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Verani M, Pagani A, Federigi I, Lauretani G, Atomsa NT, Rossi V, Viviani L, Carducci A. Wastewater-Based Epidemiology for Viral Surveillance from an Endemic Perspective: Evidence and Challenges. Viruses 2024; 16:482. [PMID: 38543847 PMCID: PMC10975420 DOI: 10.3390/v16030482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/23/2024] [Accepted: 03/11/2024] [Indexed: 05/23/2024] Open
Abstract
Wastewater-based epidemiology (WBE) is currently used to monitor not only the spread of the viral SARS-CoV-2 pandemic but also that of other viruses in endemic conditions, particularly in the absence of syndromic surveillance. The continuous monitoring of sewage requires high expenditure and significant time investments, highlighting the need for standardized methods and structured monitoring strategies. In this context, we conducted weekly wastewater monitoring in northwestern Tuscany (Italy) and targeted human adenovirus (HAdV), norovirus genogroup II (NoVggII), enterovirus (EV), and SARS-CoV-2. Samples were collected at the entrances of treatment plants and concentrated using PEG/NaCl precipitation, and viral nucleic acids were extracted and detected through real-time reverse transcription qPCR. NoVggII was the most identified target (84.4%), followed by HAdV, SARS-CoV-2, and EV. Only HAdV and EV exhibited seasonal peaks in spring and summer. Compared with data that were previously collected in the same study area (from February 2021 to September 2021), the results for SARS-CoV-2 revealed a shift from an epidemic to an endemic pattern, at least in the region under investigation, which was likely due to viral mutations that led to the spreading of new variants with increased resistance to summer environmental conditions. In conclusion, using standardized methods and an efficient monitoring strategy, WBE proves valuable for viral surveillance in pandemic and epidemic scenarios, enabling the identification of temporal-local distribution patterns that are useful for making informed public health decisions.
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Affiliation(s)
| | | | - Ileana Federigi
- Laboratory of Hygiene and Environmental Virology, Department of Biology, University of Pisa, Via S. Zeno 35/39, 56123 Pisa, Italy; (M.V.); (A.P.); (G.L.); (N.T.A.); (V.R.); (L.V.); (A.C.)
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Jin WP, Wang C, Wu J, Guo J, Meng SL, Wang ZJ, Yu DG, Shen S. Reporter Coxsackievirus A5 Expressing iLOV Fluorescent Protein or Luciferase Used for Rapid Neutralizing Assay in Cells and Living Imaging in Mice. Viruses 2023; 15:1868. [PMID: 37766275 PMCID: PMC10535187 DOI: 10.3390/v15091868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
Coxsackievirus A5 (CV-A5) is a re-emerging enterovirus that causes hand, foot, and mouth disease in children under five years of age. CV-A5-M14-611 is a mouse-adapted strain that can infect orally and lead to the death of 14-day-old mice. Here, recombinants based on CV-A5-M14-611 were constructed carrying three reporter genes in different lengths. Smaller fluorescent marker proteins, light, oxygen, voltage sensing (iLOV), and nano luciferase (Nluc) were proven to be able to express efficiently in vitro. However, the recombinant with the largest insertion of the red fluorescence protein gene (DsRed) was not rescued. The construction strategy of reporter viruses was to insert the foreign genes between the C-terminus of VP1 and the N-terminus of 2A genes and to add a 2A protease cleavage domain at both ends of the insertions. The iLOV-tagged or Nluc-tagged recombinants, CV-A5-iLOV or CV-A5-Nluc, exhibited a high capacity for viral replication, genetic stability in cells and pathogenicity in mice. They were used to establish a rapid, inexpensive and convenient neutralizing antibody assay and greatly facilitated virus neutralizing antibody titration. Living imaging was performed on mice with CV-A5-Nluc, which exhibited specific bioluminescence in virus-disseminated organs, while fluorescence induced by CV-A5-iLOV was weakly detected. The reporter-gene-tagged CV-A5 can be used to study the infection and mechanisms of CV-A5 pathogenicity in a mouse model. They can also be used to establish rapid and sensitive assays for detecting neutralizing antibodies.
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Affiliation(s)
| | | | | | | | | | | | | | - Shuo Shen
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China; (W.-P.J.); (C.W.); (J.W.); (J.G.); (S.-L.M.); (Z.-J.W.); (D.-G.Y.)
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Liang Y, Chen J, Wang C, Yu B, Zhang Y, Liu Z. Investigating the mechanism of Echovirus 30 cell invasion. Front Microbiol 2023; 14:1174410. [PMID: 37485505 PMCID: PMC10359910 DOI: 10.3389/fmicb.2023.1174410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
Viruses invade susceptible cells through a complex mechanism before injecting their genetic material into them. This causes direct damage to the host cell, as well as resulting in disease in the corresponding system. Echovirus type 30 (E30) is a member of the Enterovirus B group and has recently been reported to cause central nervous system (CNS) disorders, leading to viral encephalitis and viral meningitis in children. In this review, we aim to help in improving the understanding of the mechanisms of CNS diseases caused by E30 for the subsequent development of relevant drugs and vaccines.
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Affiliation(s)
- Yucai Liang
- Department of Microbiology, Weifang Medical University, Weifang, China
| | - Junbing Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing, China
| | - Congcong Wang
- Department of Microbiology, Weifang Medical University, Weifang, China
| | - Bowen Yu
- Department of Immunology, Weifang Medical University, Weifang, China
| | - Yong Zhang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhijun Liu
- Department of Microbiology, Weifang Medical University, Weifang, China
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Hu K, Onintsoa Diarimalala R, Yao C, Li H, Wei Y. EV-A71 Mechanism of Entry: Receptors/Co-Receptors, Related Pathways and Inhibitors. Viruses 2023; 15:v15030785. [PMID: 36992493 PMCID: PMC10051052 DOI: 10.3390/v15030785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
Enterovirus A71, a non-enveloped single-stranded (+) RNA virus, enters host cells through three stages: attachment, endocytosis and uncoating. In recent years, receptors/co-receptors anchored on the host cell membrane and involved in this process have been continuously identified. Among these, hSCARB-2 was the first receptor revealed to specifically bind to a definite site of the EV-A71 viral capsid and plays an indispensable role during viral entry. It actually acts as the main receptor due to its ability to recognize all EV-A71 strains. In addition, PSGL-1 is the second EV-A71 receptor discovered. Unlike hSCARB-2, PSGL-1 binding is strain-specific; only 20% of EV-A71 strains isolated to date are able to recognize and bind it. Some other receptors, such as sialylated glycan, Anx 2, HS, HSP90, vimentin, nucleolin and fibronectin, were discovered successively and considered as "co-receptors" because, without hSCARB-2 or PSGL-1, they are not able to mediate entry. For cypA, prohibitin and hWARS, whether they belong to the category of receptors or of co-receptors still needs further investigation. In fact, they have shown to exhibit an hSCARB-2-independent entry. All this information has gradually enriched our knowledge of EV-A71's early stages of infection. In addition to the availability of receptors/co-receptors for EV-A71 on host cells, the complex interaction between the virus and host proteins and various intracellular signaling pathways that are intricately connected to each other is critical for a successful EV-A71 invasion and for escaping the attack of the immune system. However, a lot remains unknown about the EV-A71 entry process. Nevertheless, researchers have been continuously interested in developing EV-A71 entry inhibitors, as this study area offers a large number of targets. To date, important progress has been made toward the development of several inhibitors targeting: receptors/co-receptors, including their soluble forms and chemically designed compounds; virus capsids, such as capsid inhibitors designed on the VP1 capsid; compounds potentially interfering with related signaling pathways, such as MAPK-, IFN- and ATR-inhibitors; and other strategies, such as siRNA and monoclonal antibodies targeting entry. The present review summarizes these latest studies, which are undoubtedly of great significance in developing a novel therapeutic approach against EV-A71.
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Affiliation(s)
- Kanghong Hu
- Sino-German Biomedical Center, National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Cooperative Innovation Center of Industrial Fermentation (Ministry of Education & Hubei Province), Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, Wuhan 430068, China
| | - Rominah Onintsoa Diarimalala
- Sino-German Biomedical Center, National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Cooperative Innovation Center of Industrial Fermentation (Ministry of Education & Hubei Province), Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, Wuhan 430068, China
| | - Chenguang Yao
- Sino-German Biomedical Center, National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Cooperative Innovation Center of Industrial Fermentation (Ministry of Education & Hubei Province), Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, Wuhan 430068, China
| | - Hanluo Li
- Sino-German Biomedical Center, National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Cooperative Innovation Center of Industrial Fermentation (Ministry of Education & Hubei Province), Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, Wuhan 430068, China
| | - Yanhong Wei
- Sino-German Biomedical Center, National "111" Center for Cellular Regulation and Molecular Pharmaceutics, Cooperative Innovation Center of Industrial Fermentation (Ministry of Education & Hubei Province), Key Laboratory of Fermentation Engineering (Ministry of Education), Hubei University of Technology, Wuhan 430068, China
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Mao Q, Sun G, Qian Y, Qian Y, Li W, Wang X, Shen Q, Yang S, Zhou C, Wang H, Zhang W. Viral metagenomics of pharyngeal secretions from children with acute respiratory diseases with unknown etiology revealed diverse viruses. Virus Res 2022; 321:198912. [PMID: 36058285 DOI: 10.1016/j.virusres.2022.198912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/21/2022] [Accepted: 08/31/2022] [Indexed: 12/24/2022]
Abstract
Acute respiratory tract infections are a major public health problem and the leading cause of morbidity in children younger than 5 years old. This study investigated the potential reasons of unexplained acute respiratory infections in children in Xuzhou and its environs during 2018-2019.We collected pharyngeal swab samples from 411 children under the age of five who presented with symptoms of unexplained acute respiratory infection and were negative for bacteria, mycoplasma, and influenza viruses. Using viral metagenomic techniques, viral nucleic acids were extracted, enriched, and sequenced from the samples. Results indicated that Picornaviridae, Parvoviridae, Paramyxoviridae, Coronaviridae, and Anelloviridae were the five virus families with the highest relative content of sequence reads. And we detected 35 HBoV-positive and 12 HEV-positive samples out of 411 samples by the polymerase chain reaction (PCR). Partial or nearly complete genome sequences of viruses belonging to the families Picornaviridae, Parvoviridae, and Anelloviridae were characterized, and phylogenetic trees were constructed based on the nucleic acid or amino acid sequences of the predicted viral open reading frames (ORFs), as well as genotyping of the viruses. In addition, we observed recombination events in the Saffold virus and Coxsackievirus A9 by analyzing the genetic characteristics of the viruses revealed in this study. This study provides vital information for the prevention and treatment of acute respiratory infections in children younger than five years old.
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Affiliation(s)
- Qingqing Mao
- Department of Pediatrics, Affiliated Hospital of Jiangsu University, Zhenjiang, 212013, China; School of Medicine, Jiangsu University, Zhenjiang, 212013, China
| | - Guangming Sun
- Department of Clinical Laboratory, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu, China
| | - Yu Qian
- School of Medicine, Jiangsu University, Zhenjiang, 212013, China
| | - Yuchen Qian
- School of Medicine, Jiangsu University, Zhenjiang, 212013, China
| | - Wang Li
- Clinical Laboratory Center, The Affiliated Taizhou People's Hospital, Nanjing Medical University, Taizhou, Jiangsu 225300, China
| | - Xiaochun Wang
- School of Medicine, Jiangsu University, Zhenjiang, 212013, China
| | - Quan Shen
- School of Medicine, Jiangsu University, Zhenjiang, 212013, China
| | - Shixing Yang
- School of Medicine, Jiangsu University, Zhenjiang, 212013, China
| | - Chenglin Zhou
- Clinical Laboratory Center, The Affiliated Taizhou People's Hospital, Nanjing Medical University, Taizhou, Jiangsu 225300, China.
| | - Hao Wang
- Department of Clinical Laboratory, The Affiliated Huai'an Hospital of Xuzhou Medical University, Huai'an, Jiangsu, China.
| | - Wen Zhang
- Department of Pediatrics, Affiliated Hospital of Jiangsu University, Zhenjiang, 212013, China; School of Medicine, Jiangsu University, Zhenjiang, 212013, China.
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Lee S, Yang JH, Lee JE, Kim YO. Serotype analysis of pediatric enteroviral meningitis in Gwangju, Republic of Korea: Number of annual cases, distribution by age group, and characteristics of each serotype. J Clin Virol 2022; 153:105192. [PMID: 35661584 DOI: 10.1016/j.jcv.2022.105192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 04/26/2022] [Accepted: 05/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Enteroviral meningitis is a common disease in children; however, serotype data are still lacking, especially for late childhood. OBJECTIVES This study analyzed the number of annual cases, distribution by age group, and characteristics of each serotype among children with enteroviral meningitis. STUDY DESIGN After the initial screening of 1,009 children (<18 years) with viral meningitis between 2008 and 2021, the data of enteroviral meningitis were retrospectively reviewed. The number of annual cases and serotypes were investigated. The distribution of serotypes across different ages was reviewed. Clinical characteristics of the major serotypes (detected in at least 15 patients) were further examined. RESULTS Among the 700 patients with enteroviral meningitis, serotypes were tested in 517 patients (73.9%), which could be typed in 370 patients (71.6%). EV-A71 was the most common serotype detected in 2010, 2012, and 2019. After 2020, enterovirus was rarely detected. The group B coxsackieviruses (CVBs) were commonly detected in neonates (CVB1, 33.3%) and infants (CVB5, 17.4%). The echoviruses were commonly detected beyond infancy; E30 was the most frequently detected in late childhood (14.4%) and adolescents (15.4%). EV-A71 was the most frequently detected in early childhood (17.2%). Between the 11 major serotypes, vomiting, headache, and irritability were more commonly associated with echoviruses (P <0.01). In EV-A71, neurologic symptoms and skin lesions were more common (P <0.01). CONCLUSION The CVBs were commonly detected in neonates and infants, whereas the echoviruses were commonly detected beyond infancy and caused vomiting, headache, and irritability. EV-A71 was the most frequently detected in early childhood, frequently causing neurologic and dermatologic problems.
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Affiliation(s)
- Sanghoon Lee
- Department of Pediatrics, Chonnam National University Children's Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea
| | - Jae Hyuk Yang
- Department of Pediatrics, Chonnam National University Children's Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea; Department of Pediatrics, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ji-Eun Lee
- Division of Infectious Disease Research, Health and Environment Research Institute of Gwangju, 584 Mugindae-ro, Seo-gu, Gwangju 61954, Republic of Korea
| | - Young Ok Kim
- Department of Pediatrics, Chonnam National University Children's Hospital, 42, Jebong-ro, Dong-gu, Gwangju 61469, Republic of Korea; Department of Pediatrics, Chonnam National University Medical School, Gwangju, Republic of Korea.
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The CXCL10/CXCR3 Axis Promotes Disease Pathogenesis in Mice upon CVA2 Infection. Microbiol Spectr 2022; 10:e0230721. [PMID: 35604176 PMCID: PMC9241849 DOI: 10.1128/spectrum.02307-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Coxsackievirus A2 (CVA2) is an emerging pathogen that results in hand-foot-and-mouth disease (HFMD) outbreaks. Systemic inflammatory response and central nervous system inflammation are the main pathological features of fatal HFMD. However, the immunopathogenesis of CVA2 infection is poorly understood. We first detected the transcriptional levels of 81 inflammation-related genes in neonatal mice with CVA2 infection. Remarkably, CVA2 induced higher expression of chemokine (C-X-C motif) ligand 10 (CXCL10) in multiple organs and tissues. CXCL10 acts through its cognate receptor chemokine (C-X-C motif) receptor 3 (CXCR3) and regulates immune responses. CXCL10/CXCR3 activation contributes to the pathogenesis of many inflammatory diseases. Next, we found CXCL10 and CXCR3 expression to be significantly elevated in the organs and tissues from CVA2-infected mice at 5 days postinfection (dpi) using immunohistochemistry (IHC). To further explore the role of CXCL10/CXCR3 in CVA2 pathogenesis, an anti-CXCR3 neutralizing antibody (αCXCR3) or IgG isotype control antibody was used to treat CVA2-infected mice on the same day as infection and every 24 h until 5 dpi. Our results showed that αCXCR3 therapy relieved the clinical manifestations and pathological damage and improved the survival rate of CVA2-infected mice. Additionally, αCXCR3 treatment reduced viral loads and reversed the proinflammatory cytokine (interleukin 6 [IL-6], tumor necrosis factor alpha [TNF-α], and IL-1β) expression, apoptosis, and inflammatory cell infiltration induced by CVA2. Collectively, our study presents evidence for the involvement of the CXCL10/CXCR3 axis in CVA2 pathogenesis. The activation of CXCL10/CXCR3 contributes to CVA2 pathogenesis by inducing apoptosis, proinflammatory cytokine expression, and inflammatory cell infiltration, which can be reversed by αCXCR3 therapy. This study provides new insight into the pathogenesis of HFMD, which has an important guiding significance for the treatment of HFMD. IMPORTANCE Systemic inflammatory response and central nervous system inflammation are the main pathological features of fatal HFMD cases. We detected the expression of 81 inflammation-related genes and found higher expression of CXCL10 in CVA2-infected mice. Next, we confirmed CXCL10/CXCR3 activation using immunohistochemistry and found that anti-CXCR3 neutralizing antibody (αCXCR3) therapy could relieve the clinical manifestations and pathological damage and improve the survival rate of CVA2-infected mice. Additionally, αCXCR3 treatment reduced viral loads and reversed the proinflammatory cytokine (IL-6, TNF-α, and IL-1β) expression, apoptosis, and inflammatory cell infiltration induced by CVA2. Collectively, our study presents the first evidence for the involvement of the CXCL10/CXCR3 axis in CVA2 pathogenesis. The activation of CXCL10/CXCR3 contributes to CVA2 pathogenesis via inducing apoptosis, proinflammatory cytokine expression, and inflammatory cell infiltration, which can be reversed by αCXCR3 therapy. This study provides new insight into the pathogenesis of HFMD, which has an important guiding significance for the treatment of HFMD.
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Xu J, Sun Z, Li W, Liu L, Gao F, Pan D. Epidemiological characteristics and cerebrospinal fluid cytokine profiles of enterovirus encephalitis in children in Hangzhou, China. J Med Virol 2021; 94:2645-2652. [PMID: 34862630 DOI: 10.1002/jmv.27504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 05/19/2021] [Accepted: 11/30/2021] [Indexed: 11/12/2022]
Abstract
Enteroviruses (EVs) are common causes of viral encephalitis in children. To better understand the epidemiological and pathological characteristics of EV encephalitis, we enrolled suspected encephalitis patients younger than 15 years old in Hangzhou, China, from October 2016 to September 2019 for cerebrospinal fluid (CSF) collection and analyses. A total of 7735 CSF samples were collected, among which 330 (4.27%) were positive for the EV genome. The positivity rate was significantly higher in boys than girls (χ2 = 5.68, p = 0.02). The monthly case numbers peaked from June to August (80.30%). Among the different age groups, the 0-2 months age group showed the highest number of cases (28.48% of all cases). The 6-7 years (10.82%) and 9-10 years (9.29%) age groups showed the highest EV-positivity rates among suspected encephalitis cases. Sixty-two EV-positive and 53 control CSF samples were collected for Bio-Plex Pro human cytokine assays that simultaneously tested 48 cytokines. Principle component analyses showed significant separation between EV-positive and control samples, but insignificant separation between children and newborns. The levels of 28 cytokines and chemokines were significantly elevated in the EV-positive group including many proinflammatory and a few anti-inflammatory cytokines, as well as chemokines belonging to the CC and CXC subfamilies. Only one cytokine, stem cell growth factor-β, showed a decrease in the EV-positive group. Thus, this study revealed age, sex, and seasonal preferences for EV encephalitis incidences in children and identified many cytokines dysregulated during EV encephalitis.
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Affiliation(s)
- Jialu Xu
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Zeyu Sun
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wei Li
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Lifang Liu
- Department of Dermatology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Feng Gao
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China
| | - Dongli Pan
- Department of Medical Microbiology and Parasitology, and Department of Infectious Diseases of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Yu Y, Luo Z, Jin W, Mai J, Qian S, Lu J, Wei Z, Meng S, Wang Z, Guan X, Tong Y, Shen S. Emergence of a novel recombinant of CV-A5 in HFMD epidemics in Xiangyang, China. BMC Med Genomics 2021; 14:279. [PMID: 34819054 PMCID: PMC8611921 DOI: 10.1186/s12920-021-01107-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background Hand, foot and mouth disease (HFMD) is caused by a variety of enterovirus serotypes and the etiological spectrum worldwide has changed since a large scale of outbreaks occurred in 1997. Methods A large number of clinical specimens of HFMD patients were collected in Xiangyang and genotyping was performed by qRT-PCR, conventional PCR amplification and sequencing. Among the 146 CV-A5 detected cases, the complete genome sequences of representative strains were determined for genotyping and for recombination analysis. Results It was found that CV-A5 was one of the six major serotypes that caused the epidemic from October 2016 to December 2017. Phylogenetic analyses based on the VP1 sequences showed that these CV-A5 belonged to the genotype D which dominantly circulated in China. Recombination occurred between the CV-A5 and CV-A2 strains with a breakpoint in the 2A region at the nucleotide 3791. Conclusions The result may explain the emergence of CV-A5 as one of the major pathogens of HFMD. A multivalent vaccine against HFMD is urgently needed to control the disease and to prevent emerging and spreading of new recombinants.
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Affiliation(s)
- Yuting Yu
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Zhiyu Luo
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Weiping Jin
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Jianyi Mai
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Shasha Qian
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Jia Lu
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Zhenni Wei
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Shengli Meng
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Zejun Wang
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Xuhua Guan
- Xiangyang Center for Disease Control and Prevention, Hubei, People's Republic of China.
| | - Yeqing Tong
- Xiangyang Center for Disease Control and Prevention, Hubei, People's Republic of China.
| | - Shuo Shen
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China.
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Ji W, Qin L, Tao L, Zhu P, Liang R, Zhou G, Chen S, Zhang W, Yang H, Duan G, Jin Y. Neonatal Murine Model of Coxsackievirus A2 Infection for the Evaluation of Antiviral Therapeutics and Vaccination. Front Microbiol 2021; 12:658093. [PMID: 34122374 PMCID: PMC8192712 DOI: 10.3389/fmicb.2021.658093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/30/2021] [Indexed: 01/08/2023] Open
Abstract
Coxsackievirus (CV) A2 has emerged as an important etiological agent in the pathogen spectrum of hand, foot, and mouth disease (HFMD). The symptoms of CVA2 infections are generally mild, but worsen rapidly in some people, posing a serious threat to children’s health. However, compared with enterovirus 71 detected frequently in fatal cases, limited attention has been paid to CVA2 infections because of its benign clinical course. In the present study, we identified three CVA2 strains from HFMD infections and used the cell-adapted CVA2 strain HN202009 to inoculate 5-day-old BALB/c mice intramuscularly. These mice developed remarkably neurological symptoms such as ataxia, hind-limb paralysis, and death. Histopathological determination showed neuronophagia, pulmonary hemorrhage, myofiberlysis and viral myocarditis. Viral replication was detected in multiple organs and tissues, and CVA2 exhibited strong tropism to muscle tissue. The severity of illness was associated with abnormally high levels of inflammatory cytokines, including interleukin (IL)-6, IL-10, tumor necrosis factor α, and monocyte chemotactic protein 1, although the blockade of these proinflammatory cytokines had no obvious protection. We also tested whether an experimental formaldehyde-inactivated CVA2 vaccine could induce protective immune response in adult mice. The CVA2 antisera from the vaccinated mice were effective against CVA2 infection. Moreover, the inactivated CVA2 vaccine could successfully generate immune protection in neonatal mice. Our results indicated that the neonatal mouse model could be a useful tool to study CVA2 infection and to develop CVA2 vaccines.
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Affiliation(s)
- Wangquan Ji
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Luwei Qin
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Ling Tao
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Peiyu Zhu
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ruonan Liang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Guangyuan Zhou
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Shuaiyin Chen
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Weiguo Zhang
- Department of Immunology, Duke University Medical Center, Durham, NC, United States
| | - Haiyan Yang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
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11
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Chen C, Jiang Q, Song Z, Li Y, Wang H, Lu Y, Wang D, Li M, Li T. Influence of temperature and humidity on hand, foot, and mouth disease in Guangzhou, 2013-2017. J Int Med Res 2021; 48:300060520929895. [PMID: 32527174 PMCID: PMC7446274 DOI: 10.1177/0300060520929895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective To explore associations between temperature, humidity and hand, foot and mouth disease (HFMD) incidence in Guangzhou, China from 2013 to 2017. Methods A distributed lag non-linear model was applied to estimate the effects of daily temperature and humidity on HFMD incidence after adjusting for long-term trends, seasonal trends, and day of the week. Results In total, 353,431 confirmed HFMD cases were reported in Guangzhou over the study period. A bimodal seasonal pattern was observed. High temperatures had acute short-term effects on HFMD incidence that declined quickly over time. The effects of low humidity declined over lag periods, but increased when the humidity surpassed 60.5%. Temperature and humidity were both inversely associated with HFMD incidence during lag days 0 to 3 and with lag periods Conclusions Temperature and humidity play important roles in HFMD incidence. These data are important for developing public health strategies.
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Affiliation(s)
- Chun Chen
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Qinqin Jiang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Zhuangzhi Song
- Center for Disease Control and Prevention of Inner Mongolia Autonomous Region, Hohhot, Inner Mongolia Autonomous Region, China
| | - Yilan Li
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Hui Wang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Ying Lu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Dahu Wang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Meixia Li
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Tiegang Li
- Guangzhou Chest Hospital, Guangzhou, Guangdong, China
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12
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Wiatr M, Figueiredo R, Stump-Guthier C, Winter P, Ishikawa H, Adams O, Schwerk C, Schroten H, Rudolph H, Tenenbaum T. Polar Infection of Echovirus-30 Causes Differential Barrier Affection and Gene Regulation at the Blood-Cerebrospinal Fluid Barrier. Int J Mol Sci 2020; 21:E6268. [PMID: 32872518 PMCID: PMC7503638 DOI: 10.3390/ijms21176268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/26/2020] [Accepted: 08/26/2020] [Indexed: 12/13/2022] Open
Abstract
Echovirus-30 (E-30) is responsible for the extensive global outbreaks of meningitis in children. To gain access to the central nervous system, E-30 first has to cross the epithelial blood-cerebrospinal fluid barrier. Several meningitis causing bacteria preferentially infect human choroid plexus papilloma (HIBCPP) cells in a polar fashion from the basolateral cell side. Here, we investigated the polar infection of HIBCPP cells with E-30. Both apical and basolateral infections caused a significant decrease in the transepithelial electrical resistance of HIBCPP cells. However, to reach the same impact on the barrier properties, the multiplicity of infection of the apical side had to be higher than that of the basolateral infection. Furthermore, the number of infected cells at respective time-points after basolateral infection was significantly higher compared to apical infection. Cytotoxic effects of E-30 on HIBCPP cells during basolateral infection were observed following prolonged infection and appeared more drastically compared to the apical infection. Gene expression profiles determined by massive analysis of cDNA ends revealed distinct regulation of specific genes depending on the side of HIBCPP cells' infection. Altogether, our data highlights the polar effects of E-30 infection in a human in vitro model of the blood-cerebrospinal fluid barrier leading to central nervous system inflammation.
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Affiliation(s)
- Marie Wiatr
- Pediatric Infectious Diseases, University Children’s Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; or (C.S.-G.); (C.S.); (H.S.); or
| | - Ricardo Figueiredo
- GenXpro GmbH, 60438 Frankfurt am Main, Germany; (R.F.); (P.W.)
- Johann Wolfgang Goethe University Frankfurt, 60438 Frankfurt Am Main, Germany
| | - Carolin Stump-Guthier
- Pediatric Infectious Diseases, University Children’s Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; or (C.S.-G.); (C.S.); (H.S.); or
| | - Peter Winter
- GenXpro GmbH, 60438 Frankfurt am Main, Germany; (R.F.); (P.W.)
| | - Hiroshi Ishikawa
- Department of Clinical Regenerative Medicine, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tennodai, Tsukuba, Ibaraki 305-0005, Japan;
| | - Ortwin Adams
- Institute for Virology, Heinrich Heine University, 40225 Düsseldorf, Germany;
| | - Christian Schwerk
- Pediatric Infectious Diseases, University Children’s Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; or (C.S.-G.); (C.S.); (H.S.); or
| | - Horst Schroten
- Pediatric Infectious Diseases, University Children’s Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; or (C.S.-G.); (C.S.); (H.S.); or
| | - Henriette Rudolph
- Pediatric Infectious Diseases, University Children’s Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; or (C.S.-G.); (C.S.); (H.S.); or
| | - Tobias Tenenbaum
- Pediatric Infectious Diseases, University Children’s Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany; or (C.S.-G.); (C.S.); (H.S.); or
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13
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Zhou Y, Van Tan L, Luo K, Liao Q, Wang L, Qiu Q, Zou G, Liu P, Anh NT, Hong NTT, He M, Wei X, Yu S, Lam TTY, Cui J, van Doorn HR, Yu H. Genetic Variation of Multiple Serotypes of Enteroviruses Associated with Hand, Foot and Mouth Disease in Southern China. Virol Sin 2020; 36:61-74. [PMID: 32725479 PMCID: PMC7385209 DOI: 10.1007/s12250-020-00266-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 07/06/2020] [Indexed: 12/04/2022] Open
Abstract
Enteroviruses (EVs) species A are a major public health issue in the Asia–Pacific region and cause frequent epidemics of hand, foot and mouth disease (HFMD) in China. Mild infections are common in children; however, HFMD can also cause severe illness that affects the central nervous system. To molecularly characterize EVs, a prospective HFMD virological surveillance program was performed in China between 2013 and 2016. Throat swabs, rectal swabs and stool samples were collected from suspected HFMD patients at participating hospitals. EVs were detected using generic real-time and nested reverse transcription-polymerase chain reactions (RT-PCRs). Then, the complete VP1 regions of enterovirus A71 (EV-A71), coxsackievirus A16 (CVA16) and CVA6 were sequenced to analyze amino acid changes and construct a viral molecular phylogeny. Of the 2836 enrolled HFMD patients, 2,517 (89%) were EV positive. The most frequently detected EVs were CVA16 (32.5%, 819), CVA6 (31.2%, 785), and EV-A71 (20.4%, 514). The subgenogroups CVA16_B1b, CVA6_D3a and EV-A71_C4a were predominant in China and recombination was not observed in the VP1 region. Sequence analysis revealed amino acid variations at the 30, 29 and 44 positions in the VP1 region of EV-A71, CVA16 and CVA6 (compared to the respective prototype strains BrCr, G10 and Gdula), respectively. Furthermore, in 21 of 24 (87.5%) identified EV-A71 samples, a known amino acid substitution (D31N) that may enhance neurovirulence was detected. Our study provides insights about the genetic characteristics of common HFMD-associated EVs. However, the emergence and virulence of the described mutations require further investigation.
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Affiliation(s)
- Yonghong Zhou
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam
| | - Kaiwei Luo
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410005, China
| | - Qiaohong Liao
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China.,Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, 102206, China
| | - Lili Wang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Qi Qiu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China
| | - Gang Zou
- Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, 200032, China
| | - Ping Liu
- Anhua County Center for Disease Control and Prevention, Anhua, 413000, China
| | - Nguyen To Anh
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam
| | | | - Min He
- Anhua County Center for Disease Control and Prevention, Anhua, 413000, China
| | - Xiaoman Wei
- CAS Key Laboratory of Special Pathogens and Biosafety, Center for Emerging Infectious Diseases, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Shuanbao Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, 102206, China
| | - Tommy Tsan-Yuk Lam
- Centre of Influenza Research & State Key Laboratory of Emerging Infectious Diseases, School of Public Health, The University of Hong Kong, Hong Kong SAR, 999077, China
| | - Jie Cui
- CAS Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, 200032, China
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City, 700000, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7DQ, UK
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, 200032, China.
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14
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Heinimäki S, Hankaniemi MM, Sioofy-Khojine AB, Laitinen OH, Hyöty H, Hytönen VP, Vesikari T, Blazevic V. Combination of three virus-derived nanoparticles as a vaccine against enteric pathogens; enterovirus, norovirus and rotavirus. Vaccine 2019; 37:7509-7518. [DOI: 10.1016/j.vaccine.2019.09.072] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/23/2019] [Accepted: 09/20/2019] [Indexed: 12/21/2022]
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15
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Suresh S, Rawlinson WD, Andrews PI, Stelzer‐Braid S. Global epidemiology of nonpolio enteroviruses causing severe neurological complications: A systematic review and meta‐analysis. Rev Med Virol 2019; 30:e2082. [DOI: 10.1002/rmv.2082] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Sarika Suresh
- Melbourne Medical SchoolUniversity of Melbourne Parkville Australia
- Virology Research LaboratoryPrince of Wales Hospital Randwick Australia
| | - William D. Rawlinson
- Virology Research LaboratoryPrince of Wales Hospital Randwick Australia
- School of Medical Sciences, and School of Women's and Children's Health, Faculty of Medicine, and School of Biotechnology and Biomolecular Sciences, Faculty of ScienceUniversity of New South Wales Sydney Australia
- Serology and Virology Division (SAViD)Microbiology NSW Health Pathology Randwick Australia
| | - Peter Ian Andrews
- School of Medical Sciences, and School of Women's and Children's Health, Faculty of Medicine, and School of Biotechnology and Biomolecular Sciences, Faculty of ScienceUniversity of New South Wales Sydney Australia
- Department of Paediatric NeurologySydney Children's Hospital Randwick Australia
| | - Sacha Stelzer‐Braid
- Virology Research LaboratoryPrince of Wales Hospital Randwick Australia
- School of Medical Sciences, and School of Women's and Children's Health, Faculty of Medicine, and School of Biotechnology and Biomolecular Sciences, Faculty of ScienceUniversity of New South Wales Sydney Australia
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16
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Ko Y, Jeon W, Chae MK, Yang H, Lee J. Clinical characteristics of enteroviral meningitis without pleocytosis in children: a retrospective single center observational study in the Republic of Korea. BMC Pediatr 2019; 19:335. [PMID: 31521164 PMCID: PMC6744706 DOI: 10.1186/s12887-019-1714-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/09/2019] [Indexed: 12/02/2022] Open
Abstract
Background We aimed to study the prevalence of enterovirus (EV) meningitis without the presence of cerebrospinal fluid (CSF) pleocytosis and identify patient factors and clinical features associated with it. Methods This was a retrospective analysis of patients aged < 18 years old who were diagnosed with EV meningitis by CSF reverse-transcriptase polymerase chain reaction (RT-PCR) testing between January 2015 and December 2016. Clinical variables were compared with regard to the presence of CSF pleocytosis. Results A total of 305 patients were enrolled in study; 169 (55.4%) had no pleocytosis. Patients without pleocytosis were younger (median age 2 months vs. 67.0 months, p < 0.01) and had lower white blood cell (WBC) count (median, 8600/mm3 vs. 10,300/mm3, p < 0.01). Also absolute neutrophil (ANC) count were lower than pleocytosis group (median, 4674/mm3 vs. 7600/mm3, p < 0.01). Comparing three age groups, CSF apleocytosis was present in 106 of 128 patients (82.8%) aged ≤3 months, 7 of 13 patients (53.8%) aged 3 months–3 years and 56 of 164 patients (34.1%) aged > 3 years. Younger age groups had higher prevalence of CSF apleocytosis (p < 0.01). In patients aged ≤3 months, 94.5% underwent lumbar puncture within 24 h of symptom onset. The frequency of not having pleocytosis was higher than the frequency of having pleocytosis during peak EV infection prevalent months (summer and fall) (p < 0.01). Conclusion This study shows that EV meningitis in young infants, with early lumbar puncture, or occurring during peak EV meningitis prevalent seasons cannot be solely excluded by pleocytosis. Also, a confirmation test for EV meningitis should be performed using RT-PCR.
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Affiliation(s)
- Yura Ko
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Woochan Jeon
- Department of Emergency Medicine, Inje University, Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Minjung Kathy Chae
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Heewon Yang
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jisook Lee
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
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17
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Song JH, Ahn JH, Kim SR, Cho S, Hong EH, Kwon BE, Kim DE, Choi M, Choi HJ, Cha Y, Chang SY, Ko HJ. Manassantin B shows antiviral activity against coxsackievirus B3 infection by activation of the STING/TBK-1/IRF3 signalling pathway. Sci Rep 2019; 9:9413. [PMID: 31253850 PMCID: PMC6599049 DOI: 10.1038/s41598-019-45868-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/04/2019] [Indexed: 11/27/2022] Open
Abstract
Coxsackievirus B3 (CVB3) is an important human pathogen associated with the development of acute pancreatitis, myocarditis, and type 1 diabetes. Currently, no vaccines or antiviral therapeutics are approved for the prevention and treatment of CVB3 infection. We found that Saururus chinensis Baill extract showed critical antiviral activity against CVB3 infection in vitro. Further, manassantin B inhibited replication of CVB3 and suppressed CVB3 VP1 protein expression in vitro. Additionally, oral administration of manassantin B in mice attenuated CVB3 infection-associated symptoms by reducing systemic production of inflammatory cytokines and chemokines including TNF-α, IL-6, IFN-γ, CCL2, and CXCL-1. We found that the antiviral activity of manassantin B is associated with increased levels of mitochondrial ROS (mROS). Inhibition of mROS generation attenuated the antiviral activity of manassantin B in vitro. Interestingly, we found that manassantin B also induced cytosolic release of mitochondrial DNA based on cytochrome C oxidase DNA levels. We further confirmed that STING and IRF-3 expression and STING and TBK-1 phosphorylation were increased by manassantin B treatment in CVB3-infected cells. Collectively, these results suggest that manassantin B exerts antiviral activity against CVB3 through activation of the STING/TKB-1/IRF3 antiviral pathway and increased production of mROS.
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Affiliation(s)
- Jae-Hyoung Song
- College of Pharmacy, Kangwon National University, Chuncheon, South Korea
| | - Jae-Hee Ahn
- College of Pharmacy, Kangwon National University, Chuncheon, South Korea
| | - Seong-Ryeol Kim
- College of Pharmacy, Kangwon National University, Chuncheon, South Korea
| | - Sungchan Cho
- Anticancer Agent Research Center, Korea Research Institute of Bioscience & Biotechnology, Ochang, South Korea
| | - Eun-Hye Hong
- College of Pharmacy, Kangwon National University, Chuncheon, South Korea
| | - Bo-Eun Kwon
- College of Pharmacy, Kangwon National University, Chuncheon, South Korea
| | - Dong-Eun Kim
- Anticancer Agent Research Center, Korea Research Institute of Bioscience & Biotechnology, Ochang, South Korea
| | - Miri Choi
- Anticancer Agent Research Center, Korea Research Institute of Bioscience & Biotechnology, Ochang, South Korea
| | - Hwa-Jung Choi
- Department of Beauty Science, Kwangju Women's University, Gwangju, South Korea
| | - Younggil Cha
- College of Pharmacy, Kangwon National University, Chuncheon, South Korea
| | - Sun-Young Chang
- Research Institute of Pharmaceutical Science and Technology (RIPST), College of Pharmacy, Ajou University, Suwon, South Korea.
| | - Hyun-Jeong Ko
- College of Pharmacy, Kangwon National University, Chuncheon, South Korea.
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Joshi YP, Kim JH, Kim H, Cheong HK. Impact of Drinking Water Quality on the Development of Enteroviral Diseases in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112551. [PMID: 30441791 PMCID: PMC6266091 DOI: 10.3390/ijerph15112551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 01/02/2023]
Abstract
Enterovirus diseases are fecal-orally transmitted, and its transmission may be closely related with the drinking water quality and other environmental factors. This study aimed to assess the association between environmental factors including drinking water quality and the incidence of enteroviral diseases in metropolitan provinces of Korea. Using monthly number of hand-foot-mouth disease (HFMD), aseptic meningitis (AM) and acute hemorrhage conjunctivitis (AHC) cases, generalized linear Poisson model was applied to estimate the effects of environmental factors on the monthly cases. An increase of mean temperature was associated with an increase of enteroviral diseases at 0–2 months lag, while an increase of turbidity was associated with increase in HFMD at 1 month lag and a decrease in AHC. An increase of residual chlorine in municipal drinking water was associated with a decrease in HFMD and AHC 2 and 3 months later. An increase of pH was associated with a maximum increase in AM 3 months later. The meta-analysis revealed the effects of the provincial and pooled variation in percent change of risks of environmental factors on HFMD, AM, and AHC cases at specific selected lags. This study suggests that the drinking water quality is one of the major determinants on enteroviral diseases.
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Affiliation(s)
- Yadav P Joshi
- Department of Social and Preventive Medicine, School of Medicine, Sungkyunkwan University, Suwon 440-746, Korea.
- Department of Public Health, Manmohan Memorial Institute of Health Sciences, Kathmandu 44613, Nepal.
- Asian College for Advance Studies, Lalitpur 44700, Nepal.
| | - Jong-Hun Kim
- Department of Social and Preventive Medicine, School of Medicine, Sungkyunkwan University, Suwon 440-746, Korea.
| | - Ho Kim
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, and Institute of Public Health and Environment, Seoul National University, Seoul 08826, Korea.
| | - Hae-Kwan Cheong
- Department of Social and Preventive Medicine, School of Medicine, Sungkyunkwan University, Suwon 440-746, Korea.
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Sun Y, Miao Z, Yan J, Gong L, Chen Y, Chen Y, Mao H, Zhang Y. Sero-molecular epidemiology of enterovirus-associated encephalitis in Zhejiang Province, China, from 2014 to 2017. Int J Infect Dis 2018; 79:58-64. [PMID: 30423458 DOI: 10.1016/j.ijid.2018.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/02/2018] [Accepted: 11/03/2018] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Recently, both sporadic and outbreak aseptic meningitis caused by enteroviruses have been reported in Zhejiang Province based on a surveillance system. METHODS This study analysed the epidemiologic features, phylogenetic characteristics and prevalence of enterovirus neutralizing antibodies (nAbs) from 2014 to 2017 in Zhejiang Province. RESULTS A total of 584 samples were collected. Males accounted for 66.07% while females accounted for 33.93%. The median age was 6 years (range: 1-15 years). Cases peaked in May and August (81.17%) and 162 cases (28.93%) occurred in June. We detected 15 serotypes, some of which (E6, E9, E18 and E30) were the dominant serotypes prevalent in different years and geographical regions. Phylogenetic results revealed that all of the isolates from this study belonged to the human enterovirus B family. A total of 329 subjects sampled from a healthy population were tested for nAbs against B5, E6 and E30 in Rui'an county in 2015. The seropositive rate of E30 in each age group was significantly higher than that of the other serotypes. CONCLUSION Enterovirus-associated encephalitis pathogens circulating in Zhejiang caused sporadic aseptic meningitis in children. The level of nAbs against human enterovirus reflects the history of previous infections in different age groups. Therefore, additional surveillance sites and more precise seroprevalence studies based on these populations are required to gain better insight into the epidemiology of enterovirus-associated encephalitis in Zhejiang Province.
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Affiliation(s)
- Yi Sun
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, People's Republic of China
| | - ZiPing Miao
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, People's Republic of China
| | - JuYing Yan
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, People's Republic of China.
| | - LiMing Gong
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, People's Republic of China
| | - Yin Chen
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, People's Republic of China
| | - YiJuan Chen
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, People's Republic of China
| | - HaiYan Mao
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, People's Republic of China
| | - YanJun Zhang
- Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, People's Republic of China
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20
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Gao F, Bian L, Hao X, Hu Y, Yao X, Sun S, Chen P, Yang C, Du R, Li J, Zhu F, Mao Q, Liang Z. Seroepidemiology of coxsackievirus B5 in infants and children in Jiangsu province, China. Hum Vaccin Immunother 2017; 14:74-80. [PMID: 29049009 DOI: 10.1080/21645515.2017.1384107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Coxsackievirus B5 (CV-B5) is associated with various human diseases such as viral encephalitis, aseptic meningitis, paralysis, herpangina, and hand, foot and mouth disease (HFMD). However, there is currently no effective vaccine against CV-B5.The seroepidemiologic characteristics of CV-B5 remained unknown. A cohort study was carried out in 176 participants aged 6-35 months from January 2012 to January 2014. The serum samples were collected and tested for CV-B5 neutralizing antibodies (NtAbs) four times during these two years. The confirmed enterovirus cases were recorded through the surveillance system, and their throat or rectal swabs were collected for pathogen detection. According to the changes of CV-B5 NtAbs, two CV-B5 epidemics were detected among these participants during the two-year follow-up. Sixty-seven cases out of all participants had seroconversion in CV-B5 NtAbs. During the first epidemic from March 2012 to September 2012, CV-B5 seropositivity rate increased significantly (6.8%, 12/176 vs. 21.6%, 38/176, P = 0.000). The seroconversion rate and geometric mean fold-increase (GMFI) were 18.2% (32/176) and 55.7, respectively; During the second epidemic from September 2012 to January 2014, CV-B5 seropositivity rate also increased (21.6%, 38/176 vs. 38.6%, 68/176, P = 0.000), and the seroconversion rate and GMFI were 19.9% (35/176) and 46.5, respectively. Only one case had CV-B5 associated HFMD during the two-year follow-up, and CV-B5 from the throat swab isolate was GI.D3 subtype, which belonged to the major pandemic strain in mainland China. CV-B5 infection was common in infants and children in Jiangsu province, China. Therefore, it's necessary to strengthen the surveillance on CV-B5 and to understand the epidemic characteristics of CV-B5 infection.
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Affiliation(s)
- Fan Gao
- a Division Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , P. R. China
| | - Lianlian Bian
- a Division Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , P. R. China
| | - Xiaotian Hao
- a Division Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , P. R. China
| | - Yalin Hu
- b Hualan Biological Engineering Inc , Xinxiang , Henan , P. R. China
| | - Xin Yao
- a Division Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , P. R. China
| | - Shiyang Sun
- a Division Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , P. R. China
| | - Pan Chen
- a Division Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , P. R. China
| | - Ce Yang
- a Division Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , P. R. China
| | - Ruixiao Du
- a Division Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , P. R. China
| | - Jingxin Li
- c Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , Jiangsu , P. R. China
| | - Fengcai Zhu
- c Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , Jiangsu , P. R. China
| | - Qunying Mao
- a Division Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , P. R. China
| | - Zhenglun Liang
- a Division Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , P. R. China
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Chen P, Wu X, Su Y, Hao X, Mao Q, Liang Z. Development of a pseudovirus based assay for measuring neutralizing antibodies against coxsackievirus B5. J Virol Methods 2017; 246:21-26. [PMID: 28435072 PMCID: PMC7113871 DOI: 10.1016/j.jviromet.2017.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 04/15/2017] [Accepted: 04/16/2017] [Indexed: 11/29/2022]
Abstract
Coxsackievirus B5 (CV-B5), an important Coxsackie B virus from genus Enteroviruse within the family Picornaviridae, has also been isolated from Hand, Foot, and Mouth Disease (HFMD) patients, and often associated with neurological manifestations. In this study, we found out that Coxsackievirus B3 (CV-B3) replicon RNA could be encapsidated with CV-B5 capsid to assemble infectious CV-B5 pseudovirus. We then utilized this single round infection system of CV-B5 to develop a neutralizing antibody quantification assay. This pseudovirus neutralization assay showed superiority in biosafety, sensibility, quantitativity, efficiency and high throughput, and would facilitate the epidemiological studies and vaccine development of CV-B5.
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Affiliation(s)
- Pan Chen
- Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences, Beijing 100050, China; National Institutes for Food and Drug Control, Beijing 100050, China
| | - Xing Wu
- National Institutes for Food and Drug Control, Beijing 100050, China
| | - Yao Su
- National Institutes for Food and Drug Control, Beijing 100050, China
| | - Xiaotian Hao
- National Institutes for Food and Drug Control, Beijing 100050, China
| | - Qunying Mao
- National Institutes for Food and Drug Control, Beijing 100050, China
| | - Zhenglun Liang
- National Institutes for Food and Drug Control, Beijing 100050, China.
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22
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Benschop KSM, Rahamat-Langendoen JC, van der Avoort HGAM, Claas ECJ, Pas SD, Schuurman R, Verweij JJ, Wolthers KC, Niesters HGM, Koopmans MPG. VIRO-TypeNed, systematic molecular surveillance of enteroviruses in the Netherlands between 2010 and 2014. ACTA ACUST UNITED AC 2017; 21:30352. [PMID: 27719752 PMCID: PMC5069426 DOI: 10.2807/1560-7917.es.2016.21.39.30352] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 05/23/2016] [Indexed: 12/29/2022]
Abstract
VIRO-TypeNed is a collaborative molecular surveillance platform facilitated through a web-based database. Genetic data in combination with epidemiological, clinical and patient data are shared between clinical and public health laboratories, as part of the surveillance underpinning poliovirus eradication. We analysed the combination of data submitted from 2010 to 2014 to understand circulation patterns of non-polio enteroviruses (NPEV) of public health relevance. Two epidemiological patterns were observed based on VIRO-TypeNed data and classical surveillance data dating back to 1996: (i) endemic cyclic, characterised by predictable upsurges/outbreaks every two to four years, and (ii) epidemic, where rare virus types caused upsurges/outbreaks. Genetic analysis suggests continuous temporal displacement of virus lineages due to the accumulation of (silent) genetic changes. Non-synonymous changes in the antigenic B/C loop suggest antigenic diversification, which may affect population susceptibility. Infections were frequently detected at an age under three months and at an older, parenting age (25–49 years) pointing to a distinct role of immunity in the circulation patterns. Upsurges were detected in the summer and winter which can promote increased transmissibility underlying new (cyclic) upsurges and requires close monitoring. The combination of data provide a better understanding of NPEV circulation required to control and curtail upsurges and outbreaks.
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Affiliation(s)
- Kimberley S M Benschop
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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Koh WM, Bogich T, Siegel K, Jin J, Chong EY, Tan CY, Chen MIC, Horby P, Cook AR. The Epidemiology of Hand, Foot and Mouth Disease in Asia: A Systematic Review and Analysis. Pediatr Infect Dis J 2016; 35:e285-300. [PMID: 27273688 PMCID: PMC5130063 DOI: 10.1097/inf.0000000000001242] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 12/22/2022]
Abstract
CONTEXT Hand, foot and mouth disease (HFMD) is a widespread pediatric disease caused primarily by human enterovirus 71 (EV-A71) and Coxsackievirus A16 (CV-A16). OBJECTIVE This study reports a systematic review of the epidemiology of HFMD in Asia. DATA SOURCES PubMed, Web of Science and Google Scholar were searched up to December 2014. STUDY SELECTION Two reviewers independently assessed studies for epidemiologic and serologic information about prevalence and incidence of HFMD against predetermined inclusion/exclusion criteria. DATA EXTRACTION Two reviewers extracted answers for 8 specific research questions on HFMD epidemiology. The results are checked by 3 others. RESULTS HFMD is found to be seasonal in temperate Asia with a summer peak and in subtropical Asia with spring and fall peaks, but not in tropical Asia; evidence of a climatic role was identified for temperate Japan. Risk factors for HFMD include hygiene, age, gender and social contacts, but most studies were underpowered to adjust rigorously for confounding variables. Both community-level and school-level transmission have been implicated, but their relative importance for HFMD is inconclusive. Epidemiologic indices are poorly understood: No supporting quantitative evidence was found for the incubation period of EV-A71; the symptomatic rate of EV-A71/Coxsackievirus A16 infection was from 10% to 71% in 4 studies; while the basic reproduction number was between 1.1 and 5.5 in 3 studies. The uncertainty in these estimates inhibits their use for further analysis. LIMITATIONS Diversity of study designs complicates attempts to identify features of HFMD epidemiology. CONCLUSIONS Knowledge on HFMD remains insufficient to guide interventions such as the incorporation of an EV-A71 vaccine in pediatric vaccination schedules. Research is urgently needed to fill these gaps.
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Affiliation(s)
- Wee Ming Koh
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Tiffany Bogich
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Karen Siegel
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Jing Jin
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Elizabeth Y. Chong
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Chong Yew Tan
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Mark IC Chen
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Peter Horby
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Alex R. Cook
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
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24
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Zheng S, Ye H, Yan J, Xie G, Cui D, Yu F, Wang Y, Yang X, Zhou F, Zhang Y, Tian X, Chen Y. Laboratory diagnosis and genetic analysis of a family clustering outbreak of aseptic meningitis due to echovirus 30. Pathog Glob Health 2016; 110:233-237. [PMID: 27646838 DOI: 10.1080/20477724.2016.1228297] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Echovirus 30 (E30) is a major pathogen associated with aseptic meningitis. In the summer of 2014, a family clustering aseptic meningitis outbreak occurred in urban-rural fringe of Ningbo city in Zhejiang Province in China. To identify the etiologic agent, specimens were tested by cell culture and reverse transcriptase-polymerase chain reaction. Pathogenic examination confirmed that the outbreak is caused by E30. The first case is a 6-year-old child, who studied in kindergarten in local, suffered from headache and fever. Same symptoms appeared in his parents, aunts, and other six relatives continuously. Meanwhile, vomiting occurred in majority of the patients and diarrhea in parts of them. White blood cells in cerebrospinal fluid (CSF) exceeded normal range in all patients. Protein levels in CSF were above normal range in half of the patients. Glucose levels in CSF were within normal range in all patients. We isolated six strains E30 in the stool specimens of patients, and carried out sequencing analysis to VP1 region. Sequencing results showed that 100% sequence identity was seen in both nucleotide and amino acid levels. Phylogenetic analysis discovered that isolate in this study was grouped into sublineage D2 together with sequences isolated from other areas of China in the 2000s and 2010s. Our study is the first family clustering outbreak of aseptic meningitis caused by E30 in Zhejiang Province in China. It is essential to establish an enterovirus molecular surveillance system in China to prevent mass outbreaks in Zhejiang.
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Affiliation(s)
- Shufa Zheng
- a State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital , College of Medicine, Zhejiang University , Hangzhou , PR China.,b Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province , Hangzhou , PR China
| | - Hongyan Ye
- c Center of Clinical Laboratory , Ningbo Beilun People's Hospital , Ningbo , PR China
| | - Juying Yan
- d Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , PR China
| | - Guoliang Xie
- b Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province , Hangzhou , PR China
| | - Dawei Cui
- b Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province , Hangzhou , PR China
| | - Fei Yu
- b Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province , Hangzhou , PR China
| | - Yiyin Wang
- b Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province , Hangzhou , PR China
| | - Xianzhi Yang
- b Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province , Hangzhou , PR China
| | - Fangman Zhou
- c Center of Clinical Laboratory , Ningbo Beilun People's Hospital , Ningbo , PR China
| | - Yanjun Zhang
- d Zhejiang Provincial Center for Disease Control and Prevention , Hangzhou , PR China
| | - Xueli Tian
- a State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital , College of Medicine, Zhejiang University , Hangzhou , PR China
| | - Yu Chen
- a State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital , College of Medicine, Zhejiang University , Hangzhou , PR China.,b Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province , Hangzhou , PR China
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25
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Mao Q, Wang Y, Bian L, Xu M, Liang Z. EV-A71 vaccine licensure: a first step for multivalent enterovirus vaccine to control HFMD and other severe diseases. Emerg Microbes Infect 2016; 5:e75. [PMID: 27436364 PMCID: PMC5141264 DOI: 10.1038/emi.2016.73] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/25/2016] [Accepted: 05/02/2016] [Indexed: 01/17/2023]
Abstract
Enteroviruses (EVs) are the most common viral agents in humans. Although most infections are mild or asymptomatic, there is a wide spectrum of clinical manifestations that may be caused by EV infections with varying degrees of severity. Among these viruses, EV-A71 and coxsackievirus (CV) CV-A16 from group A EVs attract the most attention because they are responsible for hand, foot and mouth disease (HFMD). Other EV-A viruses such as CV-A6 and CV-A10 were also reported to cause HFMD outbreaks in several countries or regions. Group B EVs such as CV-B3, CV-B5 and echovirus 30 were reported to be the main pathogens responsible for myocarditis and encephalitis epidemics and were also detected in HFMD patients. Vaccines are the best tools to control infectious diseases. In December 2015, China's Food and Drug Administration approved two inactivated EV-A71 vaccines for preventing severe HFMD.The CV-A16 vaccine and the EV-A71-CV-A16 bivalent vaccine showed substantial efficacy against HFMD in pre-clinical animal models. Previously, research on EV-B group vaccines was mainly focused on CV-B3 vaccine development. Because the HFMD pathogen spectrum has changed, and the threat from EV-B virus-associated severe diseases has gradually increased, it is necessary to develop multivalent HFMD vaccines. This study summarizes the clinical symptoms of diseases caused by EVs, such as HFMD, myocarditis and encephalitis, and the related EV vaccine development progress. In conclusion, developing multivalent EV vaccines should be strongly recommended to prevent HFMD, myocarditis, encephalitis and other severe diseases.
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Affiliation(s)
- Qunying Mao
- National Institutes for Food and Drug Control, Beijing 100050, China
| | - Yiping Wang
- National Institutes for Food and Drug Control, Beijing 100050, China
| | - Lianlian Bian
- National Institutes for Food and Drug Control, Beijing 100050, China
| | - Miao Xu
- National Institutes for Food and Drug Control, Beijing 100050, China
| | - Zhenglun Liang
- National Institutes for Food and Drug Control, Beijing 100050, China
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26
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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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27
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Klein M, Chong P. Is a multivalent hand, foot, and mouth disease vaccine feasible? Hum Vaccin Immunother 2015; 11:2688-704. [PMID: 26009802 DOI: 10.1080/21645515.2015.1049780] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Enterovirus A infections are the primary cause of hand, foot and mouth disease (HFMD) in infants and young children. Although enterovirus 71 (EV-A71) and coxsackievirus A16 (CV-A16) are the predominant causes of HFMD epidemics worldwide, EV-A71 has emerged as a major neurovirulent virus responsible for severe neurological complications and fatal outcomes. HFMD is a serious health threat and economic burden across the Asia-Pacific region. Inactivated EV-A71 vaccines have elicited protection against EV-A71 but not against CV-A16 infections in large efficacy trials. The current development of a bivalent inactivated EV-A71/CV-A16 vaccine is the next step toward that of multivalent HFMD vaccines. These vaccines should ultimately include other prevalent pathogenic coxsackieviruses A (CV-A6 and CV-A10), coxsackieviruses B (B3 and B5) and echovirus 30 that often co-circulate during HFMD epidemics and can cause severe HFMD, aseptic meningitis and acute viral myocarditis. The prospect and challenges for the development of such multivalent vaccines are discussed.
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Affiliation(s)
| | - Pele Chong
- b Vaccine R&D Center; National Health Research Institutes ; Zhunan Town, Miaoli County , Taiwan.,c Graduate Institute of Immunology; China Medical University ; Taichung , Taiwan
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28
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Jeon JS, Kim JK, Yu J, Kim JW. Epidemic Trends of Enterovirus Infections From Pediatric Patients in Cheonan, Korea. J Clin Lab Anal 2014; 30:161-4. [PMID: 25425450 DOI: 10.1002/jcla.21830] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 10/29/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study was performed to investigate the epidemiology of enterovirus (EV) infections in children at a single hospital during recent 5 years. This study was preformed from December 2008 to November 2013. METHODS We subjected 1,067 cerebrospinal fluid (CSF) specimens from 1,053 patients and 678 stool specimens from 665 patients using real-time reverse-transcription polymerase chain reaction tests that could detect EV. The data were analyzed according to seasonality and patient age and sex. RESULTS During this period, 176 of the total 1,053 patients (16.81%) were positive for EV in CSF. The highest rate of EV-positive samples occurred in children less than 1 year of age (114/176, 64.77%), and the most prevalent month was June. The results for CSF and stool specimens were concordant in 545 (80.38%) of 678 cases. CONCLUSION We described the epidemiological analytic data of the EV in the population of Cheonan, South Korea. The combination of the CSF and stool specimen enhances the diagnostic yield. There is a need for continuous study of EV infections and its clinical manifestations.
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Affiliation(s)
- Jae-Sik Jeon
- Department of Laboratory Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Jae Kyung Kim
- Department of Laboratory Medicine, Dankook University Hospital, Cheonan, Korea
| | - Jeesuk Yu
- Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea
| | - Jong Wan Kim
- Department of Laboratory Medicine, Dankook University College of Medicine, Cheonan, Korea
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29
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Puenpa J, Mauleekoonphairoj J, Linsuwanon P, Suwannakarn K, Chieochansin T, Korkong S, Theamboonlers A, Poovorawan Y. Prevalence and characterization of enterovirus infections among pediatric patients with hand foot mouth disease, herpangina and influenza like illness in Thailand, 2012. PLoS One 2014; 9:e98888. [PMID: 24887237 PMCID: PMC4041783 DOI: 10.1371/journal.pone.0098888] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 05/07/2014] [Indexed: 12/18/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) and herpangina are common infectious diseases caused by several genotypes of human enterovirus species A and frequently occurring in young children. This study was aimed at analyzing enteroviruses from patients with these diseases in Thailand in 2012. Detection and genotype determination of enteroviruses were accomplished by reverse transcription-polymerase chain reaction and sequencing of the VP1 region. Enterovirus-positive samples were differentiated into 17 genotypes (coxsackievirus A4 (CAV4), A5, A6, A8, A9, A10, A12, A16, A21, B1, B2, B4, B5, echovirus 7, 16, 25 and Enterovirus 71). The result showed CAV6 (33.5%), followed by CAV16 (9.4%) and EV71 (8.8%) as the most frequent genotypes in HFMD, CAV8 (19.3%) in herpangina and CAV6 (1.5%) in influenza like illness. Enterovirus infections were most prevalent during July with 34.4% in HFMD, 39.8% in herpangina and 1.6% in ILI. The higher enterovirus infection associated with HFMD and herpangina occurred in infants over one year-old. This represents the first report describing the circulation of multiple enteroviruses in Thailand.
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Affiliation(s)
- Jiratchaya Puenpa
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - John Mauleekoonphairoj
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Piyada Linsuwanon
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kamol Suwannakarn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thaweesak Chieochansin
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sumeth Korkong
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Apiradee Theamboonlers
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- * E-mail:
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30
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Clinical features of coxsackievirus A4, B3 and B4 infections in children. PLoS One 2014; 9:e87391. [PMID: 24504149 PMCID: PMC3913601 DOI: 10.1371/journal.pone.0087391] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 12/23/2013] [Indexed: 11/23/2022] Open
Abstract
Background Clinical features of coxsackievirus A4 (CA4), B3 (CB3) and B4 (CB4) infections in children have not been comprehensively described. Methods/Principal Findings From January 2004 to June 2012, a total of 386 children with culture-proven CA4, CB3 and CB4 infections treated at Chang Gung Memorial Hospital, including 296 inpatients (CA4, 103; CB3, 131; CB4, 62) and 90 outpatients (CA4, 55; CB3, 14; CB4, 21), were included. From outpatients, only demographics were extracted and from inpatients, detailed clinical and laboratory data were collected retrospectively. The mean age was 32.1±30.2 months; male to female ratio was 1.3∶1. Children with CB3 infection were youngest (76.6% <3 years of age), and had a highest hospitalization rate (90.3%) and a longest duration of hospitalization (mean ± SD, 7.5±6.2 days). Herpangina (74.8%) was the most common presentation for children with CA4 infection, aseptic meningitis (26.7%) and young infant with fever (23.7%) for those with CB3 infection, and herpangina (32.3%) and tonsillitis/pharyngitis (27.4%) for children with CB4 infection. Almost all the inpatients had fever (97.6%). Twelve out of thirteen (92.3%) children with complications and ten of 11 children with long-term sequelae had CB3 infections. Two fatal cases were noted, one due to myocarditis with CA4 infection and CB3 were detected from the other case which had hepatic necrosis with coagulopathy. The remaining 285 children (96.3%) recovered uneventfully. Conclusion CA4, CB3 and CB4 infections in children had different clinical disease spectrums and involved different age groups. Though rare, severe diseases may occur, particularly caused by CB3.
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Takamatsu Y, Uchida L, Nga PT, Okamoto K, Nabeshima T, Thao DTT, Hai DT, Tuyet NT, Duc HM, Luat LX, Hasebe F, Morita K. An approach for differentiating echovirus 30 and Japanese encephalitis virus infections in acute meningitis/encephalitis: a retrospective study of 103 cases in Vietnam. Virol J 2013; 10:280. [PMID: 24025733 PMCID: PMC3847169 DOI: 10.1186/1743-422x-10-280] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 09/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent decades, Echovirus 30 (E30) and Japanese encephalitis virus (JEV) have been reported to be the common causative agents of acute meningitis among patients in South East Asia. An E30 outbreak in Vietnam in 2001-2002 gained our interest because the initial clinical diagnosis of infected patients was due to JEV infection. There are few clinical insights regarding E30 cases, and there are no reports comparing E30 and JEV acute meningitis/encephalitis cases based on clinical symptoms and case histories. We therefore aimed to identify reliable clinical methods to differentiate E30 and JEV acute meningitis/encephalitis. METHODS A retrospective, cross-sectional study was conducted to compare E30 and JEV acute meningitis/encephalitis cases. We collected and analyzed the clinical records of 43 E30 confirmed cases (E30 group) and 60 JEV confirmed cases (JEV group). Clinical data were compared between the E30 and the JEV groups. Differences of clinical parameters were analyzed by certain statistical tests. RESULTS Fever, headache, and vomiting were the most common symptoms in both the E30 and the JEV groups. Combined symptoms of headache and vomiting and the triad of symptoms of fever, headache, and vomiting were observed in more patients in the E30 group (E30 vs. JEV: 19% vs. 0%, p < 0.001; 74% vs. 27%, p < 0.001, respectively). On the other hand, strong neurological symptoms such as seizure (5% vs. 73%, p < 0.001) and altered consciousness (12% vs. 97%, p < 0.001) were manifested primarily in the JEV group. CSF leukocytosis was observed predominantly in the E30 group (80 vs. 18 cells/μL, p = 0.003), whereas decreasing CSF sugar level was observed predominantly in the JEV group (58.7 vs. 46.9 mg/dL, p < 0.001). CONCLUSION Fever, headache, vomiting, absence of neurological symptoms (seizure, altered consciousness), and presence of CSF leukocytosis are important parameters to consider in differentiating E30 from JEV cases during early infection. Then, proper measures can be adopted immediately to prevent the spread of the disease in the affected areas.
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Affiliation(s)
- Yuki Takamatsu
- Department of Virology, Institute of Tropical Medicine, Nagasaki University, 1-12-4, Sakamoto, 852-8523 Nagasaki, Japan.
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Phylogenetic patterns of human coxsackievirus B5 arise from population dynamics between two genogroups and reveal evolutionary factors of molecular adaptation and transmission. J Virol 2013; 87:12249-59. [PMID: 24006446 DOI: 10.1128/jvi.02075-13] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to gain insights into the tempo and mode of the evolutionary processes that sustain genetic diversity in coxsackievirus B5 (CVB5) and into the interplay with virus transmission. We estimated phylodynamic patterns with a large sample of virus strains collected in Europe by Bayesian statistical methods, reconstructed the ancestral states of genealogical nodes, and tested for selection. The genealogies estimated with the structural one-dimensional gene encoding the VP1 protein and nonstructural 3CD locus allowed the precise description of lineages over time and cocirculating virus populations within the two CVB5 clades, genogroups A and B. Strong negative selection shaped the evolution of both loci, but compelling phylogenetic data suggested that immune selection pressure resulted in the emergence of the two genogroups with opposed evolutionary pathways. The genogroups also differed in the temporal occurrence of the amino acid changes. The virus strains of genogroup A were characterized by sequential acquisition of nonsynonymous changes in residues exposed at the virus 5-fold axis. The genogroup B viruses were marked by selection of three changes in a different domain (VP1 C terminus) during its early emergence. These external changes resulted in a selective sweep, which was followed by an evolutionary stasis that is still ongoing after 50 years. The inferred population history of CVB5 showed an alternation of the prevailing genogroup during meningitis epidemics across Europe and is interpreted to be a consequence of partial cross-immunity.
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Pellegrinelli L, Binda S, Chiaramonte I, Primache V, Fiore L, Battistone A, Fiore S, Gambino M, Bubba L, Barbi M. Detection and distribution of culturable Human Enteroviruses through environmental surveillance in Milan, Italy. J Appl Microbiol 2013; 115:1231-9. [PMID: 23910458 DOI: 10.1111/jam.12321] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 07/05/2013] [Accepted: 07/28/2013] [Indexed: 12/22/2022]
Abstract
AIMS Human Enteroviruses (HEVs) infections have a significant impact on public health, being implicated in outbreaks of meningitis, encephalitis, hand-foot-mouth disease and other acute and chronic manifestation. In the strategic plan for poliomyelitis eradication, the environmental surveillance of poliovirus (PV) has been identified by the World Health Organization (WHO) as an activity that can complement the surveillance of polio. Having wastewater samples available for PV surveillance allows us to study nonpolio enteroviruses (NPEVs) circulating in the study population, which are widely spread. METHODS AND RESULTS This study was carried out according to the WHO guidelines for environmental surveillance of PV and analysed the circulation of PV and NPEVs through the isolation of viruses in cell cultures in Milan area; from 2006 to 2010, 321 wastewater samples were collected, regularly over time, at the inlet of three diverse waste water treatment plants (WWTPs). Culturable HEVs were isolated in 80% of sewage samples: all isolates belonged to the HEV-B group and those circulating more intensely were CVB5 and Echo 6, while CVB4 was the predominant serotype found in 2010. In this study, two type 2 PVs were isolated, both characterized as Sabin like. CONCLUSION Environmental monitoring of HEVs in Milan has proved to be an interesting tool to investigate the circulation and distribution of viruses. SIGNIFICANCE AND IMPACT OF THE STUDY The detection of PV and other NPEV could be predictive of possible re-emergence of these viruses with an impact on public health. NPEV monitoring could also be a powerful public health tool to investigate the possible role of NPEV in different clinical manifestations.
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Affiliation(s)
- L Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Leendertse M, van Vugt M, Benschop KS, van Dijk K, Minnaar RP, van Eijk HWM, Hodiamont CJ, Wolthers KC. Pleurodynia caused by an echovirus 1 brought back from the tropics. J Clin Virol 2013; 58:490-3. [PMID: 23938303 DOI: 10.1016/j.jcv.2013.06.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 06/27/2013] [Accepted: 06/28/2013] [Indexed: 10/26/2022]
Abstract
A 31 year-old woman presented with acute pain on the left side of the thorax and abdomen, radiating to the back together with fever, after she had returned from traveling in Southeast Asia. Except for pleural friction rub auscultated on the left hemithorax, no physical abnormalities were detected. We diagnosed a classical course of Bornholm disease, caused by an echovirus type 1. While described as a classical pathogen causing Bornholm disease, this genotype has not been reported frequently in Surveillance data in the Western World.
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Affiliation(s)
- Masja Leendertse
- Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands.
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Zhang T, Du J, Xue Y, Su H, Yang F, Jin Q. Epidemics and Frequent Recombination within Species in Outbreaks of Human Enterovirus B-Associated Hand, Foot and Mouth Disease in Shandong China in 2010 and 2011. PLoS One 2013; 8:e67157. [PMID: 23840610 PMCID: PMC3686723 DOI: 10.1371/journal.pone.0067157] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 05/14/2013] [Indexed: 11/18/2022] Open
Abstract
The epidemiology and molecular characteristics of human enterovirus B (HEV-B) associated with hand, foot and mouth disease (HFMD) outbreaks in China are not well known. In the present study, we tested 201 HEV isolates from 233 clinical specimens from patients with severe HFMD during 2010-2011 in Linyi, Shandong, China. Of the 201 isolates, 189 were fully typed and 18 corresponded to HEV-B species (six serotypes CVA9, CVB1, CVB4, Echo 6, Echo 25 and Echo 30) using sensitive semi-nested polymerase chain reaction analysis of VP1 gene sequences. Phylogenetic analysis based on the VP1 region showed that eight E30SD belonged to a novel sub-genogroup D2; E25SD belonged to a novel sub-genogroup D6; E6SD belonged to sub-lineage C6 and five CVB1SD belonged to subgroup 4C; and B4SD belonged sub-lineage D2. The full viral genomes of the CVB1SD, E6SD, E25SD and E30SD isolates were sequenced. Analysis of phylogenetic and similarity plots indicated that E25SD recombined with E25-HN-2, E30FDJS03 and E4AUS250 at noncontiguous P2A-P3D regions, while E30SD, E30FDJ03, E25-HN-2 and E9 DM had shared sequences in discrete regions of P2 and P3. Both E6SD and B1SD shared sequences with E1-HN, B4/GX/10, B5-HN, and A9-Alberta in contiguous regions of most of P2 and P3. Genetic algorithm recombination detection analysis further confirmed the existence of multiple potential recombination points. In conclusion, analysis of the complete genomes of E25SD, E30SD, CVB1SD and E6SD isolated from HFMD patients revealed that they formed novel subgenogroup. Given the prevalence and recombination of these viruses in outbreaks of HFMD, persistent surveillance of HFMD-associated HEV-B pathogens is required to predict potential emerging viruses and related disease outbreaks.
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Affiliation(s)
- Ting Zhang
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiang Du
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ying Xue
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy Medical Sciences & Peking Union Medical College, Beijing, China
| | - Haoxiang Su
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fan Yang
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy Medical Sciences & Peking Union Medical College, Beijing, China
- * E-mail: (FY); (QJ)
| | - Qi Jin
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy Medical Sciences & Peking Union Medical College, Beijing, China
- * E-mail: (FY); (QJ)
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Kokkinos PA, Ziros PG, Monini M, Lampropoulou P, Karampini A, Papachatzi E, Mantagos S, Ruggeri FM, Vantarakis A. Rare types of rotaviruses isolated from children with acute gastroenteritis in Patras, Greece. Intervirology 2013; 56:237-41. [PMID: 23774743 DOI: 10.1159/000351183] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 04/04/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute diarrhea remains a major public health issue worldwide, with gastroenteritis agents associated with a high morbidity, especially in infants and young children. A 1-year study (2009-2010) of rotavirus (RV)-caused pediatric diarrhea was performed on hospitalized children admitted with symptoms of acute diarrhea to the University Hospital of Patras, Greece. METHODS Twenty-nine fecal samples were investigated for RVs, adenoviruses (AdVs), and enteroviruses (EVs) in an attempt to characterize these enteric viruses, which have been implicated in hospitalized diarrhea. RESULTS A 44.8% (13/29) incidence of viral infection was reported for the viral targets. Monoinfections accounted for 31% (9/29), while bi-infections accounted for 13.4% (4/29). Sequencing of positive samples allowed identification of RVs G4P[8] (2/29), G9P[8] (1/29), and interestingly of the rare type G12P[8] (2/29). AdV types 1, 2, and 6 were also identified in 4/29, 1/29, and 1/29 of the samples, respectively. Regarding the EVs, EV71 (2/29), coxsackievirus A4 (1/29), echovirus 11 (1/29), and EV96 (1/29) were typed. CONCLUSION The results of the present study, and specifically the detection of rare RV G12 and EV71 strains, address the need for continuous epidemiological surveys to provide epidemiological pictures of pediatric viral infections circulating in the community.
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Affiliation(s)
- Petros A Kokkinos
- Environmental Microbiology Unit, Department of Public Health, School of Medicine, University of Patras, Patras, Greece
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Wu W, Xu WB, Chen L, Chen HL, Liu Q, Wang DL, Chen YJ, Yao W, Li G, Feng B, Shu BH, Zhou YK, He YQ. Molecular identification and analysis of human enteroviruses isolated from healthy children in Shenzhen, China from 2010 to 2011. PLoS One 2013; 8:e64889. [PMID: 23762262 PMCID: PMC3675095 DOI: 10.1371/journal.pone.0064889] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 04/19/2013] [Indexed: 01/09/2023] Open
Abstract
Objective To determine the prevalence and distribution of human enteroviruses (HEVs) among healthy children in Shenzhen, China. Method Clinical specimens were obtained from 320 healthy children under 5 years old in Shenzhen, China from 2010 to 2011. The specimens were evaluated using real-time PCR and cell cultures. The positive specimens were further tested using reverse transcription-seminested PCR (RT-snPCR). Molecular typing and phylogenetic analysis were based on the sequence determined. Results Among the 320 samples, 34 were tested positive for HEVs (10.6%) and 22 different serotypes were identified using RT-snPCR. PV1 and PV2 were also detected. The predominant serotype observed was EV71 (17.6%), followed by CV-B4 (14.7%). HEV-B was detected most frequently, with an overall prevalence of 47.1%. HEV-A and HEV-C were found in 32.3% and 20.6% of the samples, respectively. No HEV-D was identified. Molecular phylogeny indicated that all EV71 strains were of C4 genotype. Conclusion Although a variety of HEVs was detected in healthy children, HEV-B was relatively more prevalent than other HEV species. Considering HEV-A is more prevalent than HEV-B among patients with hand-foot-mouth disease, additional long-term surveillance of HEV is warranted in both asymptomatic and symptomatic populations.
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Affiliation(s)
- Wei Wu
- MOE Key Laboratory of Environment & Health, Institute of Environmental Medicine, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wen-Bo Xu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Long Chen
- School of Life Sciences, Shenzhen University, Shenzhen, China
| | - Hui-Ling Chen
- MOE Key Laboratory of Environment & Health, Institute of Environmental Medicine, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qu Liu
- Shenzhen Longgang District Center for Disease Control and Prevention, Shenzhen, China
| | - Dong-Li Wang
- Shenzhen Guangming District Center for Disease Control and Prevention, Shenzhen, China
| | - Ying-Jian Chen
- Shenzhen Longgang District Center for Disease Control and Prevention, Shenzhen, China
| | - Wei Yao
- Shenzhen Longgang District Center for Disease Control and Prevention, Shenzhen, China
| | - Gang Li
- Shenzhen Longgang District Center for Disease Control and Prevention, Shenzhen, China
| | - Bin Feng
- Shenzhen Guangming District Center for Disease Control and Prevention, Shenzhen, China
| | - Bai-Hua Shu
- MOE Key Laboratory of Environment & Health, Institute of Environmental Medicine, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi-Kai Zhou
- MOE Key Laboratory of Environment & Health, Institute of Environmental Medicine, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
- * E-mail: (YKZ); (YQH)
| | - Ya-Qing He
- Shenzhen Center for Disease Control and Prevention, Major Infectious Disease Control Key Laboratory, Shenzhen, China
- * E-mail: (YKZ); (YQH)
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Smura T, Kakkola L, Blomqvist S, Klemola P, Parsons A, Kallio-Kokko H, Savolainen-Kopra C, Kainov DE, Roivainen M. Molecular evolution and epidemiology of echovirus 6 in Finland. INFECTION GENETICS AND EVOLUTION 2013; 16:234-47. [DOI: 10.1016/j.meegid.2013.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 01/10/2013] [Accepted: 02/05/2013] [Indexed: 12/30/2022]
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Zhu D, Zhao XY, Yao Y, Dai FF, He H, Li RQ, Jin RH, Liang LC, Li N. A new factor influencing pathogen detection by molecular assay in children with both mild and severe hand, foot, and mouth disease. Diagn Microbiol Infect Dis 2013; 76:162-7. [PMID: 23535205 PMCID: PMC7126308 DOI: 10.1016/j.diagmicrobio.2013.02.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 02/11/2013] [Accepted: 02/19/2013] [Indexed: 11/15/2022]
Abstract
This study aimed to find novel information concerning pathogen detection and some probable coinfection factors in hand, foot, and mouth disease (HFMD). In this study, 1104 clinically diagnosed HFMD patients were included. Enterovirus 71 (EV71), coxsackievirus A16 (CA16), and 14 different respiratory pathogens were examined from nasopharyngeal swabs using polymerase chain reaction (PCR) or reverse transcriptase PCR (RT-PCR). To evaluate the immune activation in HFMD patients, 8 cytokines and IgM antibodies to EV71 and CA16 from mild and severe patients were detected. Our results indicated that the severity of HFMD may affect the pathogen detection. The lower positive rates of enterovirus and respiratory viruses in severe HFMD cases by RT-PCR were probably related to stronger immune response. Therefore, immunological tests such as ELISA are essential supplements to PCR or RT-PCR in order to increase pathogen diagnosis in HFMD, especially in severe cases.
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Affiliation(s)
- Dong Zhu
- Department of Clinical Laboratory, YouAn Hospital Affiliated to Capital Medical University, Beijing 100069, China
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40
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Relative Frequency of Echovirus 30 in Patients Suffering from Enterovirus Meningitis in Ahvaz. Jundishapur J Microbiol 2013. [DOI: 10.5812/jjm.4972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Chen P, Tao Z, Song Y, Liu G, Wang H, Liu Y, Song L, Li Y, Lin X, Cui N, Xu A. A coxsackievirus B5-associated aseptic meningitis outbreak in Shandong Province, China in 2009. J Med Virol 2012; 85:483-9. [PMID: 23212939 DOI: 10.1002/jmv.23478] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 11/09/2022]
Abstract
In 2009, a major outbreak of aseptic meningitis was noted in Linyi city, Shandong province, China. From June to September 2009, a total of 2,104 cases were involved in this outbreak, and 98.6% of patients were <16 years of age. To determine the pathogen of the outbreak, 42 cerebrospinal fluid specimens collected from aseptic meningitis cases were tested for cell culture, and 17 (40.5%) enteroviruses were isolated and identified as Coxsackievirus B5 (CVB5). Homologous comparison indicated that these isolates had 0-7.7% nucleotide divergence with each other. Phylogenetic reconstruction showed global CVB5 could be separated into four genogroups, and all Linyi CVB5 isolates belonged to the genogroup C which had been circulating for recent 27 years in Asia and Europe. Interestingly, two distinct lineages were observed for the 17 isolates in the phylogenetic tree, indicating that at least two different transmission chains of CVB5 were responsible for this outbreak. This study showed that CVB5-associated aseptic meningitis is an emerging concern in China.
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Affiliation(s)
- Peng Chen
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, China
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Park KS, Choi YJ, Park JS. Enterovirus infection in Korean children and anti-enteroviral potential candidate agents. KOREAN JOURNAL OF PEDIATRICS 2012; 55:359-66. [PMID: 23133481 PMCID: PMC3488610 DOI: 10.3345/kjp.2012.55.10.359] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 08/25/2012] [Indexed: 12/17/2022]
Abstract
Although most enterovirus infections are not serious enough to be life threatening, several enteroviruses such as enterovirus 71 are responsible for severe, potentially life-threatening disease. The epidemic patterns of enteroviruses occur regularly during the year, but they may change due to environmental shifts induced by climate change due to global warming. Therefore, enterovirus epidemiological studies should be performed continuously as a basis for anti-viral studies. A great number of synthesized antiviral compounds that work against enteroviruses have been developed but only a few have demonstrated effectiveness in vivo. No proven effective antiviral agents are available for enterovirus disease therapy. The development of a new antiviral drug is a difficult task due to poor selective toxicity and cost. To overcome these limitations, one approach is to accelerate the availability of other existing antiviral drugs approved for antiviral effect against enteroviruses, and the other way is to screen traditional medicinal plants.
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Affiliation(s)
- Kwi Sung Park
- Chungcheongnam-do Institute of Health and Environmental Research, Daejeon, Korea
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Park K, Lee B, Baek K, Cheon D, Yeo S, Park J, Soh J, Cheon H, Yoon K, Choi Y. Enteroviruses isolated from herpangina and hand-foot-and-mouth disease in Korean children. Virol J 2012; 9:205. [PMID: 22985487 PMCID: PMC3490919 DOI: 10.1186/1743-422x-9-205] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 09/11/2012] [Indexed: 11/10/2022] Open
Abstract
Hand-foot-and-mouth disease (HFMD) and herpangina are commonly prevalent illness in young children. They are similarly characterized by lesions on the skin and oral mucosa. Both diseases are associated with various enterovirus serotypes. In this study, enteroviruses from patients with these diseases in Korea in 2009 were isolated and analyzed. Demographic data for patients with HFMD and herpangina were compared and all enterovirus isolates were amplified in the VP1 region by reverse transcription-polymerase chain reaction and sequenced. Among the enterovirus isolates, prevalent agents were coxsackievirus A16 in HFMD and coxsackievirus A5 in herpangina. More prevalent months for HFMD were June (69.2%) and May (11.5%), and June (40.0%) and July (24.0%) for herpangina. Age prevalence of HFMD patients with enterovirus infection was 1 year (23.1%), 4 years (19.2%), and over 5 years (19.2%). However, the dominant age group of herpangina patients with enterovirus infection was 1 year (48.0%) followed by 2 years (28.0%). Comparison of pairwise VP1 nucleotide sequence alignment of all isolates within the same serotypes revealed high intra-type variation of CVA2 isolates (84.6–99.3% nucleotide identity). HFMD and herpangina showed differences in demographic data and serotypes of isolated enteroviruses, but there was no notable difference in amino acid sequences by clinical syndromes in multiple comparison of the partial VP1 gene sequence.
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Affiliation(s)
- KwiSung Park
- Department of Clinical Pathology, Daejeon Health Sciences College, Daejeon, South Korea
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Lee JW, Yeo SG, Kang BH, Lee HK, Kim JW, Lee SH, Kim KS, Cheon DS. Echovirus 30 induced neuronal cell death through TRIO-RhoA signaling activation. PLoS One 2012; 7:e36656. [PMID: 22586486 PMCID: PMC3346726 DOI: 10.1371/journal.pone.0036656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/05/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Echovirus 30 (Echo30) is one of the most frequently identified human enteroviruses (EVs) causing aseptic meningitis and encephalitis. However the mechanism underlying the pathogenesis of Echo30 infection with significant clinical outcomes is not completely understood. The aim of this investigation is to illustrate molecular pathologic alteration in neuronal cells induced by Echo30 infection using clinical isolate from young patient with neurologic involvement. METHODOLOGY/PRINCIPAL FINDINGS To characterize the neuronal cellular response to Echo30 infection, we performed a proteomic analysis based on two-dimensional gel electrophoresis (2-DE) and MALDI-TOF/TOF Mass Spectrophotometric (MS) analysis. We identified significant alteration of several protein expression levels in Echo30-infected SK-N-SH cells. Among these proteins, we focused on an outstanding up-regulation of Triple functional domain (TRIO) in Echo30-infected SK-N-SH cells. Generally, TRIO acts as a key component in the regulation of axon guidance and cell migration. In this study, we determined that TRIO plays a role in the novel pathways in Echo30 induced neuronal cell death. CONCLUSIONS/SIGNIFICANCE Our finding shows that TRIO plays a critical role in neuronal cell death by Echo30 infection. Echo30 infection activates TRIO-guanine nucleotide exchange factor (GEF) domains (GEFD2) and RhoA signaling in turn. These results suggest that Echo30 infection induced neuronal cell death by activation of the TRIO-RhoA signaling. We expect the regulation of TRIO-RhoA signaling may represent a new therapeutic approach in treating aseptic meningitis and encephalitis induced by Echo30.
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Affiliation(s)
- June-Woo Lee
- Division of Enteric and Hepatitis Viruses, Center for Infectious Diseases, National Institutes of Health, Osong, Korea
| | - Sang-Gu Yeo
- Division of Enteric and Hepatitis Viruses, Center for Infectious Diseases, National Institutes of Health, Osong, Korea
| | - Byung-Hak Kang
- Division of Enteric and Hepatitis Viruses, Center for Infectious Diseases, National Institutes of Health, Osong, Korea
| | - Hoe-Kyu Lee
- Division of Enteric and Hepatitis Viruses, Center for Infectious Diseases, National Institutes of Health, Osong, Korea
| | - Jin-Won Kim
- Division of Enteric and Hepatitis Viruses, Center for Infectious Diseases, National Institutes of Health, Osong, Korea
| | - Sun-Hwa Lee
- Division of Enteric and Hepatitis Viruses, Center for Infectious Diseases, National Institutes of Health, Osong, Korea
| | - Ki-Sang Kim
- Division of Enteric and Hepatitis Viruses, Center for Infectious Diseases, National Institutes of Health, Osong, Korea
| | - Doo-Sung Cheon
- Division of Enteric and Hepatitis Viruses, Center for Infectious Diseases, National Institutes of Health, Osong, Korea
- * E-mail:
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