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Bingula R, Chabrolles H, Bonnet B, Archimbaud C, Brebion A, Cosme J, Ollier A, Dutheil F, Junda M, Mirand A, Regagnon C, Vidal M, Henquell C, Evrard B. Increase over time of antibody levels 3 months after a booster dose as an indication of better protection against Omicron infection. Emerg Microbes Infect 2023; 12:2184176. [PMID: 36848040 PMCID: PMC10013501 DOI: 10.1080/22221751.2023.2184176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
The third, "booster", vaccination increases the overall immune response against SARS-CoV-2 variants. However, after the initial peak at around 3 weeks post-vaccination, anti-spike antibody levels decline. Post-booster kinetics of cellular response has been less investigated and there is no documented evidence of a true boosting effect. Furthermore, multiple studies underline the less effective immune responses against Omicron, the latest variant of concern, at both humoral and cellular levels. In this letter, we analyse humoral (anti-RBD IgG levels) and cellular (IFN-γ release assay) immune response in 205 health care workers 3 weeks and 3 months after administration of an mRNA-based booster dose, either mRNA-1273 or BNT162b2. Since all subjects were SARS-CoV-2 infection-naïve, we also looked at the incidence of Omicron infection between 3 and 6 months post-booster.At both timepoints, 3x mRNA-1273 vaccination had the highest overall antibody and IFN-γ levels, followed by 3x BNT162b2 vaccination and heterologous mRNA-based regimens. Heterologous ChAdOx1-mRNA-based regimen had the lowest antibody levels while cellular response equal to that of 3x BNT162b2 vaccination and heterologous mRNA-based regimens. Our results show that both humoral and cellular responses waned at 3 months for all vaccination regimens. However, we identified three trajectories of dosage variation. Interestingly, the subgroup of subjects with increasing anti-RBD IgG levels over time had a lower incidence of Omicron infection. Whether increasing humoral response at 3 months post-booster is more indicative of protection than a high initial peak remains to be confirmed in a larger cohort.
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Affiliation(s)
- Rea Bingula
- UMR UNH, ECREIN, Immunology Laboratory, Faculty of Medicine, Clermont Auvergne University, Clermont-Ferrand, France
| | - Hélène Chabrolles
- Virology Department, Clermont-Ferrand University Hospital (CHU Clermont-Ferrand), 3IHP, Clermont-Ferrand, France.,CNRS UMR 6023, LMGE, Clermont Auvergne University, Clermont-Ferrand, France
| | - Benjamin Bonnet
- UMR UNH, ECREIN, Immunology Laboratory, Faculty of Medicine, Clermont Auvergne University, Clermont-Ferrand, France.,Immunology Department, Clermont-Ferrand University Hospital (CHU Clermont Ferrand), Clermont-Ferrand, France
| | - Christine Archimbaud
- Virology Department, Clermont-Ferrand University Hospital (CHU Clermont-Ferrand), 3IHP, Clermont-Ferrand, France.,CNRS UMR 6023, LMGE, Clermont Auvergne University, Clermont-Ferrand, France
| | - Amélie Brebion
- Virology Department, Clermont-Ferrand University Hospital (CHU Clermont-Ferrand), 3IHP, Clermont-Ferrand, France
| | - Justine Cosme
- Immunology Department, Clermont-Ferrand University Hospital (CHU Clermont Ferrand), Clermont-Ferrand, France
| | - Amandine Ollier
- Clinical Research and Innovation Direction, Clermont-Ferrand University Hospital (CHU Clermont-Ferrand) 3 IHP, Clermont-Ferrand, France
| | - Frédéric Dutheil
- Preventive and Occupational Medicine, Clermont-Ferrand University Hospital (CHU Clermont-Ferrand), Clermont-Ferrand, France.,CNRS, LaPSCo Physiological and Psychosocial Stress, Clermont Auvergne University, Clermont-Ferrand, France
| | - Maud Junda
- Immunology Department, Clermont-Ferrand University Hospital (CHU Clermont Ferrand), Clermont-Ferrand, France
| | - Audrey Mirand
- Virology Department, Clermont-Ferrand University Hospital (CHU Clermont-Ferrand), 3IHP, Clermont-Ferrand, France.,CNRS UMR 6023, LMGE, Clermont Auvergne University, Clermont-Ferrand, France
| | - Christel Regagnon
- Virology Department, Clermont-Ferrand University Hospital (CHU Clermont-Ferrand), 3IHP, Clermont-Ferrand, France.,CNRS UMR 6023, LMGE, Clermont Auvergne University, Clermont-Ferrand, France
| | - Magali Vidal
- Virology Department, Clermont-Ferrand University Hospital (CHU Clermont-Ferrand), 3IHP, Clermont-Ferrand, France.,CNRS UMR 6023, LMGE, Clermont Auvergne University, Clermont-Ferrand, France
| | - Cécile Henquell
- Virology Department, Clermont-Ferrand University Hospital (CHU Clermont-Ferrand), 3IHP, Clermont-Ferrand, France.,CNRS UMR 6023, LMGE, Clermont Auvergne University, Clermont-Ferrand, France
| | - Bertrand Evrard
- UMR UNH, ECREIN, Immunology Laboratory, Faculty of Medicine, Clermont Auvergne University, Clermont-Ferrand, France.,Immunology Department, Clermont-Ferrand University Hospital (CHU Clermont Ferrand), Clermont-Ferrand, France
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Combes P, Bisseux M, Bal A, Marin P, Latour J, Archimbaud C, Brebion A, Chabrolles H, Regagnon C, Lafolie J, Destras G, Simon B, Izopet J, Josset L, Henquell C, Mirand A. Evidence of co-infections during Delta and Omicron SARS-CoV-2 variants co-circulation through prospective screening and sequencing. Clin Microbiol Infect 2022; 28:1503.e5-1503.e8. [PMID: 35792280 PMCID: PMC9250411 DOI: 10.1016/j.cmi.2022.06.030] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 12/13/2022]
Abstract
Objectives To describe Delta/Omicron SARS-CoV-2 variants co-infection detection and confirmation during the fifth wave of COVID-19 pandemics in France in 7 immunocompetent and epidemiologically unrelated patients. Methods Since December 2021, the surveillance of Delta/Omicron SARS-CoV-2 variants of concern (VOC) circulation was performed through prospective screening of positive-samples using single nucleotide polymorphism (SNP) PCR assays targeting SARS-CoV-2 S-gene mutations K417N (Omicron specific) and L452R (Delta specific). Samples showing unexpected mutational profiles were further submitted to whole genome sequencing (WGS) using three different primer sets. Results Between weeks 49-2021 and 02-2022, SARS-CoV-2 genome was detected in 3831 respiratory samples, of which 3237 (84.5%) were screened for VOC specific SNPs. Unexpected mutation profiles suggesting a dual Delta/Omicron population were observed in 7 nasopharyngeal samples (0.2%). These co-infections were confirmed by WGS. For 2 patients, the sequence analyses of longitudinal samples collected 7 to 11 days apart showed that Delta or Omicron can outcompete the other variant during dual infection. Additionally, for one of these samples, a recombination event between Delta and Omicron was detected. Conclusions This work demonstrates that SARS-CoV-2 Delta/Omicron co-infections are not rare in high virus co-circulation periods. Moreover, co-infections can further lead to genetic recombination which may generate new chimeric variants with unpredictable epidemic or pathogenic properties that could represent a serious health threat.
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Tomba Ngangas S, Bisseux M, Jugie G, Lambert C, Cohen R, Werner A, Archimbaud C, Henquell C, Mirand A, Bailly JL. Coxsackievirus A6 Recombinant Subclades D3/A and D3/H Were Predominant in Hand-Foot-And-Mouth Disease Outbreaks in the Paediatric Population, France, 2010–2018. Viruses 2022; 14:v14051078. [PMID: 35632819 PMCID: PMC9144281 DOI: 10.3390/v14051078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023] Open
Abstract
Coxsackievirus A6 (CVA6) emerged as the most common enterovirus of seasonal outbreaks of hand-foot-and-mouth disease (HFMD). We investigated CVA6 genetic diversity among the clinical phenotypes reported in the paediatric population during sentinel surveillance in France between 2010 and 2018. CVA6 infection was confirmed in 981 children (mean age 1.52 years [IQR 1.17–2.72]) of whom 564 (58%) were males. Atypical HFMD was reported in 705 (72%) children, followed by typical HFMD in 214 (22%) and herpangina in 57 (6%) children. Throat specimens of 245 children were processed with a target-enrichment new-generation sequencing approach, which generated 213 complete CVA6 genomes. The genomes grouped within the D1 and D3 clades (phylogeny inferred with the P1 genomic region). In total, 201 genomes were classified among the recombinant forms (RFs) A, B, F, G, H, and N, and 12 genomes were assigned to 5 previously unreported RFs (R–V). The most frequent RFs were A (58%), H (19%), G (6.1%), and F (5.2%). The yearly number of RFs ranged between 1 (in 2012 and 2013) and 6 (2018). The worldwide CVA6 epidemic transmission began between 2005 and 2007, which coincided with the global spread of the recombinant subclade D3/RF-A.
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Affiliation(s)
- Stéphanie Tomba Ngangas
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (S.T.N.); (M.B.); (G.J.); (C.A.); (C.H.); (A.M.)
| | - Maxime Bisseux
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (S.T.N.); (M.B.); (G.J.); (C.A.); (C.H.); (A.M.)
- CHU Clermont-Ferrand, Centre National de Référence Des Entérovirus et Parechovirus, Laboratoire de Virologie, 63003 Clermont-Ferrand, France
| | - Gwendoline Jugie
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (S.T.N.); (M.B.); (G.J.); (C.A.); (C.H.); (A.M.)
| | - Céline Lambert
- CHU Clermont-Ferrand, Service Biométrie et Médico-Economie—Direction de la Recherche Clinique et Innovation, 63003 Clermont-Ferrand, France;
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), 94000 Créteil, France;
| | - Andreas Werner
- Association Française de Pédiatrie Ambulatoire (AFPA), 45000 Orléans, France;
| | - Christine Archimbaud
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (S.T.N.); (M.B.); (G.J.); (C.A.); (C.H.); (A.M.)
- CHU Clermont-Ferrand, Centre National de Référence Des Entérovirus et Parechovirus, Laboratoire de Virologie, 63003 Clermont-Ferrand, France
| | - Cécile Henquell
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (S.T.N.); (M.B.); (G.J.); (C.A.); (C.H.); (A.M.)
- CHU Clermont-Ferrand, Centre National de Référence Des Entérovirus et Parechovirus, Laboratoire de Virologie, 63003 Clermont-Ferrand, France
| | - Audrey Mirand
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (S.T.N.); (M.B.); (G.J.); (C.A.); (C.H.); (A.M.)
- CHU Clermont-Ferrand, Centre National de Référence Des Entérovirus et Parechovirus, Laboratoire de Virologie, 63003 Clermont-Ferrand, France
| | - Jean-Luc Bailly
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (S.T.N.); (M.B.); (G.J.); (C.A.); (C.H.); (A.M.)
- Correspondence:
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Bonnet B, Chabrolles H, Archimbaud C, Brebion A, Cosme J, Dutheil F, Lambert C, Junda M, Mirand A, Ollier A, Pereira B, Regagnon C, Vidal M, Evrard B, Henquell C. Decline of Humoral and Cellular Immune Responses Against SARS-CoV-2 6 Months After Full BNT162b2 Vaccination in Hospital Healthcare Workers. Front Immunol 2022; 13:842912. [PMID: 35309363 PMCID: PMC8926062 DOI: 10.3389/fimmu.2022.842912] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/10/2022] [Indexed: 12/18/2022] Open
Abstract
Clinical trials and real-world evidence on COVID-19 vaccines have shown their effectiveness against severe disease and death but the durability of protection remains unknown. We analysed the humoral and T-cell immune responses in 110 healthcare workers (HCWs) vaccinated according to the manufacturer's recommended schedule of dose 2 three weeks after dose 1 from a prospective on-going cohort in early 2021, 3 and 6 months after full vaccination with the BNT162b2 mRNA vaccine. Anti-RBD IgG titres were lower in HCWs over 60 years old 3 months after the second dose (p=0.03) and declined in all the subjects between 3 and 6 months with a median percentage change of -58.5%, irrespective of age and baseline comorbidities. Specific T-cell response measured by IGRA declined over time by at least 42% (median) in 91 HCWs and increased by 33% (median) in 17 others. Six HCWs had a negative T-cell response at 6 months. Ongoing follow-up should provide correlates of long-term protection according to the different immune response profiles observed. COVIDIM study was registered under the number NCT04896788 on clinicaltrials.gov.
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Affiliation(s)
- Benjamin Bonnet
- Clermont-Ferrand University Hospital (CHU Clermont Ferrand), Immunology Department, Clermont-Ferrand, France
- Clermont Auvergne University, UMR UNH, ECREIN, Clermont-Ferrand, France
| | - Hélène Chabrolles
- Clermont-Ferrand University Hospital (CHU Clermont Ferrand), 3IHP, Virology Department, Clermont-Ferrand, France
- Clermont Auvergne University, CNRS UMR, LMGE, Clermont-Ferrand, France
| | - Christine Archimbaud
- Clermont-Ferrand University Hospital (CHU Clermont Ferrand), 3IHP, Virology Department, Clermont-Ferrand, France
- Clermont Auvergne University, CNRS UMR, LMGE, Clermont-Ferrand, France
| | - Amélie Brebion
- Clermont-Ferrand University Hospital (CHU Clermont Ferrand), 3IHP, Virology Department, Clermont-Ferrand, France
| | - Justine Cosme
- Clermont-Ferrand University Hospital (CHU Clermont Ferrand), Immunology Department, Clermont-Ferrand, France
| | - Frédéric Dutheil
- Clermont-Ferrand University Hospital (CHU Clermont Ferrand), Preventive and Occupational Medicine, Clermont-Ferrand, France
- Clermont Auvergne University, CNRS, LaPSCo Physiological and Psychosocial Stress, Clermont-Ferrand, France
| | - Céline Lambert
- Clermont-Ferrand University Hospital (CHU Clermont Ferrand), Clinical Research and Innovation Direction (DRCI), Biostatistics Unit, Clermont-Ferrand, France
| | - Maud Junda
- Clermont-Ferrand University Hospital (CHU Clermont Ferrand), Immunology Department, Clermont-Ferrand, France
| | - Audrey Mirand
- Clermont-Ferrand University Hospital (CHU Clermont Ferrand), 3IHP, Virology Department, Clermont-Ferrand, France
- Clermont Auvergne University, CNRS UMR, LMGE, Clermont-Ferrand, France
| | - Amandine Ollier
- Clermont-Ferrand University Hospital (CHU Clermont Ferrand) 3 IHP, Clinical Research and Innovation Direction, Clermont-Ferrand, France
| | - Bruno Pereira
- Clermont-Ferrand University Hospital (CHU Clermont Ferrand), Clinical Research and Innovation Direction (DRCI), Biostatistics Unit, Clermont-Ferrand, France
| | - Christel Regagnon
- Clermont-Ferrand University Hospital (CHU Clermont Ferrand), 3IHP, Virology Department, Clermont-Ferrand, France
| | - Magali Vidal
- Clermont-Ferrand University Hospital (CHU Clermont Ferrand), 3 IHP, Infectious Diseases Department, Clermont-Ferrand, France
| | - Bertrand Evrard
- Clermont-Ferrand University Hospital (CHU Clermont Ferrand), Immunology Department, Clermont-Ferrand, France
- Clermont Auvergne University, UMR UNH, ECREIN, Clermont-Ferrand, France
| | - Cécile Henquell
- Clermont-Ferrand University Hospital (CHU Clermont Ferrand), 3IHP, Virology Department, Clermont-Ferrand, France
- Clermont Auvergne University, CNRS UMR, LMGE, Clermont-Ferrand, France
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Bonnet B, Chabrolles H, Archimbaud C, Brebion A, Godignon M, Dutheil F, Lambert C, Cosme J, Mirand A, Ollier A, Pereira B, Regagnon C, Vidal M, Evrard B, Henquell C. Comparative T and B immune responses of four different anti-COVID-19 vaccine strategies 6 months after vaccination. J Infect 2022; 84:e45-e47. [PMID: 35278482 PMCID: PMC8905884 DOI: 10.1016/j.jinf.2022.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/05/2022] [Indexed: 11/25/2022]
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Mirand A, Cohen R, Bisseux M, Tomba S, Sellem FC, Gelbert N, Béchet S, Frandji B, Archimbaud C, Brebion A, Chabrolles H, Regagnon C, Levy C, Bailly JL, Henquell C. A large-scale outbreak of hand, foot and mouth disease, France, as at 28 September 2021. ACTA ACUST UNITED AC 2021; 26. [PMID: 34713796 PMCID: PMC8555367 DOI: 10.2807/1560-7917.es.2021.26.43.2100978] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report a large-scale outbreak of hand, foot and mouth disease (HFMD) in France. As at 28 September 2021, 3,403 cases have been reported (47% higher than in 2018–19). We prospectively analysed 210 clinical samples; 190 (90.5%) were enterovirus-positive. Most children presented with atypical HFMD. Coxsackievirus (CV)A6 (49.5%; 94/190) was predominant; no enterovirus A71 was detected. Dermatological and neurological complications of HFMD justify prospective syndromic and virological surveillance for early detection of HFMD outbreaks and identification of associated types.
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Affiliation(s)
- Audrey Mirand
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France.,Université d'Auvergne, LMGE UMR CNRS 6023 Equipe EPIE - Epidémiologie et physiopathologie des infections à entérovirus, Faculté de Médecine, Clermont-Ferrand, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, France
| | - Maxime Bisseux
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France.,Université d'Auvergne, LMGE UMR CNRS 6023 Equipe EPIE - Epidémiologie et physiopathologie des infections à entérovirus, Faculté de Médecine, Clermont-Ferrand, France
| | - Stéphanie Tomba
- Université d'Auvergne, LMGE UMR CNRS 6023 Equipe EPIE - Epidémiologie et physiopathologie des infections à entérovirus, Faculté de Médecine, Clermont-Ferrand, France
| | | | - Nathalie Gelbert
- Association Française de Pédiatrie Ambulatoire (AFPA), Orléans, France
| | - Stéphane Béchet
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, France
| | | | - Christine Archimbaud
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France.,Université d'Auvergne, LMGE UMR CNRS 6023 Equipe EPIE - Epidémiologie et physiopathologie des infections à entérovirus, Faculté de Médecine, Clermont-Ferrand, France
| | - Amélie Brebion
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France
| | - Hélène Chabrolles
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France.,Université d'Auvergne, LMGE UMR CNRS 6023 Equipe EPIE - Epidémiologie et physiopathologie des infections à entérovirus, Faculté de Médecine, Clermont-Ferrand, France
| | - Christel Regagnon
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Créteil, France
| | - Jean-Luc Bailly
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France.,Université d'Auvergne, LMGE UMR CNRS 6023 Equipe EPIE - Epidémiologie et physiopathologie des infections à entérovirus, Faculté de Médecine, Clermont-Ferrand, France
| | - Cécile Henquell
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Clermont-Ferrand, France.,Université d'Auvergne, LMGE UMR CNRS 6023 Equipe EPIE - Epidémiologie et physiopathologie des infections à entérovirus, Faculté de Médecine, Clermont-Ferrand, France
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Duval M, Mirand A, Lesens O, Bay JO, Caillaud D, Gallot D, Lautrette A, Montcouquiol S, Schmidt J, Egron C, Jugie G, Bisseux M, Archimbaud C, Lambert C, Henquell C, Bailly JL. Retrospective Study of the Upsurge of Enterovirus D68 Clade D1 among Adults (2014-2018). Viruses 2021; 13:1607. [PMID: 34452471 PMCID: PMC8402803 DOI: 10.3390/v13081607] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/26/2021] [Accepted: 08/08/2021] [Indexed: 11/17/2022] Open
Abstract
Enterovirus D68 (EV-D68) has emerged as an agent of epidemic respiratory illness and acute flaccid myelitis in the paediatric population but data are lacking in adult patients. We performed a 4.5-year single-centre retrospective study of all patients who tested positive for EV-D68 and analysed full-length EV-D68 genomes of the predominant clades B3 and D1. Between 1 June 2014, and 31 December 2018, 73 of the 11,365 patients investigated for respiratory pathogens tested positive for EV-D68, of whom 20 (27%) were adults (median age 53.7 years [IQR 34.0-65.7]) and 53 (73%) were children (median age 1.9 years [IQR 0.2-4.0]). The proportion of adults increased from 12% in 2014 to 48% in 2018 (p = 0.01). All adults had an underlying comorbidity factor, including chronic lung disease in 12 (60%), diabetes mellitus in six (30%), and chronic heart disease in five (25%). Clade D1 infected a higher proportion of adults than clades B3 and B2 (p = 0.001). Clade D1 was more divergent than clade B3: 5 of 19 amino acid changes in the capsid proteins were located in putative antigenic sites. Adult patients with underlying conditions are more likely to present with severe complications associated with EV-D68, notably the emergent clade D1.
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Affiliation(s)
- Maxime Duval
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (M.D.); (A.M.); (G.J.); (M.B.); (C.A.); (C.H.)
| | - Audrey Mirand
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (M.D.); (A.M.); (G.J.); (M.B.); (C.A.); (C.H.)
- CHU Clermont-Ferrand, Centre National de Référence Des Entérovirus et Parechovirus, Laboratoire de Virologie, 63003 Clermont-Ferrand, France
| | - Olivier Lesens
- CHU Clermont-Ferrand, Service Des Maladies Infectieuses et Tropicales, 63003 Clermont-Ferrand, France;
| | - Jacques-Olivier Bay
- CHU Clermont-Ferrand, Service de Thérapie Cellulaire et Hématologie Clinique, 63003 Clermont-Ferrand, France;
| | - Denis Caillaud
- CHU Clermont-Ferrand, Service de Pneumologie, 63003 Clermont-Ferrand, France;
| | - Denis Gallot
- CHU Clermont-Ferrand, Service de Gynécologie-Obstétrique, 63003 Clermont-Ferrand, France;
| | | | - Sylvie Montcouquiol
- CHU Clermont-Ferrand, Centre de Référence et de Compétence Mucoviscidose, 63003 Clermont-Ferrand, France;
| | - Jeannot Schmidt
- CHU Clermont-Ferrand, Service Des Urgences, 63003 Clermont-Ferrand, France;
| | - Carole Egron
- CHU Clermont-Ferrand, Service de Pédiatrie Générale, 63003 Clermont-Ferrand, France;
| | - Gwendoline Jugie
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (M.D.); (A.M.); (G.J.); (M.B.); (C.A.); (C.H.)
| | - Maxime Bisseux
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (M.D.); (A.M.); (G.J.); (M.B.); (C.A.); (C.H.)
- CHU Clermont-Ferrand, Centre National de Référence Des Entérovirus et Parechovirus, Laboratoire de Virologie, 63003 Clermont-Ferrand, France
| | - Christine Archimbaud
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (M.D.); (A.M.); (G.J.); (M.B.); (C.A.); (C.H.)
- CHU Clermont-Ferrand, Centre National de Référence Des Entérovirus et Parechovirus, Laboratoire de Virologie, 63003 Clermont-Ferrand, France
| | - Céline Lambert
- CHU Clermont-Ferrand, Service Biométrie et Médico-Economie—Direction de la Recherche Clinique et Innovation, 63003 Clermont-Ferrand, France;
| | - Cécile Henquell
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (M.D.); (A.M.); (G.J.); (M.B.); (C.A.); (C.H.)
- CHU Clermont-Ferrand, Centre National de Référence Des Entérovirus et Parechovirus, Laboratoire de Virologie, 63003 Clermont-Ferrand, France
| | - Jean-Luc Bailly
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (M.D.); (A.M.); (G.J.); (M.B.); (C.A.); (C.H.)
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8
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Bisseux M, Debroas D, Mirand A, Archimbaud C, Peigue-Lafeuille H, Bailly JL, Henquell C. Monitoring of enterovirus diversity in wastewater by ultra-deep sequencing: An effective complementary tool for clinical enterovirus surveillance. Water Res 2020; 169:115246. [PMID: 31710918 DOI: 10.1016/j.watres.2019.115246] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/07/2019] [Accepted: 10/26/2019] [Indexed: 05/28/2023]
Abstract
In a one-year (October 2014-October 2015) pilot study, we assessed wastewater monitoring with sustained sampling for analysis of global enterovirus (EV) infections in an urban community. Wastewater was analysed by ultra-deep sequencing (UDS) after PCR amplification of the partial VP1 capsid protein gene. The nucleotide sequence analysis showed an unprecedented diversity of 48 EV types within the community, which were assigned to the taxonomic species A (n = 13), B (n = 23), and C (n = 12). During the same period, 26 EV types, of which 22 were detected in wastewater, were identified in patients referred to the teaching hospital serving the same urban population. Wastewater surveillance detected a silent circulation of 26 EV types including viruses reported in clinically rare respiratory diseases. Wastewater monitoring as a supplementary procedure can complement clinical surveillance of severe diseases related to non-polio EVs and contribute to the final stages of poliomyelitis eradication.
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Affiliation(s)
- Maxime Bisseux
- Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Genome et Environnement, F-63000, Clermont-Ferrand, France; CHU Clermont-Ferrand, 3 IHP, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Laboratoire de Virologie, F-63000, Clermont-Ferrand, France.
| | - Didier Debroas
- Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Genome et Environnement, F-63000, Clermont-Ferrand, France
| | - Audrey Mirand
- Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Genome et Environnement, F-63000, Clermont-Ferrand, France; CHU Clermont-Ferrand, 3 IHP, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Laboratoire de Virologie, F-63000, Clermont-Ferrand, France
| | - Christine Archimbaud
- Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Genome et Environnement, F-63000, Clermont-Ferrand, France; CHU Clermont-Ferrand, 3 IHP, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Laboratoire de Virologie, F-63000, Clermont-Ferrand, France
| | - Hélène Peigue-Lafeuille
- Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Genome et Environnement, F-63000, Clermont-Ferrand, France; CHU Clermont-Ferrand, 3 IHP, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Laboratoire de Virologie, F-63000, Clermont-Ferrand, France
| | - Jean-Luc Bailly
- Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Genome et Environnement, F-63000, Clermont-Ferrand, France; CHU Clermont-Ferrand, 3 IHP, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Laboratoire de Virologie, F-63000, Clermont-Ferrand, France
| | - Cécile Henquell
- Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Genome et Environnement, F-63000, Clermont-Ferrand, France; CHU Clermont-Ferrand, 3 IHP, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Laboratoire de Virologie, F-63000, Clermont-Ferrand, France
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9
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Ngangas ST, Lukashev A, Jugie G, Ivanova O, Mansuy JM, Mengelle C, Izopet J, L'honneur AS, Rozenberg F, Leyssene D, Hecquet D, Marque-Juillet S, Boutolleau D, Burrel S, Peigue-Lafeuille H, Archimbaud C, Benschop K, Henquell C, Mirand A, Bailly JL. Multirecombinant Enterovirus A71 Subgenogroup C1 Isolates Associated with Neurologic Disease, France, 2016-2017. Emerg Infect Dis 2019; 25:1204-1208. [PMID: 31107209 PMCID: PMC6537711 DOI: 10.3201/eid2506.181460] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In 2016, an upsurge of neurologic disease associated with infection with multirecombinant enterovirus A71 subgenogroup C1 lineage viruses was reported in France. These viruses emerged in the 2000s; 1 recombinant is widespread. This virus lineage has the potential to be associated with a long-term risk for severe disease among children.
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10
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Bisseux M, Colombet J, Mirand A, Roque-Afonso AM, Abravanel F, Izopet J, Archimbaud C, Peigue-Lafeuille H, Debroas D, Bailly JL, Henquell C. Monitoring human enteric viruses in wastewater and relevance to infections encountered in the clinical setting: a one-year experiment in central France, 2014 to 2015. ACTA ACUST UNITED AC 2019; 23. [PMID: 29471623 PMCID: PMC5824128 DOI: 10.2807/1560-7917.es.2018.23.7.17-00237] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Human enteric viruses are resistant in the environment and transmitted via the faecal-oral route. Viral shedding in wastewater gives the opportunity to track emerging pathogens and study the epidemiology of enteric infectious diseases in the community. Aim: The aim of this study was to monitor the circulation of enteric viruses in the population of the Clermont-Ferrand area (France) by analysis of urban wastewaters. Methods: Raw and treated wastewaters were collected between October 2014 and October 2015 and concentrated by a two-step protocol using tangential flow ultrafiltration and polyethylene glycol precipitation. Processed samples were analysed for molecular detection of adenovirus, norovirus, rotavirus, parechovirus, enterovirus (EV), hepatitis A (HAV) and E (HEV) viruses. Results: All wastewater samples (n = 54) contained viruses. On average, six and four virus species were detected in, respectively, raw and treated wastewater samples. EV-positive samples were tested for EV-D68 to assess its circulation in the community. EV-D68 was detected in seven of 27 raw samples. We collected data from clinical cases of EV-D68 (n = 17), HAV (n = 4) and HEV infection (n = 16) and compared wastewater-derived sequences with clinical sequences. We showed the silent circulation of EV-D68 in September 2015, the wide circulation of HAV despite few notifications of acute disease and the presence in wastewater of the major HEV subtypes involved in clinical local cases. Conclusion: The environmental surveillance overcomes the sampling bias intrinsic to the study of infections associated with hospitalisation and allows the detection in real time of viral sequences genetically close to those reported in clinical specimens.
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Affiliation(s)
- Maxime Bisseux
- CHU Clermont-Ferrand, Centre National de Référence Entérovirus et parechovirus - Laboratoire Associé, Laboratoire de Virologie, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France
| | - Jonathan Colombet
- Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France
| | - Audrey Mirand
- CHU Clermont-Ferrand, Centre National de Référence Entérovirus et parechovirus - Laboratoire Associé, Laboratoire de Virologie, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France
| | - Anne-Marie Roque-Afonso
- AP-HP, Hôpital Paul Brousse, Centre National de Référence Virus des hépatites à transmission entérique (hépatite A) - Laboratoire Associé, Laboratoire de Virologie, Villejuif, France
| | - Florence Abravanel
- CHU Toulouse, Centre National de Référence Virus des hépatites à transmission entérique (hépatite E) - Laboratoire Coordonnateur, Laboratoire de Virologie, Toulouse, France
| | - Jacques Izopet
- CHU Toulouse, Centre National de Référence Virus des hépatites à transmission entérique (hépatite E) - Laboratoire Coordonnateur, Laboratoire de Virologie, Toulouse, France
| | - Christine Archimbaud
- CHU Clermont-Ferrand, Centre National de Référence Entérovirus et parechovirus - Laboratoire Associé, Laboratoire de Virologie, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France
| | - Hélène Peigue-Lafeuille
- CHU Clermont-Ferrand, Centre National de Référence Entérovirus et parechovirus - Laboratoire Associé, Laboratoire de Virologie, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France
| | - Didier Debroas
- Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France
| | - Jean-Luc Bailly
- Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France
| | - Cécile Henquell
- CHU Clermont-Ferrand, Centre National de Référence Entérovirus et parechovirus - Laboratoire Associé, Laboratoire de Virologie, Clermont-Ferrand, France.,Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France
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11
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Lafolie J, Labbé A, L'Honneur AS, Madhi F, Pereira B, Decobert M, Adam MN, Gouraud F, Faibis F, Arditty F, Marque-Juillet S, Guitteny MA, Lagathu G, Verdan M, Rozenberg F, Mirand A, Peigue-Lafeuille H, Henquell C, Bailly JL, Archimbaud C. Assessment of blood enterovirus PCR testing in paediatric populations with fever without source, sepsis-like disease, or suspected meningitis: a prospective, multicentre, observational cohort study. Lancet Infect Dis 2018; 18:1385-1396. [PMID: 30389482 PMCID: PMC7164799 DOI: 10.1016/s1473-3099(18)30479-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/04/2018] [Accepted: 07/17/2018] [Indexed: 01/24/2023]
Abstract
Background Enteroviruses are the most frequent cause of acute meningitis and are seen increasingly in sepsis-like disease and fever without source in the paediatric population. Detection of enterovirus in cerebrospinal fluid (CSF) specimens by PCR is the gold standard diagnostic test. Our aim was to assess a method of detecting enterovirus in blood specimens by PCR. Methods We did a prospective, multicentre, observational study at 35 French paediatric and emergency departments in 16 hospitals. We recruited newborn babies (aged ≤28 days) and infants (aged >28 days to ≤2 years) with fever without source, sepsis-like disease, or suspected meningitis, and children (aged >2 years to ≤16 years) with suspected meningitis, who were admitted to a participating hospital. We used a standardised form to obtain demographic, clinical, and laboratory data, which were anonymised. Enterovirus PCR testing was done in blood and CSF specimens. Findings Between June 1, 2015, and Oct 31, 2015, and between June 1, 2016, and Oct 31, 2016, we enrolled 822 patients, of whom 672 had enterovirus PCR testing done in blood and CSF specimens. Enterovirus was detected in 317 (47%) patients in either blood or CSF, or both (71 newborn babies, 83 infants, and 163 children). Detection of enterovirus was more frequent in blood samples than in CSF specimens of newborn babies (70 [99%] of 71 vs 62 [87%] of 71; p=0·011) and infants (76 [92%] of 83 vs 62 [75%] of 83; p=0·008), and was less frequent in blood samples than in CSF specimens of children (90 [55%] of 163 vs 148 [91%] of 163; p<0·0001). Detection of enterovirus was more frequent in blood samples than in CSF specimens of infants aged 2 years or younger with fever without source (55 [100%] of 55 vs 41 [75%] of 55; p=0·0002) or with sepsis-like disease (16 [100%] of 16 vs nine [56%] of 16; p=0·008). Detection of enterovirus was less frequent in blood than in CSF of patients with suspected meningitis (165 [67%] of 246 vs 222 [90%] of 246; p<0·0001). Interpretation Testing for enterovirus in blood by PCR should be an integral part of clinical practice guidelines for infants aged 2 years or younger. This testing could decrease the length of hospital stay and reduce exposure to antibiotics for low-risk patients admitted to the emergency department with febrile illness. Funding University Hospital Clermont-Ferrand.
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Affiliation(s)
- Jérémy Lafolie
- Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Laboratory Microorganisms: Genome and Environment (LMGE), Clermont-Ferrand, France; Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence Entérovirus Parechovirus, Clermont-Ferrand, France
| | - André Labbé
- Service de Pédiatrie, Clermont-Ferrand, France
| | - Anne Sophie L'Honneur
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Virologie, Paris, France
| | - Fouad Madhi
- Centre Hospitalier Intercommunal Créteil, Service de Pédiatrie Générale, Créteil, France
| | - Bruno Pereira
- Délégation Recherche Clinique and Innovation, Méthodologie, Biostatistique, Data-management, Clermont-Ferrand, France
| | - Marion Decobert
- Groupe Hospitalier Nord Essonne, Service de Pédiatrie et Néonatologie, Orsay, France
| | - Marie Noelle Adam
- Centre Hospitalier Sud Francilien, Laboratoire de Microbiologie, Corbeil Essonnes, France
| | - François Gouraud
- Grand Hôpital de l'Est Francilien, Service de Pédiatrie, Meaux, France
| | | | - Francois Arditty
- Centre Hospitalier de Versailles André Mignot, Service de Pédiatrie, Le Chesnay, France
| | | | | | | | | | - Flore Rozenberg
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Service de Virologie, Paris, France
| | - Audrey Mirand
- Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Laboratory Microorganisms: Genome and Environment (LMGE), Clermont-Ferrand, France; Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence Entérovirus Parechovirus, Clermont-Ferrand, France
| | - Hélène Peigue-Lafeuille
- Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Laboratory Microorganisms: Genome and Environment (LMGE), Clermont-Ferrand, France; Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence Entérovirus Parechovirus, Clermont-Ferrand, France
| | - Cécile Henquell
- Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Laboratory Microorganisms: Genome and Environment (LMGE), Clermont-Ferrand, France; Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence Entérovirus Parechovirus, Clermont-Ferrand, France
| | - Jean-Luc Bailly
- Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Laboratory Microorganisms: Genome and Environment (LMGE), Clermont-Ferrand, France
| | - Christine Archimbaud
- Université Clermont Auvergne, Centre National de la Recherche Scientifique (CNRS), Laboratory Microorganisms: Genome and Environment (LMGE), Clermont-Ferrand, France; Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Laboratoire de Virologie, Centre National de Référence Entérovirus Parechovirus, Clermont-Ferrand, France.
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12
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Lafolie J, Mirand A, Salmona M, Lautrette A, Archimbaud C, Brebion A, Regagnon C, Chambon M, Mercier-Delarue S, Le Goff J, Henquell C. Severe Pneumonia Associated with Adenovirus Type 55 Infection, France, 2014. Emerg Infect Dis 2018; 22:2012-2014. [PMID: 27767916 PMCID: PMC5088017 DOI: 10.3201/eid2211.160728] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
MESH Headings
- Adenovirus Infections, Human/diagnosis
- Adenovirus Infections, Human/epidemiology
- Adenovirus Infections, Human/history
- Adenovirus Infections, Human/virology
- Adenoviruses, Human/classification
- Adenoviruses, Human/genetics
- France/epidemiology
- Genome, Bacterial
- Genotype
- History, 21st Century
- Humans
- Phylogeny
- Pneumonia, Viral/diagnosis
- Pneumonia, Viral/epidemiology
- Pneumonia, Viral/history
- Pneumonia, Viral/virology
- Severity of Illness Index
- Whole Genome Sequencing
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13
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Mirand A, le Sage FV, Pereira B, Cohen R, Levy C, Archimbaud C, Peigue-Lafeuille H, Bailly JL, Henquell C. Ambulatory Pediatric Surveillance of Hand, Foot and Mouth Disease as Signal of an Outbreak of Coxsackievirus A6 Infections, France, 2014-2015. Emerg Infect Dis 2018; 22:1884-1893. [PMID: 27767012 PMCID: PMC5088007 DOI: 10.3201/eid2211.160590] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Outbreaks can be detected by syndromic surveillance, rapid enterovirus testing, and genotyping. The clinical impact of enteroviruses associated with hand, foot and mouth disease (HFMD) is unknown outside Asia, and the prevalence of enterovirus A71 (EV-A71) in particular might be underestimated. To investigate the prevalence of enterovirus serotypes and the clinical presentations associated with HFMD in France, we conducted prospective ambulatory clinic–based surveillance of children during April 2014–March 2015. Throat or buccal swabs were collected from children with HFMD and tested for the enterovirus genome. Physical examinations were recorded on a standardized form. An enterovirus infection was detected in 523 (79.3%) of 659 children tested. Two epidemic waves occurred, dominated by coxsackievirus (CV) A6, which was detected in 53.9% of enterovirus-infected children. CV-A6 was more frequently related to atypical HFMD manifestations (eruptions extended to limbs and face). Early awareness and documentation of HFMD outbreaks can be achieved by syndromic surveillance of HFMD by ambulatory pediatricians and rapid enterovirus testing and genotyping.
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MESH Headings
- Adolescent
- Age Factors
- Child
- Child, Preschool
- Disease Outbreaks
- Enterovirus A, Human/classification
- Enterovirus A, Human/genetics
- Female
- France/epidemiology
- Hand, Foot and Mouth Disease/diagnosis
- Hand, Foot and Mouth Disease/epidemiology
- Hand, Foot and Mouth Disease/history
- Hand, Foot and Mouth Disease/virology
- History, 21st Century
- Humans
- Infant
- Infant, Newborn
- Male
- Molecular Typing
- Phylogeny
- Population Surveillance
- Prospective Studies
- RNA, Viral
- Serogroup
- Symptom Assessment
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14
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Hassel C, Mirand A, Lukashev A, TerletskaiaLadwig E, Farkas A, Schuffenecker I, Diedrich S, Huemer HP, Archimbaud C, Peigue-Lafeuille H, Henquell C, Bailly JL. Transmission patterns of human enterovirus 71 to, from and among European countries, 2003 to 2013. Euro Surveill 2015; 20:30005. [DOI: 10.2807/1560-7917.es.2015.20.34.30005] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 01/21/2015] [Indexed: 11/20/2022] Open
Abstract
Enterovirus 71 (EV-71) is involved in epidemics of hand, foot, and mouth disease (HFMD) and has been reported to occur with severe neurological complications in eastern and south-east Asia. In other geographical areas, the transmission of this virus is poorly understood. We used large sequence datasets (of the gene encoding the viral protein 1, VP1) and a Bayesian phylogenetic approach to compare the molecular epidemiology and geographical spread patterns of EV-71 subgenogroups B4, B5, C1, C2, and C4 in Europe relative to other parts of the world. For the study, European countries considered were European Union (EU) Member States and Iceland, Norway and Switzerland. Viruses of the B4, B5, and C4 subgenogroups circulate mainly in eastern and south-east Asia. In Europe sporadic introductions of these subgenogroups are observed, however C1 and C2 viruses predominate. The phylogenies showed evidence of multiple events of spread involving C1 and C2 viruses within Europe since the mid-1990s. Two waves of sporadic C2 infections also occurred in 2010 and 2013. The 2007 Dutch outbreak caused by C2 and the occurrence of B5 and C4 infections in the EU between 2004 and 2013 arose while the circulation of C1 viruses was low. A transmission chain involving a C4 virus was traced from Japan to the EU and then further to Canada between 2001 and 2006. Recent events whereby spread of viruses have occurred from, to, and within Europe appear to be involved in the long term survival of EV-71, highlighting the need for enhanced surveillance of this virus.
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Affiliation(s)
- Chervin Hassel
- Clermont Université, Université d’Auvergne, EPIE, EA 4843, Clermont-Ferrand, France
| | - Audrey Mirand
- Clermont Université, Université d’Auvergne, EPIE, EA 4843, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Service de Virologie, Centre National de Référence des Entérovirus et Paréchovirus – Laboratoire associé, Clermont-Ferrand, France
| | - Alexander Lukashev
- Chumakov Institute of Poliomyelitis and Viral Encephalitides, Moscow, Russia
| | - Elena TerletskaiaLadwig
- Prof. Gisela Enders & Kollegen MVZ GbR and Institute of Virology, Infectious Diseases and Epidemiology, Stuttgart, Germany
| | - Agnes Farkas
- Division of Virology, National Center for Epidemiology, Budapest, Hungary
| | - Isabelle Schuffenecker
- Laboratoire de Virologie Est des Hospices Civils de Lyon, Centre National de Référence des Entérovirus et Paréchovirus, Bron, France
| | - Sabine Diedrich
- National Reference Center for Poliomyelitis and Enterovirus, Robert Koch Institute, Berlin, Germany
| | | | - Christine Archimbaud
- Clermont Université, Université d’Auvergne, EPIE, EA 4843, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Service de Virologie, Centre National de Référence des Entérovirus et Paréchovirus – Laboratoire associé, Clermont-Ferrand, France
| | - Hélène Peigue-Lafeuille
- Clermont Université, Université d’Auvergne, EPIE, EA 4843, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Service de Virologie, Centre National de Référence des Entérovirus et Paréchovirus – Laboratoire associé, Clermont-Ferrand, France
| | - Cécile Henquell
- Clermont Université, Université d’Auvergne, EPIE, EA 4843, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Service de Virologie, Centre National de Référence des Entérovirus et Paréchovirus – Laboratoire associé, Clermont-Ferrand, France
| | - Jean-Luc Bailly
- Clermont Université, Université d’Auvergne, EPIE, EA 4843, Clermont-Ferrand, France
- CHU Clermont-Ferrand, Service de Virologie, Centre National de Référence des Entérovirus et Paréchovirus – Laboratoire associé, Clermont-Ferrand, France
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15
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Volle R, Archimbaud C, Couraud PO, Romero IA, Weksler B, Mirand A, Pereira B, Henquell C, Peigue-Lafeuille H, Bailly JL. Differential permissivity of human cerebrovascular endothelial cells to enterovirus infection and specificities of serotype EV-A71 in crossing an in vitro model of the human blood-brain barrier. J Gen Virol 2015; 96:1682-95. [PMID: 25711966 DOI: 10.1099/vir.0.000103] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Human cerebral microvascular endothelial cells (hCMEC/D3 cell line) form a steady polarized barrier when cultured in vitro on a permeable membrane. Their susceptibility to enterovirus (EV) strains was analysed to investigate how these viruses may cross the blood-brain barrier. A sample of 88 virus strains was selected on phylogenetic features amongst 43 epidemiologically relevant types of the four EV species A-D. The EV-A71 genome was replicated at substantial rates, whilst the infectious virus was released at extremely low but sustained rates at both barrier sides for at least 4 days. EV-A71 antigens were detected in a limited number of cells. The properties of the endothelial barrier (structure and permeability) remained intact throughout infection. The chronic EV-A71 infection was in sharp contrast to the productive infection of cytolytic EVs (e.g. echoviruses E-6 and E-30). The hCMEC/D3 barriers infected with the latter EVs exhibited elevated proportions of apoptotic and necrotic cells, which resulted in major injuries to the endothelial barriers with a dramatic increase of paracellular permeability and virus crossing to the abluminal side. The following intracellular rearrangements were also seen: early destruction of the actin cytoskeleton, remodelling of intracellular membranes and reorganization of the mitochondrion network in a small cluster near the perinuclear space.
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Affiliation(s)
- Romain Volle
- 1Clermont Université, Université d'Auvergne, EPIE, EA 4843, Clermont-Ferrand, France 2CHU Clermont-Ferrand, Service de Virologie, Clermont-Ferrand, France
| | - Christine Archimbaud
- 1Clermont Université, Université d'Auvergne, EPIE, EA 4843, Clermont-Ferrand, France 2CHU Clermont-Ferrand, Service de Virologie, Clermont-Ferrand, France
| | | | - Ignacio A Romero
- 5Department of Life, Health and Chemical Sciences, Open University, Milton Keynes, UK
| | | | - Audrey Mirand
- 1Clermont Université, Université d'Auvergne, EPIE, EA 4843, Clermont-Ferrand, France 2CHU Clermont-Ferrand, Service de Virologie, Clermont-Ferrand, France
| | - Bruno Pereira
- 3CHU Clermont-Ferrand, DRCI, Clermont-Ferrand, France
| | - Cécile Henquell
- 2CHU Clermont-Ferrand, Service de Virologie, Clermont-Ferrand, France
| | - Hélène Peigue-Lafeuille
- 1Clermont Université, Université d'Auvergne, EPIE, EA 4843, Clermont-Ferrand, France 2CHU Clermont-Ferrand, Service de Virologie, Clermont-Ferrand, France
| | - Jean-Luc Bailly
- 1Clermont Université, Université d'Auvergne, EPIE, EA 4843, Clermont-Ferrand, France 2CHU Clermont-Ferrand, Service de Virologie, Clermont-Ferrand, France
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Peigue-Lafeuille H, Mirand A, Archimbaud C, Bailly JL, Henquell C. Emerging and reemerging enterovirus diseases: From poliomyelitis to hand, foot and mouth disease. Virologie (Montrouge) 2014; 18:87-104. [PMID: 33065878 DOI: 10.1684/vir.2014.0563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Several picornaviruses (Picornaviridae) are currently attracting interest without the need of being "emergent". The Parechovirus genus, validated 40 years after the discovery of the first two members ("echoviruses 22 and 23") includes neurotropic viruses whose molecular diagnosis demonstrated the involvement in infant meningitis and newborn sepsis, in particular type 3. Improvements in multiplex molecular diagnosis of respiratory infections - thanks to the Influenza AH1N1pdm2009 pandemy - showed that rhinoviruses may be involved in severe forms. The risk of the re-emergence of poliomyelitis in Europe, after an 11-year period of elimination, is a serious threat, owing to the circulation of the wild-type poliovirus in the Middle East and Africa because of conflicts, population displacements and poverty. The current widespread epidemics of hand-foot-mouth disease and/or meningitis infections due to enterovirus 71, with fatal encephalitis and cardio-pulmonary failure, are clear evidence of its emergence in South-East Asia. Although uncommon in Europe and less frequently incriminated than coxsackieviruses A6 and A10 in hand-foot-mouth disease, EV71 represents a real risk for the future. Extensive genotyping of the enteroviruses by the Enterovirus Surveillance Network should ward off these two potential risks of emergence/reemergence.
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Affiliation(s)
- Hélène Peigue-Lafeuille
- Service de virologie, CNR des entérovirus et parechovirus (Laboratoire associé), CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand cedex, France, Laboratoire de virologie, Équipe d'accueil 4843 « épidémiologie et pathogénie des infections à entérovirus », Faculté de médecine, Université d'Auvergne Clermont 1, 28, place Henri-Dunant, 63001 Clermont-Ferrand, France
| | - Audrey Mirand
- Service de virologie, CNR des entérovirus et parechovirus (Laboratoire associé), CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand cedex, France, Laboratoire de virologie, Équipe d'accueil 4843 « épidémiologie et pathogénie des infections à entérovirus », Faculté de médecine, Université d'Auvergne Clermont 1, 28, place Henri-Dunant, 63001 Clermont-Ferrand, France
| | - Christine Archimbaud
- Service de virologie, CNR des entérovirus et parechovirus (Laboratoire associé), CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand cedex, France, Laboratoire de virologie, Équipe d'accueil 4843 « épidémiologie et pathogénie des infections à entérovirus », Faculté de médecine, Université d'Auvergne Clermont 1, 28, place Henri-Dunant, 63001 Clermont-Ferrand, France
| | - Jean-Luc Bailly
- Laboratoire de virologie, Équipe d'accueil 4843 « épidémiologie et pathogénie des infections à entérovirus », Faculté de médecine, Université d'Auvergne Clermont 1, 28, place Henri-Dunant, 63001 Clermont-Ferrand, France
| | - Cécile Henquell
- Service de virologie, CNR des entérovirus et parechovirus (Laboratoire associé), CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand cedex, France
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Volle R, Bailly JL, Mirand A, Pereira B, Marque-Juillet S, Chambon M, Regagnon C, Brebion A, Henquell C, Peigue-Lafeuille H, Archimbaud C. Variations in Cerebrospinal Fluid Viral Loads Among Enterovirus Genotypes in Patients Hospitalized With Laboratory-Confirmed Meningitis Due to Enterovirus. J Infect Dis 2014; 210:576-84. [DOI: 10.1093/infdis/jiu178] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Archimbaud C, Ouchchane L, Mirand A, Chambon M, Demeocq F, Labbé A, Laurichesse H, Schmidt J, Clavelou P, Aumaître O, Regagnon C, Bailly JL, Henquell C, Peigue-Lafeuille H. Improvement of the management of infants, children and adults with a molecular diagnosis of Enterovirus meningitis during two observational study periods. PLoS One 2013; 8:e68571. [PMID: 23874676 PMCID: PMC3708915 DOI: 10.1371/journal.pone.0068571] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 05/29/2013] [Indexed: 12/02/2022] Open
Abstract
Enteroviruses (EVs) are a major cause of aseptic meningitis, and RNA detection using molecular assay is the gold standard diagnostic test. The aim of this study was to assess the impact of an EV positive diagnosis on the clinical management of patients admitted for meningitis over the course of two observational study periods (2005 and 2008–09) in the same clinical departments. We further investigated in multivariate analysis various factors possibly associated with hospital length of stay (LOS) in all age groups (infants, children, and adults). The results showed an overall improvement in the management of patients (n = 142) between the study periods, resulting in a significantly shorter hospital LOS for adults and children, and a shorter duration of antibiotic use for adults and infants. In multivariate analysis, we observed that the time from molecular test results to discharge of patients and the median duration of antibiotic treatment were associated with an increase in LOS in all age groups. In addition, among adults, the turnaround time of the molecular assay was significantly correlated with LOS. The use of CT scan in children and hospital admission outside the peak of EV prevalence in infants tended to increase LOS. In conclusion, the shorter length of stay of patients with meningitis in this study was due to various factors including the rapidity of the EV molecular test (particularly in adults), greater physician responsiveness after a positive result (in adults and children), and greater experience on the part of physicians in handling EV meningitis, as evidenced by the shorter duration of antibiotic use in adults and infants.
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Affiliation(s)
- Christine Archimbaud
- Université d'Auvergne, Laboratoire de Virologie - EPIE EA4843, Clermont-Ferrand, France.
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Mirand A, Archimbaud C, Chambon M, Regagnon C, Brebion A, Bailly JL, Peigue-Lafeuille H, Henquell C. Diagnosis of human parechovirus infections of the central nervous system with a commercial real-time reverse transcription–polymerase chain reaction kit and direct genotyping of cerebrospinal fluid specimens. Diagn Microbiol Infect Dis 2012; 74:78-80. [DOI: 10.1016/j.diagmicrobio.2012.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 05/10/2012] [Accepted: 05/13/2012] [Indexed: 11/16/2022]
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Mirand A, Henquell C, Archimbaud C, Ughetto S, Antona D, Bailly JL, Peigue-Lafeuille H. Outbreak of hand, foot and mouth disease/herpangina associated with coxsackievirus A6 and A10 infections in 2010, France: a large citywide, prospective observational study. Clin Microbiol Infect 2012; 18:E110-8. [PMID: 22404077 DOI: 10.1111/j.1469-0691.2012.03789.x] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hand, foot and mouth disease (HFMD) and herpangina (HA) are frequently caused by several distinct serotypes belonging to the human enterovirus A species (HEVA). Enterovirus 71 is considered as a significant public health threat because of rare but fatal neurological complications. A sentinel surveillance system involving paediatricians from Clermont-Ferrand (France) was set up to determine the clinical and epidemiological characteristics of HFMD/HA associated with enterovirus infections. A standardized report form was used to collect demographic and clinical data. Throat or buccal specimens were obtained prospectively and tested for the presence of enteroviruses. The frequency of HEVA serotypes was determined by genotyping. Phylogenetic relationships were analysed to identify potential new virus variants. From 1 April to 31 December 2010, a total of 222 children were enrolled. The predominant clinical presentation was HA (63.8%) and this was frequently associated with clinical signs of HFMD (48%). An enterovirus infection was diagnosed in 143 (64.4%) patients and serotype identification was achieved in 141/143 (98.6%). The predominant serotypes were coxsackievirus A10 (39.9%) and A6 (28%), followed by coxsackievirus A16 (17.5%) and enterovirus 71 (6.3%). Fever was observed in 115 (80.4%) children. No patient had neurological complications. Coxsackievirus A10 and A6 strains involved in the outbreak were consistently genetically related with those detected earlier in Finland and constituted distinct European lineages. Although several enterovirus serotypes have been involved in HFMD/HA cases, the outbreak described in this population survey was caused by coxsackievirus A6 and coxsackievirus A10, the third dual outbreak in Europe in the last 3 years.
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Affiliation(s)
- A Mirand
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre de Biologie, Clermont-Ferrand, France.
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Schuffenecker I, Mirand A, Antona D, Henquell C, Chomel JJ, Archimbaud C, Billaud G, Peigue-Lafeuille H, Lina B, Bailly JL. Epidemiology of human enterovirus 71 infections in France, 2000-2009. J Clin Virol 2010; 50:50-6. [PMID: 21035387 DOI: 10.1016/j.jcv.2010.09.019] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 09/24/2010] [Accepted: 09/29/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Human enterovirus 71 (EV-71) emerged as a significant pathogen able to cause large outbreaks involving severe neurological cases and children fatalities in Asia. OBJECTIVES To describe epidemiology of EV-71 infections in France. STUDY DESIGN Fifty-nine patients admitted in 12 different hospitals from 1994 to 2009 were included. The entire VP1 coding gene of 58 EV-71 strains was sequenced and phylogenetic analyses were performed to assign strains to genogroups/subgenogroups and to compare French isolates to European and worldwide isolates. RESULTS The median age of the patients was 1.04 years (9 days to 7 years). Among 46 documented EV-71 infections, 39 were self-limited. Seven children developed severe sepsis-like, respiratory or neurological complications. Among them, 2 children died from acute respiratory distress syndrome. All the EV-71 strains belonged to genogroup C: 31 isolates belonged to subgenogroup C1, 26 to subgenogroup C2 and 1 to subgenogroup C4. All the strains were genetically related to other European strains isolated at the same period of time. Although C1 isolates were predominant between 1994 and 2005, C2 strains have been predominant since 2007. No association was found between any genotype and the age or the clinical symptoms. CONCLUSIONS The C4 subgenogroup, which was associated with large outbreaks in China, did not spread in France. It is important to monitor more carefully the EV-71 strains circulating in France to detect the introduction of new genetic variants that could be associated with major outbreaks.
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Affiliation(s)
- Isabelle Schuffenecker
- Centre National de Référence des Entérovirus, Laboratoire de Virologie Est des Hospices Civils de Lyon, Groupement Hospitalier Est, 59 boulevard Pinel, F-69677 Bron Cedex, France.
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Bailly JL, Mirand A, Henquell C, Archimbaud C, Chambon M, Regagnon C, Charbonné F, Peigue-Lafeuille H. Repeated genomic transfers from echovirus 30 to echovirus 6 lineages indicate co-divergence between co-circulating populations of the two human enterovirus serotypes. Infect Genet Evol 2010; 11:276-89. [PMID: 20615482 DOI: 10.1016/j.meegid.2010.06.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Revised: 06/07/2010] [Accepted: 06/25/2010] [Indexed: 10/19/2022]
Abstract
Human echovirus types 6 (E-6) and 30 (E-30) cause seasonal epidemics of aseptic meningitis. These two enteroviruses are frequently observed in co-circulation, an epidemiological pattern that is prerequisite for the occurrence of dual infections, which can lead to recombination between co-infecting virus strains. Viral sequences were determined at loci 1D (VP1 capsid protein) and 3CD (non structural proteins) in 49 E-6 strains recovered in a single geographical region in France from 1999 to 2007, during the epidemiological survey of enterovirus infections. They were compared with previously recorded sequences of E-30 strains to investigate their evolutionary histories and possible recombination patterns. Phylogenetic analyses identified two distinct E-6 populations and different subpopulations. Assuming a relaxed molecular clock model and a Bayesian skyline demographic model in coalescent analyses with the BEAST program, the substitution rate in E-6 was estimated at 8.597×10(-3) and 6.252×10(-3) substitution/site/year for loci 1D and 3CD respectively. Consistent estimates of divergence times (t(MRCA)) were obtained for loci 1D and 3CD indicating that two distinct E-6 populations originated in 1997 and 1999. Incongruent phylogenetic patterns inferred for the two loci were indicative of recombination events between the two populations. Phylogenies including the E-30 3CD sequences showed close genetic relationships between E-6 and discrete E-30 subpopulations. Recombination breakpoints were located with statistical significance in E-6 and E-30 genomes. Estimates of t(MRCA) of phylogenetic recombinant clades indicated directional genetic transfers from E-30 to E-6 populations and their co-divergence over the time period studied.
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Affiliation(s)
- J-L Bailly
- Clermont Université, Université d'Auvergne, EA 3843, BP 10448, F-63000 Clermont-Ferrand, France.
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Mirand A, Schuffenecker I, Henquell C, Billaud G, Jugie G, Falcon D, Mahul A, Archimbaud C, Terletskaia-Ladwig E, Diedrich S, Huemer HP, Enders M, Lina B, Peigue-Lafeuille H, Bailly JL. Phylogenetic evidence for a recent spread of two populations of human enterovirus 71 in European countries. J Gen Virol 2010; 91:2263-77. [PMID: 20505012 DOI: 10.1099/vir.0.021741-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Human enterovirus 71 (EV-71) is a cause of seasonal epidemics of hand, foot and mouth disease, and of less common but severe neurological manifestations. Uncertainty persists regarding the circulation of virus populations in several geographical areas and the timescale of their dissemination. We determined EV-71 sequences at loci 1D (VP1 capsid protein) and 3CD (non-structural proteins) in 86 strains recovered in Austria, France and Germany and performed an evolutionary genetic study of extant virus populations. Phylogenetic analyses positioned 78 of the 86 sequences within two clades among subgenogroups C1 and C2. A minor sequence cluster was assigned to subgenogroup C4. Analyses incorporating the available sequences estimated the substitution rate in genogroup C at 3.66 x 10(-3) and 4.46 x 10(-3) substitutions per site year(-1) for loci 1D and 3CD, respectively, assuming a relaxed molecular-clock model for sequence evolution. Most of the 'European' strains belonged to clades C1b and C2b, which originated in 1994 [95 % confidence interval (CI), 1992.7-1995.8] and 2002 (95 % CI, 2001.6-2003.8), respectively. Estimates of divergence times for locus 3CD were consistent with those measured for locus 1D. Intertwining between clades representing EV-71 subgenogroups and clades corresponding to other enterovirus types (notably early coxsackievirus A prototype strains) in the 3CD phylogeny is highly indicative of ancestral recombination events. Incongruent phylogenetic patterns estimated for loci 1D and 3CD show that a single tree cannot model the epidemic history of circulating EV-71 populations. The evolutionary timescale of genogroup C estimated for both loci was measured only in decades, indicating recent dissemination.
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Affiliation(s)
- A Mirand
- Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
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Mirand A, Rouveyrol F, Chambon M, Archimbaud C, Regagnon C, Bailly JL, Peigue-Lafeuille H, Henquell C. Enterovirus genotyping directly from original clinical specimens: prospective application to a severe neonatal infection. J Clin Virol 2008; 44:177-8. [PMID: 19101198 DOI: 10.1016/j.jcv.2008.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Revised: 11/06/2008] [Accepted: 11/07/2008] [Indexed: 11/28/2022]
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Archimbaud C, Chambon M, Bailly JL, Petit I, Henquell C, Mirand A, Aublet-Cuvelier B, Ughetto S, Beytout J, Clavelou P, Labbé A, Philippe P, Schmidt J, Regagnon C, Traore O, Peigue-Lafeuille H. Impact of rapid enterovirus molecular diagnosis on the management of infants, children, and adults with aseptic meningitis. J Med Virol 2008; 81:42-8. [PMID: 19031461 DOI: 10.1002/jmv.21330] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Enteroviruses (EV) are the main etiological agents of aseptic meningitis. Diagnosis is made by detecting the genome using RT-PCR. The aim of the study was to evaluate the impact of a positive diagnosis on the management of infants, children, and adults. During 2005, 442 patients were admitted to hospital with suspected meningitis. Clinical and laboratory data and initial treatment were recorded for all patients with enteroviral meningitis. The turnaround time of tests and the length of hospital stay were analyzed. The results showed that EV-PCR detected EV in 69 patients (16%), 23% (16/69) were adults. About 18% of CSF samples had no pleocytosis. After positive PCR results, 63% of children were discharged immediately (mean 2 hr 30 min) and 95% within 24 hr. Infants and adults were discharged later (after 1.8 and 2 days, respectively). The use of antibiotics was significantly lower in children than in infants and adults. The PCR results allowed discontinuation of antibiotics in 50-60% of all patients treated. Patients received acyclovir in 16% of cases (7% children vs. 50% adults) and 23% (11% vs. 69%) underwent a CT scan. Clinical data were compared between patients whose positive EV-PCR results were available within 24 hr (n = 32) and those whose results were available > 24 hr after collection of CSF (n = 14). Duration of antibiotic treatment (difference: 2.3 days; P = 0.05) was reduced between the two groups. No statistical difference in the length of stay was observed. The EV-PCR assay should be performed daily in hospital laboratory practice and considered as part of the initial management of meningitis.
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Affiliation(s)
- C Archimbaud
- CHU Clermont-Ferrand, Centre de Biologie, Laboratoire de Virologie, Hopital G Montpied, Clermont-Ferrand, France.
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Bailly JL, Mirand A, Henquell C, Archimbaud C, Chambon M, Charbonné F, Traoré O, Peigue-Lafeuille H. Phylogeography of circulating populations of human echovirus 30 over 50 years: nucleotide polymorphism and signature of purifying selection in the VP1 capsid protein gene. Infect Genet Evol 2008; 9:699-708. [PMID: 18595781 DOI: 10.1016/j.meegid.2008.04.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Revised: 04/27/2008] [Accepted: 04/30/2008] [Indexed: 10/22/2022]
Abstract
A comprehensive set of 443 1D gene sequences (encoding the VP1 capsid protein) was analyzed to investigate the phylogenetic relationships and evolutionary patterns among strains of human echovirus 30 (E30; genus Enterovirus, family Picornaviridae) characterized over 50 years. Maximum-likelihood (ML) phylogenetic trees of complete and nonredundant 1D gene sequences (total length=876 nucleotides) showed evidence of distinct lineages related to the isolation period of virus strains. Virus transportation was confirmed as a major epidemiological factor in the appearance of epidemics since recurrence of aseptic meningitis outbreaks in a given geographic area was associated with distinct E30 variants detected earlier in distant regions. Detection of the codon changes associated with E30 evolution was investigated with methods implemented in the Datamonkey web server. Evolution of the 1D gene was dominated by continual negative (purifying) selection against nonsynonymous substitutions at most codon sites, as determined by dN/dS ratio. Amino acid polymorphism was maintained at a limited number of sites (10/292) in the VP1 protein (within loops connecting beta strands and C-terminus). Amino acid changes are allowed at these sites because they are likely exposed on the virion particle and nonsynonymous substitutions are observed in the corresponding codons because negative selection is relaxed.
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Affiliation(s)
- J-L Bailly
- Université d'Auvergne, Laboratoire de Virologie-EA3843, UFR Médecine, Clermont-Ferrand, France.
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Bailly JL, Mirand A, Henquell C, Archimbaud C, Chambon M, Charbonné F, Traoré O, Peigue-Lafeuille H. [Genotyping and molecular epidemiology of non polyomyelitic enteroviruses]. Virologie (Montrouge) 2008; 12:53-65. [PMID: 36131434 DOI: 10.1684/12-1.2011.10007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Nonpolio enteroviruses can be reliably identified with molecular and computer tools for taxonomic, diagnostic and epidemiologic purposes. Seroneutralization tests can efficiently be replaced by genotyping assays using the VP1 capsid protein encoding gene to identify enterovirus strains isolated in cell cultures. Genotyping showed the close genetic relatedness between human enterovirus serotypes and animal enteroviruses and also rhinoviruses currently classified in a separate genus within the Picornaviridae family. Enterovirus genotyping can be done prospectively within 2 to 5 days in a greater number of meningitis patients, using cerebrospinal fluid specimens and hence can help in providing a prompt response to health alert. In the molecular epidemiology of human enteroviruses, recent advances were made by investigating genetic diversity within individual serotypes (genotypes, lineages) and the patterns of circulation and transmission of virus variants involved in epidemics (echovirus 30, enterovirus 71). The observation of epidemiologic features such as the frequent viral immigration of strains from different geographical origins speaks in favour of developing molecular identification of enteroviruses. Recombinant enterovirus strains can also be identified by genotyping. Homologous recombination is a major contributor to the genetic diversity in enteroviruses. Molecular signatures of recombination events are observed in circulating strains, suggesting the occurrence of frequent co-infections during their circulation within the general population. The role of genetic recombination in the emergence of virus variants and its involvement in the epidemiology of human enteroviruses should be investigated.
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Affiliation(s)
- J-L Bailly
- Université d'Auvergne, Laboratoire de virologie EA 3843, UFR Médecine, 28 place Henri-Dunant, 63001 Clermont-Ferrand
| | - A Mirand
- Université d'Auvergne, Laboratoire de virologie EA 3843, UFR Médecine, 28 place Henri-Dunant, 63001 Clermont-Ferrand, CHU, Laboratoire de virologie, Centre de Biologie, 63003 Clermont-Ferrand
| | - C Henquell
- CHU, Laboratoire de virologie, Centre de Biologie, 63003 Clermont-Ferrand
| | - C Archimbaud
- Université d'Auvergne, Laboratoire de virologie EA 3843, UFR Médecine, 28 place Henri-Dunant, 63001 Clermont-Ferrand, CHU, Laboratoire de virologie, Centre de Biologie, 63003 Clermont-Ferrand
| | - M Chambon
- Université d'Auvergne, Laboratoire de virologie EA 3843, UFR Médecine, 28 place Henri-Dunant, 63001 Clermont-Ferrand, CHU, Laboratoire de virologie, Centre de Biologie, 63003 Clermont-Ferrand
| | - F Charbonné
- Université d'Auvergne, Laboratoire de virologie EA 3843, UFR Médecine, 28 place Henri-Dunant, 63001 Clermont-Ferrand, CHU, Laboratoire de virologie, Centre de Biologie, 63003 Clermont-Ferrand
| | - O Traoré
- CHU, Laboratoire d'hygiène hospitalière, Centre de Biologie, 63003 Clermont-Ferrand
| | - H Peigue-Lafeuille
- Université d'Auvergne, Laboratoire de virologie EA 3843, UFR Médecine, 28 place Henri-Dunant, 63001 Clermont-Ferrand, CHU, Laboratoire de virologie, Centre de Biologie, 63003 Clermont-Ferrand
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28
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Mirand A, Henquell C, Archimbaud C, Chambon M, Charbonne F, Peigue-Lafeuille H, Bailly JL. Prospective identification of enteroviruses involved in meningitis in 2006 through direct genotyping in cerebrospinal fluid. J Clin Microbiol 2008; 46:87-96. [PMID: 17977989 PMCID: PMC2224282 DOI: 10.1128/jcm.01020-07] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 08/27/2007] [Accepted: 10/24/2007] [Indexed: 11/20/2022] Open
Abstract
Enterovirus infections were investigated with special emphasis on performing rapid molecular identification of enterovirus serotypes responsible for aseptic meningitis directly in cerebrospinal fluid (CSF). Enterovirus genotyping was carried out directly with specimens tested for the diagnostic procedure, using two seminested PCR assays designed to amplify the complete and partial gene sequences encoding the VP1 and VP4/VP2 capsid proteins, respectively. The method was used for identifying the enterovirus serotypes involved in meningitis in 45 patients admitted in 2005. Enterovirus genotyping was achieved in 98% of the patients studied, and we obtained evidence of 10 of the most frequent serotypes identified earlier by genotyping of virus isolates. The method was applied for the prospective investigation of 54 patients with meningitis admitted consecutively in 2006. The enterovirus serotypes involved were identified with the cerebrospinal fluid (CSF) of 52 patients (96%) and comprised 13 serotypes within the human enterovirus B species and 1 within the human enterovirus A species. The three most common serotypes were echovirus 13 (E13; 24%), E6 (23%), and coxsackievirus B5 (11.5%), a pattern different from that observed in 2005. Genotyping of virus isolates was also performed in 35 patients in 2006 (meningitis, n = 31; other diseases, n = 4). By comparison, direct genotyping in CSF yielded a more complete pattern of enterovirus serotypes, thereby allowing the detection of rare serotypes: three less common serotypes (CB2, E21, and E27) were not detected by indirect genotyping alone. The study shows the feasibility of prospective enterovirus genotyping within 1 week in a laboratory setting.
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MESH Headings
- Aged
- Capsid Proteins/genetics
- Cerebrospinal Fluid/virology
- DNA, Viral/chemistry
- DNA, Viral/genetics
- Enterovirus A, Human/classification
- Enterovirus A, Human/genetics
- Enterovirus A, Human/isolation & purification
- Enterovirus B, Human/classification
- Enterovirus B, Human/genetics
- Enterovirus B, Human/isolation & purification
- Enterovirus Infections/virology
- Female
- Genotype
- Humans
- Infant
- Male
- Meningitis, Viral/virology
- Molecular Sequence Data
- Polymerase Chain Reaction/methods
- Prospective Studies
- RNA, Viral/genetics
- Sequence Analysis, DNA
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Affiliation(s)
- Audrey Mirand
- Centre de Biologie-CHRU Clermont Ferrand, Laboratoire de Virologie, 58, Rue Montalembert, 63003 Clermont-Ferrand, France.
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29
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Mirand A, Henquell C, Archimbaud C, Peigue-Lafeuille H, Bailly JL. Emergence of recent echovirus 30 lineages is marked by serial genetic recombination events. J Gen Virol 2007; 88:166-176. [PMID: 17170449 DOI: 10.1099/vir.0.82146-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
In an earlier report, different variants of echovirus 30 (E-30), an enterovirus serotype, were identified during two outbreaks in 1997 and 2000. Here, the diversity of E-30 was investigated over a longer period (1991–2005) and the variations in four genomic segments were determined in 52 isolates involved in meningitis cases, to characterize the evolutionary processes underlying the emergence of lineages. Phylogenetic analysis of the VP1 sequences showed that five phylogenetic variants succeeded one another. When a partial 3CD segment was examined, the five variants split further into 10 lineages. Phylogenetic groupings observed with both the VP1 and 3CD sequences were clearly related to the calendar time of virus isolation. The rapid turnover of lineages during the study period was not associated with variations in amino acid residues in either the VP1 or the 3CD sequences, indicating major evolutionary contraints in E-30. The variation patterns were examined further along a subgenomic segment of 4878 nt in 13 virus isolates, representative of the 10 lineages. Breakpoints detected in the similarity profiles were investigated by bootscanning and maximum-likelihood phylogenetic analysis of virus genes. Evidence of several past recombination events was observed in the middle of the genome and predicted recombination crossover sites were mapped with precision. The contribution of recombination to the evolution of E-30 is substantial. It is associated tightly with the emergence of new genetic lineages and certain recombinants have undergone epidemic spread.
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Affiliation(s)
- Audrey Mirand
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre de Biologie, F-63003 Clermont-Ferrand, France
- Université d'Auvergne, Laboratoire de Virologie-EA3843, UFR Médecine, 28 place Henri-Dunant, F-63001 Clermont-Ferrand, France
| | - Cécile Henquell
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre de Biologie, F-63003 Clermont-Ferrand, France
| | - Christine Archimbaud
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre de Biologie, F-63003 Clermont-Ferrand, France
- Université d'Auvergne, Laboratoire de Virologie-EA3843, UFR Médecine, 28 place Henri-Dunant, F-63001 Clermont-Ferrand, France
| | - Hélène Peigue-Lafeuille
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre de Biologie, F-63003 Clermont-Ferrand, France
- Université d'Auvergne, Laboratoire de Virologie-EA3843, UFR Médecine, 28 place Henri-Dunant, F-63001 Clermont-Ferrand, France
| | - Jean-Luc Bailly
- Université d'Auvergne, Laboratoire de Virologie-EA3843, UFR Médecine, 28 place Henri-Dunant, F-63001 Clermont-Ferrand, France
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30
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Regagnon C, Chambon M, Archimbaud C, Charbonné F, Demeocq F, Labbé A, Aumaître O, Ughetto S, Peigue-Lafeuille H, Henquell C. Diagnostic rapide des infections à rotavirus : étude prospective comparative de deux techniques de détection d'antigènes dans les selles. ACTA ACUST UNITED AC 2006; 54:343-6. [PMID: 16481124 DOI: 10.1016/j.patbio.2005.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Accepted: 12/01/2005] [Indexed: 11/24/2022]
Abstract
The ability of two commercially available diagnosis rapid assays in detecting rotavirus antigen was compared in a prospective study conducted from September 2002 to May 2003. Five hundred and twelve faecal specimens were studied by IDEIA Rotavirus enzyme immunoassay test (EIA) and Diarlex MB immunochromatographic test (ICG). Specimens giving discrepant results were examined by electron microscopy (EM) and clinical data reconsidered. Out of 512 stool specimens, 155 (30.3%) were positive and 332 (64.8%) negative with the two assays. Discrepant results were obtained for 25 (4.88%) specimens (24 children, 1 adult), with EIA giving more positive results. The retrospective examination by EM, possible for fifteen stools on the 25 that gave discrepant results, confirmed the presence of rotavirus in 7/14 stools which were positive only by EIA and in the stool specimen that was found positive only by ICG. The 25 clinical observations re-examination showed the presence of GEA signs in all cases. The statistical analysis shows an excellent concordance between the EIA and the ICG tests (kappa = 0.89, IC(95%) = [0.85-0.93]) in spite of the underestimation of ICG test in comparison with EIA test (P < 0.0001).
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Affiliation(s)
- C Regagnon
- Service de virologie médicale, centre de biologie, CHU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand, France.
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31
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Peigue-Lafeuille H, Archimbaud C, Mirand A, Chambon M, Regagnon C, Laurichesse H, Clavelou P, Labbé A, Bailly JL, Henquell C. Du diagnostic moléculaire initial prospectif des méningites à entérovirus⋯ à la lutte contre l'antibiorésistance. Med Mal Infect 2006; 36:124-31. [PMID: 16480842 DOI: 10.1016/j.medmal.2005.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Accepted: 12/06/2005] [Indexed: 10/25/2022]
Abstract
Meningitis initially presents with intense manifestations that are not generally specific to a given etiology. The first major question for the physician is to decide whether to initiate a probabilistic treatment. Enteroviruses are a major cause of aseptic meningitis, which is benign in immunocompetent patients. Molecular diagnosis is now becoming the gold standard and its prospective use at the time of patient admission, on the sole basis of clinical suspicion of meningitis, has yielded more reliable data. Cytological and biochemical data from CSF analyses are of low predictive value to influence the initial decision to treat with antibiotics. In addition, cases of meningitis during winter are not uncommon. Adults are concerned in about 25% of cases. Thus, if molecular diagnostic tools are not rapidly available, patient management may be inconsistent, leading to unnecessary scans, laboratory investigations and treatment (including overconsumption of antibiotics). Current progress in the automation and practicability of viral genomic detection yields the result within a few hours after admission. Rapid molecular viral diagnosis of a benign disease that does not require treatment but which is initially worrying is of unquestionable advantage. It is of benefit to both the patient and the community because of its input on health economics, the needless consumption of drugs and, as a result, resistance to antibiotics. The diagnosis of meningitis can no longer remain a retrospective diagnosis after elimination of all the possible causes, since not prescribing unnecessary laboratory tests and not treating are true therapeutic decisions.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents/therapeutic use
- Case Management
- Cerebrospinal Fluid/virology
- Child
- Child, Preschool
- Diagnosis, Differential
- Drug Resistance
- Drug Utilization
- Early Diagnosis
- Encephalitis, Herpes Simplex/diagnosis
- Enterovirus/isolation & purification
- Enterovirus Infections/cerebrospinal fluid
- Enterovirus Infections/diagnosis
- Enterovirus Infections/epidemiology
- Enterovirus Infections/therapy
- France/epidemiology
- Genome, Viral
- Humans
- Incidence
- Infant
- Meningitis, Aseptic/cerebrospinal fluid
- Meningitis, Aseptic/diagnosis
- Meningitis, Aseptic/epidemiology
- Meningitis, Aseptic/therapy
- Middle Aged
- RNA, Viral/cerebrospinal fluid
- Reverse Transcriptase Polymerase Chain Reaction
- Unnecessary Procedures
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Affiliation(s)
- H Peigue-Lafeuille
- Laboratoire de virologie, centre de biologie, CHRU de Clermont-Ferrand, 58, rue Montalembert, 63003 Clermont-Ferrand cedex, France.
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32
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Mirand A, Archimbaud C, Henquell C, Michel Y, Chambon M, Peigue-Lafeuille H, Bailly JL. Prospective identification of HEV-B enteroviruses during the 2005 outbreak. J Med Virol 2006; 78:1624-34. [PMID: 17063526 DOI: 10.1002/jmv.20747] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Enteroviruses (EVs) represent the main etiological agents of epidemics of viral meningitis and especially the serotypes related to the human enterovirus B species. Genetic typing by sequencing a PCR-amplified portion of the genome has proved to be useful for identifying EVs and is more rapid than standard seroneutralization tests. However, prospective genotyping has not been reported in routine practice within a clinical diagnostic laboratory. A genetic typing assay using two sets of primers was developed for the amplification and sequencing of the VP1 coding sequence of the HEV-B serotypes. Identification was carried out by sequence comparisons with EV sequences in GenBank using the BLAST search tool and confirmed by phylogenetic analysis. This method was used to identify prospectively the 48 enteroviruses isolated in patients with either enterovirus-proved meningitis (n = 41) or other clinical manifestations (n = 7) admitted to the University Hospital of Clermont-Ferrand (France) in 2005. The assay was also used to type retrospectively EVs isolated in cerebrospinal fluid specimens of 25 patients admitted to the Trousseau Paediatric Hospital in Paris (France) between February and August 2005. In both prospective and retrospective investigations of meningitis, echovirus 30 (E30) was the most frequent serotype, followed in decreasing order by E18, E13, coxsackievirus B5, B3, E6, E4, E7, E11, E33, and coxsackievirus A9. In patients with other manifestations, coxsackievirus B3, B5, and E3 were each identified twice, and E2 once. In E30 infected patients, nine different lineages were demonstrated by phylogenetic analysis. Genetic typing allowed the prospective, effective and rapid identification of all EV isolates involved in the 2005 outbreak. Molecular typing in combination with phylogenetic analysis will be a reliable means to confirm the emergence of new EV variants, and is of interest of both individual patients and public health.
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Affiliation(s)
- Audrey Mirand
- CHU Clermont-Ferrand, Laboratoire de Virologie, Centre de Biologie, Clermont-Ferrand, France.
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33
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Regagnon C, Souweine B, Archimbaud C, Duperron F, Thouvenot D, Peigue-Lafeuille H. [A fatal case of adenovirus type 3 pneumonia in an immunocompetent adult]. Med Mal Infect 2005; 34:102-4. [PMID: 15620023 DOI: 10.1016/j.medmal.2003.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- C Regagnon
- Service de virologie, faculté de médecine, CHU de Clermont-Ferrand, 28, place Henri-Dunant, 63001 Clermont-Ferrand cedex, France
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34
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Archimbaud C, Mirand A, Chambon M, Regagnon C, Bailly JL, Peigue-Lafeuille H, Henquell C. Improved diagnosis on a daily basis of enterovirus meningitis using a one-step real-time RT-PCR assay. J Med Virol 2005; 74:604-11. [PMID: 15484276 DOI: 10.1002/jmv.20217] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The detection of the enterovirus genome in cerebrospinal fluid (CSF) by PCR techniques has proved to be more sensitive than traditional cell culture for the diagnosis of enterovirus meningitis. However, PCR assays are time consuming and labor intensive, particularly if separate hybridization steps are used to confirm the specificity of positive findings. The aim of this study was to develop a one-step real-time RT-PCR assay with LightCycler (LC) technology that was sensitive, rapid, and easy to perform in routine practice. The enterovirus detection limit was determined by testing 10-fold limiting dilution series of cell culture stocks with the echovirus 25 (E-25) prototype strain and with the third European Union Quality Control Concerted Action (EU-QCCA) enterovirus proficiency panel. A total of 100 CSF specimens were investigated in a comparative study. With the E-25 strain, the detection limit of the real-time assay was 286 TCID50/ml (50% tissue culture infective dose). When samples of the EU-QCCA panel were tested, our assay gave identical results (detection limit down to 3.6 TCID50/ml) to those of the reference laboratory, which used one-step RT-PCR assay. When CSF specimens were tested, there was a correlation between the real-time assay and the conventional in-house assay in 96 of 100 CSFs tested. This one-step real-time assay allows rapid enterovirus detection in CSF since results are obtained in 3 hr as against 36 hr with the "in-house" RT-PCR assay. This new assay is now being used in routine practice, and allows diagnosis on a daily basis.
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Affiliation(s)
- Christine Archimbaud
- Laboratoire de Virologie Médicale du Centre Hospitalier Universitaire, Faculté de Médecine, Clermont-Ferrand Cedex 1, France.
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35
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Chambon M, Archimbaud C, Bailly JL, Gourgand JM, Charbonné F, Peigue-Lafeuille H. Virucidal efficacy of glutaraldehyde against enteroviruses is related to the location of lysine residues in exposed structures of the VP1 capsid protein. Appl Environ Microbiol 2004; 70:1717-22. [PMID: 15006797 PMCID: PMC368296 DOI: 10.1128/aem.70.3.1717-1722.2004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Glutaraldehyde (GTA) is a potent virucidal disinfectant whose exact mode of action against enteroviruses is not understood. Earlier reports showed that GTA reacts preferentially with the VP1 capsid protein of echovirus 25 and poliovirus 1 and that GTA has affinity for exposed lysine residues on proteins. To investigate further the inactivation of enteroviruses by GTA, seven strains were selected on the basis of differences in their overall number and the positions of lysine residues in the amino acid sequences of the VP1 polypeptide. Inactivation kinetics experiments were performed with 0.10% GTA. The viruses grouped into three clusters and exhibited significantly different levels of sensitivity to GTA. The results were analyzed in the light of current knowledge of the three-dimensional structure of enteroviruses and the viral life cycle. The differences observed in sensitivity to GTA were related to the number of lysine residues and their locations in the VP1 protein. The overall findings suggest that the BC and DE loops, which cluster at the fivefold axis of symmetry and are the most exposed on the outer surface of the virions, are primary reactive sites for GTA.
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Affiliation(s)
- Martine Chambon
- Laboratoire de Virologie, Faculté de Médecine, 63001 Clermont-Ferrand Cédex, France.
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36
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Archimbaud C, Bailly JL, Chambon M, Tournilhac O, Travade P, Peigue-Lafeuille H. Molecular evidence of persistent echovirus 13 meningoencephalitis in a patient with relapsed lymphoma after an outbreak of meningitis in 2000. J Clin Microbiol 2004; 41:4605-10. [PMID: 14532190 PMCID: PMC254333 DOI: 10.1128/jcm.41.10.4605-4610.2003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Enteroviral meningoencephalitis was diagnosed in a patient with an immunodeficiency syndrome acquired after treatment with rituximab for a relapsed primary B-cell lymphoma. A second meningoencephalitic episode was diagnosed 6 months later and was successfully treated with a combination of immunoglobulins and pleconaril. The infection was persistent since the enterovirus genome was detected in five sequential specimens of cerebrospinal fluid collected over 9 months. An echovirus 13 isolate was isolated in the first three samples. The viral sequence encoding the VP1 capsid protein of the three isolates was determined and was compared with that of four control viruses. The virus isolates recovered from the patient shared >99% nucleotide sequence similarity with one another. In a phylogenetic tree, they were directly related to a control virus obtained from a patient hospitalized in 2000 during an outbreak of enterovirus meningitis. The epidemiological origin of a chronic echovirus infection in a patient with immune deficiency suggests that the echovirus had been continuously circulating in the general population after the outbreak that had revealed its emergence.
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Affiliation(s)
- Christine Archimbaud
- Laboratoire de Virologie, Faculté de Médecine, 63000 Clermont-Ferrand 1, France.
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37
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Quartier P, Tournilhac O, Archimbaud C, Lazaro L, Chaleteix C, Millet P, Peigue-Lafeuille H, Blanche S, Fischer A, Casanova JL, Travade P, Tardieu M. Enteroviral meningoencephalitis after anti-CD20 (rituximab) treatment. Clin Infect Dis 2003; 36:e47-9. [PMID: 12539090 DOI: 10.1086/345746] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2002] [Accepted: 10/08/2002] [Indexed: 11/03/2022] Open
Abstract
Treatment with the chimeric anti-CD20 monoclonal antibody rituximab induces rapid and long-lasting depletion of circulating B cells. We report the occurrence of enteroviral meningoencephalitis following rituximab therapy in 1 child with immune thrombocytopenia and in 1 adult patient with relapsed B cell lymphoma.
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Affiliation(s)
- Pierre Quartier
- Unité d'Immunologie-Hématologie et Rhumatologie Pédiatrique, Hôpital Necker-Enfants Malades, 75 743 Paris cedex 15, France.
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38
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Bailly JL, Brosson D, Archimbaud C, Chambon M, Henquell C, Peigue-Lafeuille H. Genetic diversity of echovirus 30 during a meningitis outbreak, demonstrated by direct molecular typing from cerebrospinal fluid. J Med Virol 2002; 68:558-67. [PMID: 12376964 DOI: 10.1002/jmv.10235] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Echovirus 30 is one of the enterovirus serotypes isolated most frequently in meningitis cases. The genetic diversity of echovirus 30 was investigated in patients hospitalised during an outbreak in 2000 in Clermont-Ferrand, France. A nested reverse transcription-PCR (RT-PCR) assay was developed for qualitative analysis of the echovirus 30 VP1 encoding sequence directly from cerebrospinal fluid. The viral sequences obtained for 22 patients were compared with those of virus isolates obtained from nine patients with echovirus 30 meningitis admitted to hospital in 1996-1997 and with echovirus 30 sequences from international databases. In 2000, meningitis cases were caused by two virus variants (C3 and C4) distinct genetically from the other two variants (C1 and C2) identified during the period 1996-1997. A detailed phylogenetic analysis established that the C1, C2, and C3 variants had close relatives among viruses previously identified in other geographical areas. The C4 variant had not been described earlier. The genomic differences observed between the four echovirus 30 variants arose at synonymous sites indicating that the viruses shared similar antigenic sites in the VP1 encoding sequence. Overall, these observations suggest wide circulation of different echovirus 30 variants and periodic importation of new viruses. The apparent displacement observed between virus variants did not result from a selective advantage caused by antigenic variation.
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Affiliation(s)
- Jean-Luc Bailly
- UFR Médecine, Laboratoire de Virologie-EA2148, Clermont-Ferrand, France.
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39
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Peigue-Lafeuille H, Archimbaud C, De Champs C, Croquez N, Laurichesse H, Clavelou P, Aumaître O, Schmidt J, Henquell C, Bailly JL, Chambon M. [Enteroviral meningitis in adults, underestimated illness: description of 30 observations from 1999 to 2000, and evolution of clinical practices during 2001]. Pathol Biol (Paris) 2002; 50:516-24. [PMID: 12490413 DOI: 10.1016/s0369-8114(02)00348-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Enteroviral meningitis is well documented in children but underestimated in adults. The analysis of 30 cases of adult meningitis prospectively diagnosed by enterovirus genome detection (RT-PCR) in cerebrospinal fluid (CSF) between 1999 and 2000 in routine practice showed diagnosis to be problematic. Characteristic symptoms were inconstant (the association of fever/headache/stiff neck absent in 41%) and sometimes misleading (the presence of peribuccal lesions). CSF data showed a predominance of lymphocytes in only 44% of patients. The most reliable criterion was normal constant CSF glucose levels. Thirty three per cent of patients were admitted during cold months. Management of patients varied markedly between departments, and included computed tomography (33%), and the prescription of aciclovir (20%) or antibiotics (53%). A report of positive enterovirus RT-PCR had only low impact on management because it took 6 days to obtain the results (versus 3 days in children during the same period). These findings were communicated to all hospital physicians concerned and as a result, the number of RT-PCR in adults increased significantly during 2001. Again, enteroviral meningitis was diagnosed in adults despite a much lower incidence of the illness in 2001 compared to 2000. Thus this pathology should not be underestimated in adults. Considerable medical expenditure might be avoided (cumulative numbers of 172 days in hospital and 82 days of antibiotics in this study), if rapid and accurate diagnostic techniques were available.
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Affiliation(s)
- H Peigue-Lafeuille
- Laboratoire de virologie du CHRU, faculté de médecine, 28, Place Henri-Dunant, 63001 Cedex, Clermont-Ferrand, France.
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40
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Peigue-Lafeuille H, Croquez N, Laurichesse H, Clavelou P, Aumaître O, Schmidt J, Maillet-Vioud M, Henquell C, Archimbaud C, Bailly JL, Chambon M. Enterovirus meningitis in adults in 1999-2000 and evaluation of clinical management. J Med Virol 2002; 67:47-53. [PMID: 11920817 DOI: 10.1002/jmv.2191] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Enterovirus meningitis is well documented in children. However, there is a paucity of reports in adults, despite the availability of genome detection (RT-PCR) in cerebrospinal fluid (CSF), which provides a rapid and reliable diagnosis. The clinical course and management of 30 cases of entero-virus proven meningitis prospectively diagnosed between August 1999 and November 2000 in immunocompetent adults were analysed, and laboratory and clinical strategies evaluated. Patient age ranged between 17 and 43 (median 29). The analysis of clinical, biological, and epidemiological data showed the difficulty of recognising enterovirus meningitis in adults. Characteristic symptoms were either inconstant (the association of fever/headache/stiff neck) or misleading (the presence of vesicular lesions). CSF data showed moderate pleocytosis but a predominance of lymphocytes in only 12/27 (44%) patients. An epidemiological background was present in 10/30 (33%) patients, but 10/30 (33%) patients were admitted during cold months. Consequently, although the detection of enterovirus genome in CSF was positive in all cases, the results were communicated within a median of 6 days [2-9] after admission, mainly because the aetiology was not considered early enough. Management of patients varied between departments and between individual physicians, with measures ranging from computed tomography (33%) to the prescription of aciclovir (20%) or antibiotics (53%). Enterovirus meningitis should not be underestimated in adults. Management could be improved and standardised, and costs reduced by more systematic year-round use of enterovirus RT-PCR in meningitis, provided results are rapid.
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Archimbaud C, Shankar N, Forestier C, Baghdayan A, Gilmore MS, Charbonné F, Joly B. In vitro adhesive properties and virulence factors of Enterococcusfaecalis strains. Res Microbiol 2002; 153:75-80. [PMID: 11900266 DOI: 10.1016/s0923-2508(01)01291-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Twenty-nine Enterococcus faecalis isolates from patients with endocarditis or bacteremia or from stools of healthy volunteers were investigated for their ability to adhere to Int-407 and Girardi heart cell lines and for the presence of known enterococcal virulence factors. Eight strains (27.6%) adhered predominantly to Int-407 cells. The adherence of enterococci was enhanced by proteolytic digestion, suggesting that some cell binding components become surface-exposed after treatment with trypsin. The occurrence of known potential virulence factors of enterococci among these strains was determined and was as follows: enterococcal surface protein (72.4%), gelatinase (58.6%), aggregation substance (48.3%) and cytolysin (17.2%). Bacterial adherence was not significantly associated with any of these virulence factors.
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Affiliation(s)
- Christine Archimbaud
- Laboratoire de Bactériologie-Virologie, Université d'Auvergne, Faculté de Pharmacie, Clermont-Ferrand, France.
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Chambon M, Archimbaud C, Bailly JL, Henquell C, Regagnon C, Charbonné F, Peigue-Lafeuille H. Circulation of enteroviruses and persistence of meningitis cases in the winter of 1999-2000. J Med Virol 2001; 65:340-7. [PMID: 11536242 DOI: 10.1002/jmv.2039] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The seasonal incidence of enterovirus meningitis was analyzed in a prospective study of patients admitted for suspected meningitis from October 1, 1998 to April 30, 2000. In-house reverse transcription-polymerase chain reaction (RT-PCR) in cerebrospinal fluid (CSF) was used irrespective of cytological results. Fifty-two (45.2%) of the 115 patients had positive RT-PCR in CSF, including 44/86 children (51.2%) and 8/29 adults (27.6%). Six of the 52 (11.5%) had no pleocytosis. The numbers of CSF specimens with a predominance of lymphocytes or a predominance of neutrophils were closely similar. In 33 of the positive patients, an enterovirus, mainly echoviruses type 6 (48%) and 30 (24%), was recovered in one or more specimens. Sixteen cases of enteroviral meningitis were observed between November 1999 and March 2000 as against 2 cases between November 1998 and March 1999, showing that the disease persisted through the winter months of 1999-2000. During the same period, 96 enterovirus isolates were recovered from clinical specimens from other patients. The number of isolates was higher in the winter of 1999-2000 (P < 0.01) than in the winter of 1998-1999, indicating that the risk of enterovirus infection increased significantly in winter 1999-2000. Sixteen patients had aseptic meningitis, made a rapid recovery and had an enterovirus in throat swabs and stools (9/16) or in one of the two (7/16). RT-PCR was not requested. Nine patients were admitted during the cold months. The clinical management of both adult and child patients could be improved by year-round use of enterovirus generic RT-PCR.
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Affiliation(s)
- M Chambon
- Laboratoire de Virologie, Faculté de Médecine et CHRU, Clermont-Ferrand, France.
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Henquell C, Chambon M, Bailly JL, Alcaraz S, De Champs C, Archimbaud C, Labbé A, Charbonné F, Peigue-Lafeuille H. Prospective analysis of 61 cases of enteroviral meningitis: interest of systematic genome detection in cerebrospinal fluid irrespective of cytologic examination results. J Clin Virol 2001; 21:29-35. [PMID: 11255095 DOI: 10.1016/s1386-6532(00)00176-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Enteroviruses are the most commonly identified cause of viral meningitis. Detection of the enterovirus genome in cerebrospinal fluid (CSF) using reverse-transcription polymerase chain reaction (PCR) has proved to be useful in diagnosis and is more rapid and sensitive than viral cultures. In routine practice, cytologic examination results of CSF are obtained swiftly and PCR indication is performed as a second step. OBJECTIVES The aim of this study was to determine, by analysis of complete data from CSF results for 61 cases of proven enteroviral meningitis, whether cytologic CSF findings can be used to establish viral etiology and to indicate if PCR assay should be performed. STUDY DESIGN From a prospective study of children admitted during 1997 for suspected enterovirus meningitis in which PCR and viral cultures of CSF were systematically performed, we selected 61 patients with proven enterovirus meningitis. We compared global white cell count (WCC), relative percentage of lymphocytes/neutrophils, PCR and culture for enterovirus, patient age, and clinical data. RESULTS 92% of patients (56/61) had positive PCR in CSF and in 48% (29/61) enterovirus was isolated in CSF. Nine patients (14.75%) had WCC<10/mm(3); eight of them had positive PCR and two had positive culture. There were comparable numbers of CSF with a predominance of lymphocytes (n=25) and CSF with a predominance of neutrophils (n=22), and of positive PCR and positive cultures of CSF in the two groups. Results were not influenced by the age of the patients. CONCLUSION Irrespective of other CSF parameters, it seems difficult to dispense with PCR assay for enterovirus genome detection. It should be introduced as a true rapid routine test. Early reporting of a positive PCR result could result in a considerable saving in health resources.
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Affiliation(s)
- C Henquell
- Laboratoire de Virologie, Faculté de Médecine, 28, Place Henri-Dunant, 63001 Clermont-Ferrand Cedex, France
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Chambon M, Bailly JL, Béguet A, Henquell C, Archimbaud C, Gaulme J, Labbé A, Malpuech G, Peigue-Lafeuille H. An outbreak due to echovirus type 30 in a neonatal unit in France in 1997: usefulness of PCR diagnosis. J Hosp Infect 1999; 43:63-8. [PMID: 10462641 DOI: 10.1053/jhin.1999.0634] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Between February and August 1997, 53 patients with enterovirus meningitis were hospitalized in Clermont-Ferrand, France. All but one were children. Echovirus type 30 was involved in 70% of cases with identified serotype. The outbreak ceased on August 8. Two months later, a neonate was admitted to the neonatal unit with an echovirus type 30 meningitis thought to be acquired at delivery. Twenty days later a nosocomial outbreak of echovirus type 30 involving five neonates occurred. Two of them presented with meningitis and two with febrile seizure; One was asymptomatic. The retrospective examination of the maternal sera in a neutralization test, using the index case strain as a source of antigen, showed that none of the neonates was passively immunized before hospitalization. The use of genome detection in cerebrospinal fluid allowed rapid diagnosis and infection was contained by re-inforcing hygiene measures. Prospective examination of stools in the neonatal and paediatric units showed no further occurrences of the disease. No sporadic case was observed in the general population. Hence, nosocomial infections can occur a long time after an outbreak in the general population; rapid diagnosis with molecular tools is useful both for a definite diagnosis in patients already hospitalized, and to act as a rapid alert, even in intervals between seasonal outbreaks.
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Affiliation(s)
- M Chambon
- Departments of Paediatrics and Clinical Virology, Centre Hospitalier Universitaire, Clermont-Ferrand, France
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