hand, foot and mouth disease is a common illness in children and is usually caused by coxsackievirus A 16 and enterovirus 71. It has been noted that enterovirus 71 infection is more severe with significantly greater frequency of serious complications and fatality than coxsackievirus A 16. Therefore, it is important to develop a rapid and specific assay for discriminating coxsackievirus A 16 and enterovirus 71 in hand, foot and mouth disease outbreaks. In this study we designed two sets of RT-PCR primers specific for coxsackievirus A 16 and enterovirus 71. One hundred and eighty-nine viruses were evaluated for this molecular diagnosis assay. Among 110 enterovirus 71 strains, the enterovirus 71 specific primers gave clear signal for 107 clinical enterovirus 71 isolates and three reference enterovirus 71 strains. None of coxsackievirus A 16, other enteroviruses or non-enteroviruses show signal for enterovirus 71-specific primers. On the other hand, among 28 coxsackievirus A 16 strains, the coxsackievirus A 16-specific primers detect 27 clinical isolates and one reference strain but show no cross-reaction with other viruses. The molecular assay developed in this study provides a sensitive and specific way to distinguish coxsackievirus A 16 and enterovirus 71 induced hand, foot and mouth disease, which will be a useful rapid diagnostic method in future outbreaks.
Collapse
Affiliation(s)
- Kuo Chien Tsao
- School of Medical Technology, Chang Gung University, Kwei-Shan, 259 Wen-Hua 1st Road, Kwei-Shan, 333, Tao-Yuan, Taiwan, ROC
| | | | | | | | | | | | | | | |
Collapse
|
46
|
McMinn PC. An overview of the evolution of enterovirus 71 and its clinical and public health significance. FEMS Microbiol Rev 2002; 26:91-107. [PMID: 12007645 DOI: 10.1111/j.1574-6976.2002.tb00601.x] [Citation(s) in RCA: 573] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Since its discovery in 1969, enterovirus 71 (EV71) has been recognised as a frequent cause of epidemics of hand-foot-and-mouth disease (HFMD) associated with severe neurological sequelae in a small proportion of cases. There has been a significant increase in EV71 epidemic activity throughout the Asia-Pacific region since 1997. Recent HFMD epidemics in this region have been associated with a severe form of brainstem encephalitis associated with pulmonary oedema and high case-fatality rates. The emergence of large-scale epidemic activity in the Asia-Pacific region has been associated with the circulation of three genetic lineages that appear to be undergoing rapid evolutionary change. Two of these lineages (B3 and B4) have not been described previously and appear to have arisen from an endemic focus in equatorial Asia, which has served as a source of virus for HFMD epidemics in Malaysia, Singapore and Australia. The third lineage (C2) has previously been identified [Brown, B.A. et al. (1999) J. Virol. 73, 9969-9975] and was primarily responsible for the large HFMD epidemic in Taiwan during 1998. As EV71 appears not to be susceptible to newly developed antiviral agents and a vaccine is not currently available, control of EV71 epidemics through high-level surveillance and public health intervention needs to be maintained and extended throughout the Asia-Pacific region. Future research should focus on (1) understanding the molecular genetics of EV71 virulence, (2) identification of the receptor(s) for EV71, (3) development of antiviral agents to ameliorate the severity of neurological disease and (4) vaccine development to control epidemics. Following the successful experience of the poliomyelitis control programme, it may be possible to control EV71 epidemics if an effective live-attenuated vaccine is developed.
Collapse
Affiliation(s)
- Peter C McMinn
- Division of Virology, TVW Telethon Institute for Child Health Research, 100 Roberts Road, Subiaco, WA 6008, Australia.
| |
Collapse
|
47
|
Bendig JW, O'Brien PS, Muir P. Serotype-specific detection of coxsackievirus A16 in clinical specimens by reverse transcription-nested PCR. J Clin Microbiol 2001; 39:3690-2. [PMID: 11574592 PMCID: PMC88408 DOI: 10.1128/jcm.39.10.3690-3692.2001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe the development of a coxsackievirus A16 (CVA16) serotype-specific PCR which correctly differentiated between CVA16 and other enterovirus serotypes of both laboratory isolates and clinical specimens. The assay will be useful for monitoring CVA16 outbreaks and studying the disease association, epidemiology, and evolution of this common enterovirus serotype.
Collapse
Affiliation(s)
- J W Bendig
- PHLS Coxsackievirus Reference Unit, Epsom, Surrey, United Kingdom.
| | | | | |
Collapse
|
48
|
Yan JJ, Su IJ, Chen PF, Liu CC, Yu CK, Wang JR. Complete genome analysis of enterovirus 71 isolated from an outbreak in Taiwan and rapid identification of enterovirus 71 and coxsackievirus A16 by RT-PCR. J Med Virol 2001; 65:331-9. [PMID: 11536241 DOI: 10.1002/jmv.2038] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hand, foot, and mouth disease (HFMD) and encephalomyelitis were two major clinical manifestations during the 1998 enterovirus 71 (EV71) epidemic in Taiwan. To investigate whether different clinical patterns were caused by alterations in EV71 genomes, the complete nucleotide sequences of four EV71 strains associated with HFMD or encephalomyelitis were compared. Among these viral strains, two or three nucleotide differences were found within the 5'-noncoding region, and two or four amino acid differences were found within the regions encoding viral polyproteins; however, none of these differences were correlated with either clinical manifestation. Because coxsackievirus A16 was another major causative agent of HFMD, a reverse transcription-polymerase chain reaction assay, with high sensitivity and specificity for identification of EV71 (both 100%) and coxsackievirus A16 (100 and 98.8%), was developed for the rapid differential identification of these two viruses in HFMD patients.
Collapse
Affiliation(s)
- J J Yan
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan
| | | | | | | | | | | |
Collapse
|
49
|
Kilpatrick DR, Quay J, Pallansch MA, Oberste MS. Type-specific detection of echovirus 30 isolates using degenerate reverse transcriptase PCR primers. J Clin Microbiol 2001; 39:1299-302. [PMID: 11283045 PMCID: PMC87928 DOI: 10.1128/jcm.39.4.1299-1302.2001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2000] [Accepted: 01/22/2001] [Indexed: 11/20/2022] Open
Abstract
Following an approach used to specifically identify polioviruses and enterovirus 71, we have developed reverse transcriptase (RT) PCR primers containing mixed-base residues or deoxyinosine at positions of codon degeneracy. These primers permit specific RT-PCR amplification of echovirus 30 (E30) sequences by targeting sites that encode conserved amino acid motifs within the major capsid protein, VP1. All 221 E30 strains tested, isolated in 16 countries over a 44-year period, yielded the predicted 158-bp PCR product. No specific products were obtained by PCR assays containing templates from any of the other 63 EV serotypes. Inosine-containing degenerate primers may be widely applicable to the identification of echovirus serotypes by PCR.
Collapse
Affiliation(s)
- D R Kilpatrick
- Respiratory and Enteric Viruses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
| | | | | | | |
Collapse
|