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Laksono BM, Sooksawasdi Na Ayudhya S, Aguilar-Bretones M, Embregts CWE, van Nierop GP, van Riel D. Human B cells and dendritic cells are susceptible and permissive to enterovirus D68 infection. mSphere 2024; 9:e0052623. [PMID: 38259063 PMCID: PMC10900886 DOI: 10.1128/msphere.00526-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Enterovirus D68 (EV-D68) is predominantly associated with mild respiratory infections, but can also cause severe respiratory disease and extra-respiratory complications, including acute flaccid myelitis. Systemic dissemination of EV-D68 is crucial for the development of extra-respiratory diseases, but it is currently unclear how EV-D68 spreads systemically (viremia). We hypothesize that immune cells contribute to the systemic dissemination of EV-D68, as this is a mechanism commonly used by other enteroviruses. Therefore, we investigated the susceptibility and permissiveness of human primary immune cells for different EV-D68 isolates. In human peripheral blood mononuclear cells inoculated with EV-D68, only B cells were susceptible but virus replication was limited. However, in B cell-rich cultures, such as Epstein-Barr virus-transformed B-lymphoblastoid cell line (BLCL) and primary lentivirus-transduced B cells, which better represent lymphoid B cells, were productively infected. Subsequently, we showed that dendritic cells (DCs), particularly immature DCs, are susceptible and permissive for EV-D68 infection and that they can spread EV-D68 to autologous BLCL. Altogether, our findings suggest that immune cells, especially B cells and DCs, could play an important role in the pathogenesis of EV-D68 infection. Infection of these cells may contribute to systemic dissemination of EV-D68, which is an essential step toward the development of extra-respiratory complications.IMPORTANCEEnterovirus D68 (EV-D68) is an emerging respiratory virus that has caused outbreaks worldwide since 2014. EV-D68 infects primarily respiratory epithelial cells resulting in mild respiratory diseases. However, EV-D68 infection is also associated with extra-respiratory complications, including polio-like paralysis. It is unclear how EV-D68 spreads systemically and infects other organs. We hypothesized that immune cells could play a role in the extra-respiratory spread of EV-D68. We showed that EV-D68 can infect and replicate in specific immune cells, that is, B cells and dendritic cells (DCs), and that virus could be transferred from DCs to B cells. Our data reveal a potential role of immune cells in the pathogenesis of EV-D68 infection. Intervention strategies that prevent EV-D68 infection of immune cells will therefore potentially prevent systemic spread of virus and thereby severe extra-respiratory complications.
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Affiliation(s)
| | | | | | | | | | - Debby van Riel
- Department of Viroscience, Erasmus MC, Rotterdam, the Netherlands
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2
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Ndiaye N, Kébé O, Diarra M, Thiaw FD, Dia M, Dia ND, Sall AA, Fall M, Faye O, Faye M. Non-polio enteroviruses circulation in acute flaccid paralysis cases and sewage in Senegal from 2013 to 2021. Int J Infect Dis 2024; 138:54-62. [PMID: 37995831 DOI: 10.1016/j.ijid.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVES Several factors can cause acute flaccid paralysis cases including non-polio enteroviruses. In Senegal, few studies on non-polio enteroviruses (NPEV) have been performed. METHODS Our study assess the molecular epidemiology of non-polio enteroviruses in Senegal from 2013 to 2021 through the previously existing programs for surveillance of polioviruses. RESULTS A total of 3815 stool samples and 281 sewage samples were collected. After virus isolation by cell culture, non-polio enteroviruses-positive isolates were confirmed by reverse transcriptase-quantitative polymerase chain reaction. Following this detection, the positive samples were subjected to molecular characterization. Our data showed that 15.22% and 52.66% were positive in cell culture for non-polio enteroviruses in acute flaccid paralysis surveillance and environmental surveillance, respectively. These non-polio enteroviruses-positive isolates were detected all year round but tend to unequal peaks of circulation, and the age group 0-5 years was more vulnerable to infection (84.4%). Genetic characterization revealed the circulation of enteroviruses species infecting humans (Enterovirus A - Enterovirus D): Enterovirus A (29.2%) and Enterovirus B (63.1%) isolates from both the acute flaccid paralysis surveillance and environmental surveillance while Enterovirus C (5.3%) and Enterovirus D (2.4%) were only isolated from the acute flaccid paralysis surveillance. However, the highly prevalent Enterovirus B species from the acute flaccid paralysis surveillance included echovirus 7 and echovirus 13, whereas coxsackievirus A6 was the predominant species from the environmental surveillance. CONCLUSION This first 8-year period study of NPEV in Senegal showed that NPEV represent important viral etiologies associated with acute flaccid paralysis cases and circulating in environmental surveillance in Senegal and highlighted the need to promote effective long-term strategies for monitoring of non-polio enteroviruses infections.
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Affiliation(s)
- Ndack Ndiaye
- Virology Department, Institut Pasteur de Dakar, Dakar, Senegal; Département de Biologie Animale, Faculté des sciences et techniques, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal.
| | - Ousmane Kébé
- Virology Department, Institut Pasteur de Dakar, Dakar, Senegal
| | - Maryam Diarra
- Virology Department, Institut Pasteur de Dakar, Dakar, Senegal
| | | | - Mohamed Dia
- Virology Department, Institut Pasteur de Dakar, Dakar, Senegal
| | - NDongo Dia
- Virology Department, Institut Pasteur de Dakar, Dakar, Senegal
| | | | - Malick Fall
- Département de Biologie Animale, Faculté des sciences et techniques, Université Cheikh Anta Diop de Dakar, Dakar, Sénégal
| | - Ousmane Faye
- Virology Department, Institut Pasteur de Dakar, Dakar, Senegal
| | - Martin Faye
- Virology Department, Institut Pasteur de Dakar, Dakar, Senegal
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3
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Hooi YT, Balasubramaniam VRMT. In vitro and in vivo models for the study of EV-D68 infection. Pathology 2023; 55:907-916. [PMID: 37852802 DOI: 10.1016/j.pathol.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/03/2023] [Accepted: 08/14/2023] [Indexed: 10/20/2023]
Abstract
Enterovirus D68 (EV-D68) is one of hundreds of non-polio enteroviruses that typically cause cold-like respiratory illness. The first EV-D68 outbreak in the United States in 2014 aroused widespread concern among the public and health authorities. The infection was found to be associated with increased surveillance of acute flaccid myelitis, a neurological condition that causes limb paralysis in conjunction with spinal cord inflammation. In vitro studies utilising two-dimensional (2D) and three-dimensional (3D) culture systems have been employed to elucidate the pathogenic mechanism of EV-D68. Various animal models have also been developed to investigate viral tropism and distribution, pathogenesis, and immune responses during EV-D68 infection. EV-D68 infections have primarily been investigated in respiratory, intestinal and neural cell lines/tissues, as well as in small-size immunocompetent rodent models that were limited to a young age. Some studies have implemented strategies to overcome the barriers by using immunodeficient mice or virus adaptation. Although the existing models may not fully recapitulate both respiratory and neurological disease observed in human EV-D68 infection, they have been valuable for studying pathogenesis and evaluating potential vaccine or therapeutic candidates. In this review, we summarise the methodologies and findings from each experimental model and discuss their applications and limitations.
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Affiliation(s)
- Yuan Teng Hooi
- Infection and Immunity Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia.
| | - Vinod R M T Balasubramaniam
- Infection and Immunity Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia.
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Weng KF, Tee HK, Tseligka ED, Cagno V, Mathez G, Rosset S, Nagamine CM, Sarnow P, Kirkegaard K, Tapparel C. Variant enterovirus A71 found in immune-suppressed patient binds to heparan sulfate and exhibits neurotropism in B-cell-depleted mice. Cell Rep 2023; 42:112389. [PMID: 37058406 PMCID: PMC10590055 DOI: 10.1016/j.celrep.2023.112389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/30/2023] [Accepted: 03/29/2023] [Indexed: 04/15/2023] Open
Abstract
Enterovirus A71 (EV-A71) causes hand, foot, and mouth disease outbreaks with neurological complications and deaths. We previously isolated an EV-A71 variant in the stool, cerebrospinal fluid, and blood of an immunocompromised patient who had a leucine-to-arginine substitution on the VP1 capsid protein, resulting in increased heparin sulfate binding. We show here that this mutation increases the virus's pathogenicity in orally infected mice with depleted B cells, which mimics the patient's immune status, and increases susceptibility to neutralizing antibodies. However, a double mutant with even greater heparin sulfate affinity is not pathogenic, suggesting that increased heparin sulfate affinity may trap virions in peripheral tissues and reduce neurovirulence. This research sheds light on the increased pathogenicity of variant with heparin sulfate (HS)-binding ability in individuals with decreased B cell immunity.
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Affiliation(s)
- Kuo-Feng Weng
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Han Kang Tee
- Department of Microbiology and Molecular Medicine, University of Geneva Medical School, Geneva, Switzerland
| | - Eirini D Tseligka
- Department of Microbiology and Molecular Medicine, University of Geneva Medical School, Geneva, Switzerland
| | - Valeria Cagno
- Department of Microbiology and Molecular Medicine, University of Geneva Medical School, Geneva, Switzerland
| | - Gregory Mathez
- Department of Microbiology and Molecular Medicine, University of Geneva Medical School, Geneva, Switzerland
| | - Stéphane Rosset
- Department of Microbiology and Molecular Medicine, University of Geneva Medical School, Geneva, Switzerland
| | - Claude M Nagamine
- Department of Comparative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter Sarnow
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Karla Kirkegaard
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Caroline Tapparel
- Department of Microbiology and Molecular Medicine, University of Geneva Medical School, Geneva, Switzerland.
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5
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Helfferich J, de Lange MMA, Benschop KSM, Jacobs BC, Van Leer-Buter CC, Meijer A, Bakker DP, de Bie E, Braakman HMH, Brandsma R, Neuteboom RF, Niks EH, Niermeijer JM, Roelfsema V, Schoenmaker N, Sie LT, Niesters HG, Brouwer OF, te Wierik MJM. Epidemiology of acute flaccid myelitis in children in the Netherlands, 2014 to 2019. Euro Surveill 2022; 27:2200157. [PMID: 36268734 PMCID: PMC9585879 DOI: 10.2807/1560-7917.es.2022.27.42.2200157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Acute flaccid myelitis (AFM) is a polio-like condition affecting mainly children and involving the central nervous system (CNS). AFM has been associated with different non-polio-enteroviruses (EVs), in particular EV-D68 and EV-A71. Reliable incidence rates in European countries are not available. Aim To report AFM incidence in children in the Netherlands and its occurrence relative to EV-D68 and EV-A71 detections. Methods In 10 Dutch hospitals, we reviewed electronic health records of patients diagnosed with a clinical syndrome including limb weakness and/or CNS infection and who were < 18 years old when symptoms started. After excluding those with a clear alternative diagnosis to AFM, those without weakness, and removing duplicate records, only patients diagnosed in January 2014–December 2019 were retained and further classified according to current diagnostic criteria. Incidence rates were based on definite and probable AFM cases. Cases’ occurrences during the study period were co-examined with laboratory-surveillance detections of EV-D68 and EV-A71. Results Among 143 patients included, eight were classified as definite and three as probable AFM. AFM mean incidence rate was 0.06/100,000 children/year (95% CI: −0.03 to 0.14). All patient samples were negative for EV-A71. Of respiratory samples in seven patients, five were EV-D68 positive. AFM cases clustered in periods with increased EV-D68 and EV-A71 detections. Conclusions AFM is rare in children in the Netherlands. The temporal coincidence of EV-D68 circulation and AFM and the detection of this virus in several cases’ samples support its association with AFM. Increased AFM awareness among clinicians, adequate diagnostics and case registration matter to monitor the incidence.
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Affiliation(s)
- Jelte Helfferich
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marit MA de Lange
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Kimberley SM Benschop
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Bart C Jacobs
- Department of Neurology and Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Coretta C Van Leer-Buter
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Adam Meijer
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Dewi P Bakker
- Department of Paediatric Neurology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Eva de Bie
- Department of Paediatric Neurology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Hilde MH Braakman
- Department of Paediatric Neurology, Amalia Children’s Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rick Brandsma
- Department of Paediatric Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rinze F Neuteboom
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Erik H Niks
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Vincent Roelfsema
- Department of Paediatrics, Martini Hospital, Groningen, the Netherlands
| | | | - Lilian T Sie
- Department of Paediatric Neurology, Haga Hospital, the Hague, the Netherlands
| | - Hubert G Niesters
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Oebele F Brouwer
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Margreet JM te Wierik
- Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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Othman I, Slama I, Mastouri M, Bailly JL, Aouni M. First detection and characterization of EV-A71 and a new genogroup of CVA-24 causing neurological disease in Tunisia. Future Virol 2022. [DOI: 10.2217/fvl-2021-0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim: Molecular characterization of enterovirus A71 (EV-A71) and coxsackievirus A24 (CVA-24) strains isolated during neurological diseases surveillance activities in Tunisian patients. Materials & methods: Specimens were obtained from two Tunisian children and analyzed for enterovirus with quantitative reverse transcription PCR (RT-qPCR). We sequenced the whole genome of strains detected. Results: The EV-A71 sequence reported was assigned to subgenogroup C2 with a high nucleotide sequence identity to other EV-A71 C2 detected in other countries, which suggests virus migration. Interestingly, in the VP1 coding region, the Tunisian CV-A24 strain displayed high sequence divergence from other CV-A24, which confirms that it represents a new genogroup. Conclusion: This is the first report of EV-A71 in Tunisia and the first report of a CV-A24 strain causing aseptic meningitis.
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Affiliation(s)
- Ines Othman
- Faculty of Pharmacy, LR99-ES27, Monastir, Tunisia
| | - Ichrak Slama
- Faculty of Pharmacy, LR99-ES27, Monastir, Tunisia
| | - Maha Mastouri
- Faculty of Pharmacy, LR99-ES27, Monastir, Tunisia
- Fattouma Bourguiba University Hospital, Laboratory of Microbiology, Monastir, Tunisia
| | - Jean-Luc Bailly
- Université Clermont Auvergne, Faculty of Pharmacy, LMGE CNRS 6023, Clermont-Ferrand, 63001, France
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Larsson SB, Vracar D, Karlsson M, Ringlander J, Norder H. Epidemiology and clinical manifestations of different enterovirus and rhinovirus types show EV‐D68 may still impact on severity of respiratory infections. J Med Virol 2022; 94:3829-3839. [PMID: 35403229 PMCID: PMC9321759 DOI: 10.1002/jmv.27767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/16/2022] [Accepted: 04/07/2022] [Indexed: 11/10/2022]
Abstract
Respiratory infections are often caused by enteroviruses (EVs). The aim of this study was to identify whether certain types of EV were more likely to cause severe illness in 2016, when an increasing spread of upper respiratory infections was observed in Gothenburg, Sweden. The EV strain in 137 of 1341 nasopharyngeal samples reactive for EV by polymerase chain reaction could be typed by sequencing the viral 5′‐untranslated region and VP1 regions. Phylogenetic trees were constructed. Patient records were reviewed. Hospital care was needed for 46 of 74 patients with available medical records. The majority of the patients (83) were infected with the rhinovirus (RV). The remaining 54 were infected with EV A, B, C, and D strains of 13 different types, with EV‐D68 and CV‐A10 being the most common (17 vs. 14). Significantly more patients with EV‐D68 presented with dyspnea, both when compared with other EV types (p = 0.003) and compared to all other EV and RV infections (p = 0.04). Phylogenetic analysis of the sequences revealed the spread of both Asian and European CV‐A10 strains and 12 different RV C types. This study showed an abundance of different EV types spreading during a year with increased upper respiratory increased infections. EV‐D68 infections were associated with more severe disease manifestation. Other EV and RV types were more evenly distributed between hospitalized and nonhospitalized patients. The EV type CV‐A10 was also found in infected patients, which warrants further studies and surveillance, as this pathogen could cause more severe disease and outbreaks of hand, foot, and mouth disease.
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Affiliation(s)
- Simon B. Larsson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Beroendekliniken, Region Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| | - Diana Vracar
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Clinical Microbiology, Sahlgrenska University HospitalGothenburgSweden
| | - Marie Karlsson
- Department of Clinical Microbiology, Sahlgrenska University HospitalGothenburgSweden
| | - Johan Ringlander
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Clinical Microbiology, Sahlgrenska University HospitalGothenburgSweden
| | - Heléne Norder
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of GothenburgGothenburgSweden
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Fall A, Kenmoe S, Ebogo-Belobo JT, Mbaga DS, Bowo-Ngandji A, Foe-Essomba JR, Tchatchouang S, Amougou Atsama M, Yéngué JF, Kenfack-Momo R, Feudjio AF, Nka AD, Mbongue Mikangue CA, Taya-Fokou JB, Magoudjou-Pekam JN, Noura EA, Zemnou-Tepap C, Meta-Djomsi D, Maïdadi-Foudi M, Kame-Ngasse GI, Nyebe I, Djukouo LG, Kengne Gounmadje L, Tchami Ngongang D, Oyono MG, Demeni Emoh CP, Tazokong HR, Mahamat G, Kengne-Ndé C, Sadeuh-Mba SA, Dia N, La Rosa G, Ndip L, Njouom R. Global prevalence and case fatality rate of Enterovirus D68 infections, a systematic review and meta-analysis. PLoS Negl Trop Dis 2022; 16:e0010073. [PMID: 35134062 PMCID: PMC8824346 DOI: 10.1371/journal.pntd.0010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
A substantial amount of epidemiological data has been reported on Enterovirus D68 (EV-D68) infections after the 2014 outbreak. Our goal was to map the case fatality rate (CFR) and prevalence of current and past EV-D68 infections. We conducted a systematic review (PROSPERO, CRD42021229255) with published articles on EV-68 infections in PubMed, Embase, Web of Science and Global Index Medicus up to January 2021. We determined prevalences using a model random effect. Of the 4,329 articles retrieved from the databases, 89 studies that met the inclusion criteria were from 39 different countries with apparently healthy individuals and patients with acute respiratory infections, acute flaccid myelitis and asthma-related diseases. The CFR estimate revealed occasional deaths (7/1353) related to EV-D68 infections in patients with severe acute respiratory infections. Analyses showed that the combined prevalence of current and past EV-D68 infections was 4% (95% CI = 3.1–5.0) and 66.3% (95% CI = 40.0–88.2), respectively. The highest prevalences were in hospital outbreaks, developed countries, children under 5, after 2014, and in patients with acute flaccid myelitis and asthma-related diseases. The present study shows sporadic deaths linked to severe respiratory EV-D68 infections. The study also highlights a low prevalence of current EV-D68 infections as opposed to the existence of EV-D68 antibodies in almost all participants of the included studies. These findings therefore highlight the need to implement and/or strengthen continuous surveillance of EV-D68 infections in hospitals and in the community for the anticipation of the response to future epidemics. Enterovirus D68 (EV-D68) infections represent a global public health concern. EV-D68 are detected in apparently healthy subjects and patients with acute respiratory illnesses, acute flaccid myelitis, and asthma-related illnesses. Enterovirus D68 was first described in 1962 and exhibited sporadic circulation until August 2014 when outbreaks of EV-D68 infections were reported in the USA and Canada mainly in children with acute flaccid myelitis and severe acute respiratory disease. We systematically reviewed the literature on EV-D68 infections globally in the present study to determine the case fatality rate and prevalence of current and past infections. Our results show sporadic deaths in patients with severe acute respiratory EV-D68 infections. Our data also show a low prevalence of EV-D68 in current infections unlike the presence of EV-D68 antibodies (past infections) in almost all individuals of all ages. EV-D68 infections were more prevalent in hospital outbreaks, industrialized countries, children < 5 years, and patients with acute flaccid myelitis and asthma-related diseases. These data highlight the need to strengthen the surveillance of EV-D68 infections.
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Affiliation(s)
- Amary Fall
- Virology Department, Institute Pasteur of Dakar, Dakar, Senegal
| | - Sebastien Kenmoe
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- * E-mail: (SK); (RN)
| | - Jean Thierry Ebogo-Belobo
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | | | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | | | | | - Marie Amougou Atsama
- Centre de Recherche sur les Maladies Émergentes et Re-Emergentes, Institut de Recherches Médicales et d’Etudes des Plantes Médicinales, Yaounde, Cameroon
| | | | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde, Cameroon
| | | | - Alex Durand Nka
- Virology Laboratory, Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaounde, Cameroon
| | | | | | | | - Efietngab Atembeh Noura
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | | | - Dowbiss Meta-Djomsi
- Centre de Recherche sur les Maladies Émergentes et Re-Emergentes, Institut de Recherches Médicales et d’Etudes des Plantes Médicinales, Yaounde, Cameroon
| | - Martin Maïdadi-Foudi
- Centre de Recherche sur les Maladies Émergentes et Re-Emergentes, Institut de Recherches Médicales et d’Etudes des Plantes Médicinales, Yaounde, Cameroon
| | - Ginette Irma Kame-Ngasse
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Inès Nyebe
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | | | | | | | - Martin Gael Oyono
- Department of Animals Biology and Physiology, The University of Yaounde I, Yaounde, Cameroon
| | | | | | - Gadji Mahamat
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | - Cyprien Kengne-Ndé
- Research Monitoring and Planning Unit, National Aids Control Committee, Douala, Cameroon
| | | | - Ndongo Dia
- Virology Department, Institute Pasteur of Dakar, Dakar, Senegal
| | - Giuseppina La Rosa
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Lucy Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Richard Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
- * E-mail: (SK); (RN)
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Acute flaccid rhombencephalomyelitis with radiculitis in a child with an enterovirus A71 infection seen for the first time in Denmark: a case report. J Med Case Rep 2022; 16:32. [PMID: 35073972 PMCID: PMC8786451 DOI: 10.1186/s13256-021-03246-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 12/27/2021] [Indexed: 11/24/2022] Open
Abstract
Background Acute flaccid myelitis is a serious condition of the spinal cord. More than 80% of patients experience a mild respiratory illness or fever consistent with a viral infection prior to acute flaccid myelitis development. Enterovirus A71 is known to circulate in Denmark, and has previously been associated with severe neurological symptoms. In this case report we describe acute flaccid rhombencephalomyelitis with radiculitis in an infant with an enterovirus infection. Case presentation The 8-month-old male of Asian origin presented with fever and gastrointestinal symptoms, followed by severe neurological deficits such as flaccid paralysis of the neck and upper extremities. An initial magnetic resonance imaging scan of the brain was normal, and the boy was treated for encephalitis. A follow-up magnetic resonance imaging scan of the brain and spinal cord 1 week later showed the development of pathological symmetrical gray matter hyperintensity lesions on T2-weighted images in the brainstem and upper medulla spinalis, and nerve enhancement in the terminal thread of the spinal cord and the cervical roots; findings consistent with rhombencephalomyelitis with radiculitis causing flaccid paralysis. Enterovirus A71 was detected in both nasopharyngeal and fecal specimens. Other differential diagnostic etiologies of viral and bacterial encephalitis, including poliovirus, were excluded. Conclusions This is the first case in Denmark of a patient diagnosed with acute flaccid rhombencephalomyelitis strongly linked to an enterovirus A71 infection. This case emphasizes the diagnostic importance of combining a history of respiratory and/or gastrointestinal illness, fever, and delayed onset of varying degrees of paralysis with progressive characteristic spinal and brain lesions. Analysis of respiratory, fecal, and cerebrospinal samples for the presence of enterovirus, and eliminating other differential pathogens, is essential to confirm the diagnosis.
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10
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Tan JK, Chen R, Lee RCH, Li F, Dai K, Zhou GC, Chu JJH. Discovery of Novel Andrographolide Derivatives as Antiviral Inhibitors against Human Enterovirus A71. Pharmaceuticals (Basel) 2022; 15:ph15020115. [PMID: 35215228 PMCID: PMC8880313 DOI: 10.3390/ph15020115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 01/06/2023] Open
Abstract
Hand-foot-and-mouth disease (HFMD) caused by human enterovirus A71 (EV-A71) infection has been associated with severe neurological complications. With the lack of an internationally approved antiviral, coupled with a surge in outbreaks globally, EV-A71 has emerged as a neurotropic virus of high clinical importance. Andrographolide has many pharmacological effects including antiviral activity and its derivative, andrographolide sulfonate, has been used in China clinically to treat EV-A71 infections. This study sought to identify novel andrographolide derivatives as EV-A71 inhibitors and elucidate their antiviral mode of action. Using an immunofluorescence-based phenotypic screen, we identified novel EV-A71 inhibitors from a 344-compound library of andrographolide derivatives and validated them with viral plaque assays. Among these hits, ZAF-47, a quinolinoxy-andrographolide, was selected for downstream mechanistic studies. It was found that ZAF-47 acts on EV-A71 post-entry stages and inhibits EV-A71 protein expression. Subsequent luciferase studies confirm that ZAF-47 targets EV-A71 genome RNA replication specifically. Unsuccessful attempts in generating resistant mutants led us to believe a host factor is likely to be involved which coincide with the finding that ZAF-47 exhibits broad-spectrum antiviral activity against other enteroviruses (CV-A16, CV-A6, Echo7, CV-B5, CV-A24 and EV-D68). Furthermore, ZAF-46 and ZAF-47, hits from the screen, were derivatives of the same series containing quinolinoxy and olefin modifications, suggesting that an andrographolide scaffold mounted with these unique moieties could be a potential anti-EV-A71/HFMD strategy.
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Affiliation(s)
- Jie Kai Tan
- Laboratory of Molecular RNA Virology and Antiviral Strategies, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117545, Singapore; (J.K.T.); (R.C.H.L.)
| | - Ran Chen
- School of Pharmaceutical Sciences, Nanjing Tech University, Nanjing 211816, China; (R.C.); (F.L.); (K.D.)
| | - Regina Ching Hua Lee
- Laboratory of Molecular RNA Virology and Antiviral Strategies, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117545, Singapore; (J.K.T.); (R.C.H.L.)
| | - Feng Li
- School of Pharmaceutical Sciences, Nanjing Tech University, Nanjing 211816, China; (R.C.); (F.L.); (K.D.)
| | - Kun Dai
- School of Pharmaceutical Sciences, Nanjing Tech University, Nanjing 211816, China; (R.C.); (F.L.); (K.D.)
| | - Guo-Chun Zhou
- School of Pharmaceutical Sciences, Nanjing Tech University, Nanjing 211816, China; (R.C.); (F.L.); (K.D.)
- Correspondence: (G.-C.Z.); (J.J.H.C.)
| | - Justin Jang Hann Chu
- Laboratory of Molecular RNA Virology and Antiviral Strategies, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117545, Singapore; (J.K.T.); (R.C.H.L.)
- Infectious Disease Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Collaborative and Translation Unit for HFMD, Institute of Molecular and Cell Biology, Agency for Science, Technology and Research, Singapore 138673, Singapore
- Correspondence: (G.-C.Z.); (J.J.H.C.)
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11
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Zhang Z, Ma P, Ahmed R, Wang J, Akin D, Soto F, Liu BF, Li P, Demirci U. Advanced Point-of-Care Testing Technologies for Human Acute Respiratory Virus Detection. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2103646. [PMID: 34623709 DOI: 10.1002/adma.202103646] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/25/2021] [Indexed: 04/14/2023]
Abstract
The ever-growing global threats to human life caused by the human acute respiratory virus (RV) infections have cost billions of lives, created a significant economic burden, and shaped society for centuries. The timely response to emerging RVs could save human lives and reduce the medical care burden. The development of RV detection technologies is essential for potentially preventing RV pandemic and epidemics. However, commonly used detection technologies lack sensitivity, specificity, and speed, thus often failing to provide the rapid turnaround times. To address this problem, new technologies are devised to address the performance inadequacies of the traditional methods. These emerging technologies offer improvements in convenience, speed, flexibility, and portability of point-of-care test (POCT). Herein, recent developments in POCT are comprehensively reviewed for eight typical acute respiratory viruses. This review discusses the challenges and opportunities of various recognition and detection strategies and discusses these according to their detection principles, including nucleic acid amplification, optical POCT, electrochemistry, lateral flow assays, microfluidics, enzyme-linked immunosorbent assays, and microarrays. The importance of limits of detection, throughput, portability, and specificity when testing clinical samples in resource-limited settings is emphasized. Finally, the evaluation of commercial POCT kits for both essential RV diagnosis and clinical-oriented practices is included.
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Affiliation(s)
- Zhaowei Zhang
- Oil Crops Research Institute of Chinese Academy of Agricultural Sciences, National Reference Laboratory for Agricultural Testing (Biotoxin), Key Laboratory of Biology and Genetic Improvement of Oil Crops, Key Laboratory of Detection for Mycotoxins, Ministry of Agriculture and Rural Affairs, Wuhan, 430062, P. R. China
- Bio-Acoustic MEMS in Medicine (BAMM) Laboratory, Canary Center at Stanford for Cancer Early Detection, Department of Radiology, Stanford School of Medicine, Palo Alto, CA, 94304, USA
| | - Peng Ma
- Bio-Acoustic MEMS in Medicine (BAMM) Laboratory, Canary Center at Stanford for Cancer Early Detection, Department of Radiology, Stanford School of Medicine, Palo Alto, CA, 94304, USA
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics - Hubei Bioinformatics & Molecular Imaging Key Laboratory Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China
| | - Rajib Ahmed
- Bio-Acoustic MEMS in Medicine (BAMM) Laboratory, Canary Center at Stanford for Cancer Early Detection, Department of Radiology, Stanford School of Medicine, Palo Alto, CA, 94304, USA
| | - Jie Wang
- Bio-Acoustic MEMS in Medicine (BAMM) Laboratory, Canary Center at Stanford for Cancer Early Detection, Department of Radiology, Stanford School of Medicine, Palo Alto, CA, 94304, USA
| | - Demir Akin
- Bio-Acoustic MEMS in Medicine (BAMM) Laboratory, Canary Center at Stanford for Cancer Early Detection, Department of Radiology, Stanford School of Medicine, Palo Alto, CA, 94304, USA
| | - Fernando Soto
- Bio-Acoustic MEMS in Medicine (BAMM) Laboratory, Canary Center at Stanford for Cancer Early Detection, Department of Radiology, Stanford School of Medicine, Palo Alto, CA, 94304, USA
| | - Bi-Feng Liu
- The Key Laboratory for Biomedical Photonics of MOE at Wuhan National Laboratory for Optoelectronics - Hubei Bioinformatics & Molecular Imaging Key Laboratory Systems Biology Theme, Department of Biomedical Engineering, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China
| | - Peiwu Li
- Oil Crops Research Institute of Chinese Academy of Agricultural Sciences, National Reference Laboratory for Agricultural Testing (Biotoxin), Key Laboratory of Biology and Genetic Improvement of Oil Crops, Key Laboratory of Detection for Mycotoxins, Ministry of Agriculture and Rural Affairs, Wuhan, 430062, P. R. China
| | - Utkan Demirci
- Bio-Acoustic MEMS in Medicine (BAMM) Laboratory, Canary Center at Stanford for Cancer Early Detection, Department of Radiology, Stanford School of Medicine, Palo Alto, CA, 94304, USA
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12
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Matthews PC, Campbell C, Săndulescu O, Matičič M, Ruta SM, Rivero-Juárez A, van Welzen BJ, Tan BK, Garcia F, Gherlan GS, Çınar G, Hasanoğlu İ, Gmizić I, Nicolini LA, Santos L, Sargsyants N, Velikov P, Habibović S, Fourati S, Židovec-Lepej S, Herder V, Dudman S, Miron VD, Irving W, Şahin GÖ. Acute severe hepatitis outbreak in children: A perfect storm. What do we know, and what questions remain? Front Pharmacol 2022; 13:1062408. [PMID: 36506522 PMCID: PMC9732095 DOI: 10.3389/fphar.2022.1062408] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022] Open
Abstract
During the first half of 2022, the World Health Organization reported an outbreak of acute severe hepatitis of unknown aetiology (AS-Hep-UA) in children, following initial alerts from the United Kingdom (UK) where a cluster of cases was first observed in previously well children aged <6 years. Sporadic cases were then reported across Europe and worldwide, although in most countries incidence did not increase above the expected baseline. There were no consistent epidemiological links between cases, and microbiological investigations ruled out known infectious causes of hepatitis. In this review, we explore the evidence for the role of viral infection, superimposed on a specific host genetic background, as a trigger for liver pathology. This hypothesis is based on a high prevalence of Human Adenovirus (HAdV) 41F in affected children, together with metagenomic evidence of adeno-associated virus (Adeno-associated viruses)-2, which is a putative trigger for an immune-mediated liver injury. Roles for superantigen-mediated pathology have also been explored, with a focus on the potential contribution of SARS-CoV-2 infection. Affected children also had a high frequency of the MHC allele HLA-DRB1*04:01, supporting an immunological predisposition, and may have been vulnerable to viral coinfections due to disruption in normal patterns of exposure and immunity as a result of population lockdowns during the COVID-19 pandemic. We discuss areas of ongoing uncertainty, and highlight the need for ongoing scrutiny to inform clinical and public health interventions for this outbreak and for others that may evolve in future.
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Affiliation(s)
- Philippa C Matthews
- The Francis Crick Institute, London, United Kingdom.,Division of Infection and Immunity, University College London, London, United Kingdom.,Department of Infection, University College London Hospitals, London, United Kingdom
| | - Cori Campbell
- Nuffield Department of Medicine, University of Oxford, Oxford, England
| | - Oana Săndulescu
- Department of Infectious Diseases, National Institute for Infectious Diseases-Prof. Dr. Matei Balş, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mojca Matičič
- Faculty of Medicine, Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, University of Ljubljana, Ljubljana, Slovenia
| | - Simona Maria Ruta
- Virology Department, Stefan S. Nicolau Institute of Virology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Antonio Rivero-Juárez
- Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - Berend Joost van Welzen
- Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Boun Kim Tan
- INSERM U1052, Department of Intensive Care Unit, Hôpital Lyon Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Federico Garcia
- Microbiology Department, Instituto de Investigacion Ibs.Granada and Ciber de Enfermedades Infecciosas (CIBERINFEC), University Hospital San Cecilio, Granada, Spain
| | - George Sebastian Gherlan
- Department of Infectious Diseases, "Dr. Victor Babes" Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Güle Çınar
- Department of Infectious Diseases and Clinical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - İmran Hasanoğlu
- Department of Infectious Disease and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Ivana Gmizić
- Clinic for Infectious and Tropical Diseases, University Clinical Center of Serbia, Belgrade, Serbia
| | - Laura Ambra Nicolini
- Division of Infectious Diseases , Ospedale Policlinico San Martino, Genova, Italy
| | - Lurdes Santos
- Nephrology and Infectious Diseases R&D, Infectious Diseases Intensive Care Unit, Faculty of Medicine of University of Porto, Centro Hospitalar Universitário São João, I3S - Instituto de Investigação e Inovaçãoem Saúde, University of Porto, Porto, Portugal
| | - Narina Sargsyants
- Ministry of Health, National Centre for Infectious Diseases, National Institute of Health, Yerevan, Armenia
| | - Petar Velikov
- Infectious Diseases Hospital Prof. Ivan Kirov and Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Sofia, Bulgaria
| | - Selma Habibović
- Department of Microbiology, Public Health Institute Novi Pazar, Novi Pazar, Serbia
| | - Slim Fourati
- Department of Virology, INSERM, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Institut Mondor de Recherche Biomédicale, Université Paris-Est, Créteil, France
| | - Snježana Židovec-Lepej
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb, Croatia
| | - Vanessa Herder
- Medical Research Council-University of Glasgow Centre for Virus Research, University of Glasgow, Glasgow, United Kingdom
| | - Susanne Dudman
- Department of Microbiology, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Victor Daniel Miron
- National Institute for Mother and Child Health "Alessandrescu-Rusescu", Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - William Irving
- NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, United Kingdom
| | - Gülşen Özkaya Şahin
- Department of Laboratory Medicine, Section of Clinical Microbiology, Region Skåne, Lund, Sweden.,Department of Translational Medicine, Lund University, Malmö, Sweden
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13
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Chen J, Jing H, Martin-Nalda A, Bastard P, Rivière JG, Liu Z, Colobran R, Lee D, Tung W, Manry J, Hasek M, Boucherit S, Lorenzo L, Rozenberg F, Aubart M, Abel L, Su HC, Soler Palacin P, Casanova JL, Zhang SY. Inborn errors of TLR3- or MDA5-dependent type I IFN immunity in children with enterovirus rhombencephalitis. J Exp Med 2021; 218:212742. [PMID: 34726731 PMCID: PMC8570298 DOI: 10.1084/jem.20211349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/31/2021] [Accepted: 10/11/2021] [Indexed: 12/14/2022] Open
Abstract
Enterovirus (EV) infection rarely results in life-threatening infection of the central nervous system. We report two unrelated children with EV30 and EV71 rhombencephalitis. One patient carries compound heterozygous TLR3 variants (loss-of-function F322fs2* and hypomorphic D280N), and the other is homozygous for an IFIH1 variant (loss-of-function c.1641+1G>C). Their fibroblasts respond poorly to extracellular (TLR3) or intracellular (MDA5) poly(I:C) stimulation. The baseline (TLR3) and EV-responsive (MDA5) levels of IFN-β in the patients’ fibroblasts are low. EV growth is enhanced at early and late time points of infection in TLR3- and MDA5-deficient fibroblasts, respectively. Treatment with exogenous IFN-α2b before infection renders both cell lines resistant to EV30 and EV71, whereas post-infection treatment with IFN-α2b rescues viral susceptibility fully only in MDA5-deficient fibroblasts. Finally, the poly(I:C) and viral phenotypes of fibroblasts are rescued by the expression of WT TLR3 or MDA5. Human TLR3 and MDA5 are critical for cell-intrinsic immunity to EV, via the control of baseline and virus-induced type I IFN production, respectively.
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Affiliation(s)
- Jie Chen
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY.,Department of Infectious Diseases, Shanghai Sixth Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Huie Jing
- Laboratory of Clinical Immunology and Microbiology, Intramural Research Program, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Andrea Martin-Nalda
- Infection in Immunocompromised Pediatric Patients Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Paul Bastard
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163, Paris, France.,University of Paris, Imagine Institute, Paris, France
| | - Jacques G Rivière
- Infection in Immunocompromised Pediatric Patients Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Zhiyong Liu
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY
| | - Roger Colobran
- Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain.,Diagnostic Immunology Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Immunology Division, Genetics Department, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Danyel Lee
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163, Paris, France.,University of Paris, Imagine Institute, Paris, France
| | - Wesley Tung
- Laboratory of Clinical Immunology and Microbiology, Intramural Research Program, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Jeremy Manry
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163, Paris, France.,University of Paris, Imagine Institute, Paris, France
| | - Mary Hasek
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY
| | - Soraya Boucherit
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163, Paris, France.,University of Paris, Imagine Institute, Paris, France
| | - Lazaro Lorenzo
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163, Paris, France.,University of Paris, Imagine Institute, Paris, France
| | - Flore Rozenberg
- Laboratory of Virology, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Paris, France
| | - Mélodie Aubart
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163, Paris, France.,University of Paris, Imagine Institute, Paris, France.,Pediatric Neurology Department, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laurent Abel
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163, Paris, France.,University of Paris, Imagine Institute, Paris, France
| | - Helen C Su
- Laboratory of Clinical Immunology and Microbiology, Intramural Research Program, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
| | - Pere Soler Palacin
- Infection in Immunocompromised Pediatric Patients Research Group, Vall d'Hebron Research Institute, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron University Hospital, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Jeffrey Modell Diagnostic and Research Center for Primary Immunodeficiencies, Barcelona, Spain
| | - Jean-Laurent Casanova
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163, Paris, France.,University of Paris, Imagine Institute, Paris, France.,Howard Hughes Medical Institute, New York, NY
| | - Shen-Ying Zhang
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY.,Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale U1163, Paris, France.,University of Paris, Imagine Institute, Paris, France
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14
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Stokes V, Milner S, Surridge J. Paediatric rhombencephalitis presenting with bradycardia: a good recovery despite cardiac involvement. BMJ Case Rep 2021; 14:e244189. [PMID: 34753718 PMCID: PMC8578938 DOI: 10.1136/bcr-2021-244189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 11/04/2022] Open
Abstract
Rhombencephalitis is a rare condition, often caused by infection, commonly presenting with myoclonic jerks, ataxia and cranial nerve palsy. Typically, it has a high morbidity and mortality, with worse prognosis associated with cardiopulmonary involvement. Herein, we present the case of a 10-year-old boy, presenting with headache, vomiting, symptomatic bradycardia and rapidly progressing ophthalmoplegia from a sixth nerve palsy, without additional brainstem symptoms. Previously, pericarditis, myocarditis and heart failure have been associated with rhombencephalitis, but not bradycardia. The cause of his rhombencephalitis was presumed viral, but despite extensive screening, the virus responsible was never isolated. Following treatment with intravenous antibiotics and antivirals in a high dependency unit, he recovered well with no neurological deficit on discharge and marked radiological improvement on MRI 4 weeks later. Although rare, rhombencephalitis should be considered in a child presenting with neurological symptoms, particularly alongside a cranial nerve palsy, developing over a rapid time course.
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Affiliation(s)
| | - Sarah Milner
- Paediatrics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Julia Surridge
- Children's Emergency Department, Royal Derby Hospital, Derby, UK
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15
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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: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [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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16
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Keeren K, Böttcher S, Diedrich S. Enterovirus Surveillance (EVSurv) in Germany. Microorganisms 2021; 9:2005. [PMID: 34683328 PMCID: PMC8538599 DOI: 10.3390/microorganisms9102005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 01/22/2023] Open
Abstract
The major aim of the enterovirus surveillance (EVSurv) in Germany is to prove the absence of poliovirus circulation in the framework of the Global Polio Eradication Program (GPEI). Therefore, a free-of-charge enterovirus diagnostic is offered to all hospitals for patients with symptoms compatible with a polio infection. Within the quality proven laboratory network for enterovirus diagnostic (LaNED), stool and cerebrospinal fluid (CSF) samples from patients with suspected aseptic meningitis/encephalitis or acute flaccid paralysis (AFP) are screened for enterovirus (EV), typing is performed in all EV positive sample to exclude poliovirus infections. Since 2006, ≈200 hospitals from all 16 German federal states have participated annually. On average, 2500 samples (70% stool, 28% CSF) were tested every year. Overall, the majority of the patients studied are children <15 years. During the 15-year period, 53 different EV serotypes were detected. While EV-A71 was most frequently detected in infants, E30 dominated in older children and adults. Polioviruses were not detected. The German enterovirus surveillance allows monitoring of the circulation of clinically relevant serotypes resulting in continuous data about non-polio enterovirus epidemiology.
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Affiliation(s)
- Kathrin Keeren
- Secretary of the National Commission for Polio Eradication in Germany, Robert Koch Institute, 13353 Berlin, Germany;
| | - Sindy Böttcher
- National Reference Centre for Poliomyelitis and Enteroviruses, Robert Koch Institute, 13353 Berlin, Germany;
| | | | - Sabine Diedrich
- National Reference Centre for Poliomyelitis and Enteroviruses, Robert Koch Institute, 13353 Berlin, Germany;
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17
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Harvala H, Benschop KSM, Berginc N, Midgley S, Wolthers K, Simmonds P, Feeney S, Bailly JL, Mirand A, Fischer TK. European Non-Polio Enterovirus Network: Introduction of Hospital-Based Surveillance Network to Understand the True Disease Burden of Non-Polio Enterovirus and Parechovirus Infections in Europe. Microorganisms 2021; 9:microorganisms9091827. [PMID: 34576722 PMCID: PMC8469463 DOI: 10.3390/microorganisms9091827] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Non-polio enteroviruses (EVs) and human parechoviruses (PeVs) cause a wide range of human infections. Limited data on their true disease burden exist as standardized European-wide surveillance is lacking. AIMS Our aim is to estimate the disease burden of EV and PeV infections in Europe via establishment of standardized surveillance for hand, foot and mouth disease (HFMD) and respiratory and neurological infections caused by these viruses. We will also assess the sensitivity of assays implemented in the network of participating laboratories so that all EV and PeV types are adequately detected. Plan. The European Non-Polio Enterovirus Network (ENPEN) has developed standardized protocols for a prospective, multi-center and cross-sectional hospital-based pilot study. Protocols include guidance for diagnosis, case definition, detection, characterization and reporting of EV and PeV infections associated with HFMD and respiratory and neurological diseases. Over 30 sites from 17 European countries have already registered to this one pilot study, likely to be commenced in 2022. BENEFITS This surveillance will allow European-wide comparison of data on EV and PeV infection. These data will also be used to determine the burden of EV and PeV infections, which is needed to guide the further prevention measures and policies.
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Affiliation(s)
- Heli Harvala
- NHS Blood and Transplant, Microbiology Services, Colindale, London NW9 5BG, UK
- Department of Infection, University College London (UCL), London WC1E 6BT, UK
- Correspondence: ; Tel.: +44-77-47096974
| | | | - Natasa Berginc
- Laboratory for Public Health Virology, 1000 Ljubljana, Slovenia;
| | - Sofie Midgley
- The WHO National Reference Laboratory for Poliovirus, Statens Serum Institute, DK-2300 Copenhagen, Denmark;
| | - Katja Wolthers
- Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands;
| | - Peter Simmonds
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, UK;
| | - Susan Feeney
- Regional Virus Laboratory, Royal Victoria Hospital, Belfast BT12 6BA, Northern Ireland, UK;
| | - Jean-Luc Bailly
- CHU Clermont-Ferrand, National Reference Centre for Enteroviruses and Parechoviruses–Associated Laboratory, 63000 Clermont-Ferrand, France; (J.-L.B.); (A.M.)
| | - Audrey Mirand
- CHU Clermont-Ferrand, National Reference Centre for Enteroviruses and Parechoviruses–Associated Laboratory, 63000 Clermont-Ferrand, France; (J.-L.B.); (A.M.)
| | - Thea K. Fischer
- Department of Clinical Research, Nordsjaellands University Hospital, DK-3400 Hilleroed, Denmark;
- Department of Public Health and Department of International Health, University of Copenhagen, DK-1353 Copenhagen, Denmark
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18
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Kamau E, Nguyen D, Celma C, Blomqvist S, Horby P, Simmonds P, Harvala H. Seroprevalence and Virologic Surveillance of Enterovirus 71 and Coxsackievirus A6, United Kingdom, 2006-2017. Emerg Infect Dis 2021; 27:2261-2268. [PMID: 34423767 PMCID: PMC8386771 DOI: 10.3201/eid2709.204915] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Enterovirus A71 (EV-A71) and coxsackievirus A6 (CVA6) cause hand, foot and mouth disease (HFMD) and are occasionally linked to severe neurologic complications and large outbreaks worldwide. We estimated EV-A71 and CVA6 seroprevalence using cross-sectional age-stratified samples collected in 2006, 2011, and 2017. Seroprevalences of EV-A71 and CVA6 increased from 32% and 54% at 6-11 months to >75% by 10 years of age. Antibody titers declined after 20 years, which could indicate infrequent re-exposure in older populations. Age profiles for acquiring infections and mean titers were comparable in the 3 testing years, despite the marked increase in incidence of CVA6-related HFMD from 2010. The uncoupling of changes in disease severity from the infection kinetics of CVA6 as we inferred from the seroprevalence data, rather than incidence of infection over the 11-year study period, provides further evidence for a change in its pathogenicity.
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19
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Sooksawasdi Na Ayudhya S, Laksono BM, van Riel D. The pathogenesis and virulence of enterovirus-D68 infection. Virulence 2021; 12:2060-2072. [PMID: 34410208 PMCID: PMC8381846 DOI: 10.1080/21505594.2021.1960106] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In 2014, enterovirus D68 (EV-D68) emerged causing outbreaks of severe respiratory disease in children worldwide. In a subset of patients, EV-D68 infection was associated with the development of central nervous system (CNS) complications, including acute flaccid myelitis (AFM). Since then, the number of reported outbreaks has risen biennially, which emphasizes the need to unravel the systemic pathogenesis in humans. We present here a comprehensive review on the different stages of the pathogenesis of EV-D68 infection – infection in the respiratory tract, systemic dissemination and infection of the CNS – based on observations in humans as well as experimental in vitro and in vivo studies. This review highlights the knowledge gaps on the mechanisms of systemic dissemination, routes of entry into the CNS and mechanisms to induce AFM or other CNS complications, as well as the role of virus and host factors in the pathogenesis of EV-D68.
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Affiliation(s)
| | - Brigitta M Laksono
- Department of Viroscience, Erasmus MC, Dr Molewaterplein 40, GD Rotterdam, The Netherlands
| | - Debby van Riel
- Department of Viroscience, Erasmus MC, Dr Molewaterplein 40, GD Rotterdam, The Netherlands
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20
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Wörner N, Rodrigo-García R, Antón A, Castellarnau E, Delgado I, Vazquez È, González S, Mayol L, Méndez M, Solé E, Rosal J, Andrés C, Casquero A, Lera E, Sancosmed M, Campins M, Pumarola T, Rodrigo C. Enterovirus-A71 Rhombencephalitis Outbreak in Catalonia: Characteristics, Management and Outcome. Pediatr Infect Dis J 2021; 40:628-633. [PMID: 34097655 PMCID: PMC8189429 DOI: 10.1097/inf.0000000000003114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Between April and June 2016, an outbreak of rhombencephalitis (RE) caused by enterovirus (EV) A71 was detected in Catalonia, Spain-the first documented in Western Europe. The clinical characteristics and outcome of patients with this condition differed from those reported in outbreaks occurring in Southeast Asia. METHODS Observational, multicenter study analyzing characteristics, treatment and outcome of patients with EV-A71 rhombencephalitis diagnosed in 6 publicly funded hospitals within the Catalonian Health Institute. A review of clinical characteristics, diagnosis, treatment and outcome of these patients was conducted. RESULTS Sixty-four patients met the clinical and virologic criteria for rhombencephalitis caused by EV-A71. All patients had symptoms suggesting viral disease, mainly fever, lethargy, ataxia and tremor, with 30% of hand-foot-mouth disease. Intravenous immunoglobulin therapy was given to 44/64 (69%) patients and methylprednisolone to 27/64 (42%). Six patients (9%) required pediatric intensive care unit admission. Three patients had acute flaccid paralysis of 1 limb, and another had autonomic nervous system (ANS) dysfunction with cardiorespiratory arrest. Outcome in all patients (except the patient with hypoxic-ischemic encephalopathy) was good, with complete resolution of the symptoms. CONCLUSIONS During the 2016 outbreak, rhombencephalitis without ANS symptoms was the predominant form of presentation and most patients showed no hand-foot-mouth disease. These findings contrast with those of other patient series reporting associated ANS dysfunction (10%-15%) and hand-foot-mouth disease (60%-80%). Complete recovery occurred in almost all cases. In light of the favorable outcome in untreated mild cases, therapies for this condition should be reserved for patients with moderate-severe infection. The main relevance of this study is to provide useful information for setting priorities, management approaches and adequate use of resources in future EV-A71 associated rhombencephalitis outbreaks.
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Affiliation(s)
- Núria Wörner
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Rocío Rodrigo-García
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Andrés Antón
- Department of Microbiology, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ester Castellarnau
- Department of Pediatrics, Joan XXIII University Hospital, Tarragona, Spain
| | - Ignacio Delgado
- Department of Pediatric Radiology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Èlida Vazquez
- Department of Pediatric Radiology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Sebastià González
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Lluís Mayol
- Department of Pediatrics, Josep Trueta University Hospital, Girona, Spain
| | - Maria Méndez
- Department of Pediatrics, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Eduard Solé
- Department of Pediatrics, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Jaume Rosal
- Department of Pediatrics, Verge de la Cinta Hospital, Tortosa, Spain
| | - Cristina Andrés
- Department of Microbiology, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
| | - Alejandro Casquero
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Esther Lera
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Mónica Sancosmed
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Magda Campins
- Vall d’Hebron Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Preventive Medicine and Epidemiology, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Tomàs Pumarola
- Department of Microbiology, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Rodrigo
- From the Pediatric Emergency Department, Department of Pediatrics, Vall d’Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Research Institute, Barcelona, Spain
- Faculty of Medicine at Germans Trias i Pujol University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain. Carlos Rodrigo, MD, PhD, is currently at the Department of Pediatrics, Germans Trias i Pujol University Hospital, Badalona, Barcelona, Spain
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21
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Zhang C, Xu C, Dai W, Wang Y, Liu Z, Zhang X, Wang X, Wang H, Gong S, Cong Y, Huang Z. Functional and structural characterization of a two-MAb cocktail for delayed treatment of enterovirus D68 infections. Nat Commun 2021; 12:2904. [PMID: 34006855 PMCID: PMC8131599 DOI: 10.1038/s41467-021-23199-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 04/14/2021] [Indexed: 02/03/2023] Open
Abstract
Enterovirus D68 (EV-D68) is an emerging pathogen associated with respiratory diseases and/or acute flaccid myelitis. Here, two MAbs, 2H12 and 8F12, raised against EV-D68 virus-like particle (VLP), show distinct preference in binding VLP and virion and in neutralizing different EV-D68 strains. A combination of 2H12 and 8F12 exhibits balanced and potent neutralization effects and confers broader protection in mice than single MAbs when given at onset of symptoms. Cryo-EM structures of EV-D68 virion complexed with 2H12 or 8F12 show that both antibodies bind to the canyon region of the virion, creating steric hindrance for sialic acid receptor binding. Additionally, 2H12 binding can impair virion integrity and trigger premature viral uncoating. We also capture an uncoating intermediate induced by 2H12 binding, not previously described for picornaviruses. Our study elucidates the structural basis and neutralizing mechanisms of the 2H12 and 8F12 MAbs and supports further development of the 2H12/8F12 cocktail as a broad-spectrum therapeutic agent against EV-D68 infections in humans.
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MESH Headings
- Animals
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/immunology
- Antibodies, Monoclonal/metabolism
- Antibodies, Neutralizing/administration & dosage
- Antibodies, Neutralizing/immunology
- Antibodies, Neutralizing/metabolism
- Cell Line, Tumor
- Cryoelectron Microscopy
- Enterovirus D, Human/drug effects
- Enterovirus D, Human/immunology
- Enterovirus D, Human/physiology
- Enterovirus Infections/drug therapy
- Enterovirus Infections/immunology
- Enterovirus Infections/virology
- Female
- Humans
- Mice, Inbred BALB C
- Protein Binding/drug effects
- Receptors, Cell Surface/immunology
- Receptors, Cell Surface/metabolism
- Time-to-Treatment
- Treatment Outcome
- Virion/drug effects
- Virion/immunology
- Virion/metabolism
- Virion/ultrastructure
- Virus Uncoating/drug effects
- Mice
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Affiliation(s)
- Chao Zhang
- Joint Center for Infection and Immunity, Guangzhou Institute of Pediatrics, Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- CAS Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Cong Xu
- State Key Laboratory of Molecular Biology, National Center for Protein Science Shanghai, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Wenlong Dai
- CAS Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Yifan Wang
- State Key Laboratory of Molecular Biology, National Center for Protein Science Shanghai, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Zhi Liu
- CAS Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Xueyang Zhang
- CAS Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Xuesong Wang
- CAS Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Haikun Wang
- CAS Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China
| | - Sitang Gong
- Joint Center for Infection and Immunity, Guangzhou Institute of Pediatrics, Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
| | - Yao Cong
- State Key Laboratory of Molecular Biology, National Center for Protein Science Shanghai, Shanghai Institute of Biochemistry and Cell Biology, Center for Excellence in Molecular Cell Science, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China.
- Shanghai Science Research Center, Chinese Academy of Sciences, Shanghai, China.
| | - Zhong Huang
- CAS Key Laboratory of Molecular Virology & Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, China.
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22
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Enteroviruses in Respiratory Samples from Paediatric Patients of a Tertiary Care Hospital in Germany. Viruses 2021; 13:v13050882. [PMID: 34064852 PMCID: PMC8151397 DOI: 10.3390/v13050882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
Enteroviruses are associated with various diseases accompanied by rare but severe complications. In recent years, outbreaks of enterovirus D68 and enterovirus A71 associated with severe respiratory infections and neurological complications have been reported worldwide. Since information on molecular epidemiology in respiratory samples is still limited, the genetic diversity of enteroviruses was retrospectively analysed over a 4-year period (2013-2016) in respiratory samples from paediatric patients. Partial viral major capsid protein gene (VP1) sequences were determined for genotyping. Enteroviruses were detected in 255 (6.1%) of 4187 specimens. Phylogenetic analyses of 233 (91.4%) strains revealed 25 different genotypes distributed to Enterovirus A (39.1%), Enterovirus B (34.3%), and Enterovirus D (26.6%). The most frequently detected genotypes were enterovirus D68 (26.6%), coxsackievirus A6 (15.9%), and enterovirus A71 (7.3%). Enterovirus D68 detections were associated with lower respiratory tract infections and increased oxygen demand. Meningitis/encephalitis and other neurological symptoms were related to enterovirus A71, while coxsackievirus A6 was associated with upper respiratory diseases. Prematurity turned out as a potential risk factor for increased oxygen demand during enterovirus infections. The detailed analysis of epidemiological and clinical data contributes to the non-polio enterovirus surveillance in Europe and showed high and rapidly changing genetic diversity of circulating enteroviruses, including different enterovirus D68 variants.
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23
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Luciani L, Morand A, Zandotti C, Piorkowski G, Boutin A, Mazenq J, Minodier P, Ninove L, Nougairède A. Circulation of enterovirus A71 during 2019-2020, Marseille, France. J Med Virol 2021; 93:5163-5166. [PMID: 33605462 DOI: 10.1002/jmv.26893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 11/11/2022]
Abstract
Enteroviruses A71 (EVs-A71) are known to cause serious neurological infections, especially in the pediatric population. We report here eight cases of EV-A71 infection diagnosed in Marseille over the past 2 years (seven cases in 2019 and one case in 2020). Only children under 5 years of age were affected, including one case of acute flaccid paralysis. Viral RNA was detected by RT-PCR in peripheral samples for all cases (feces and upper respiratory samples). Phylogenetic analyses based on VP1 and 2C3C coding regions revealed that all these cases of EV-A71 infection were caused by viruses belonging to the subgenogroup C1 that currently circulates in Europe and that these viruses are genetically closed to other EVs-A71 recently detected in European countries. These data therefore reinforce the usefulness of the enterovirus surveillance network and the need for systematic screening for EV-A71 in case of an enteroviral infection. This study therefore suggests that the systematic screening for EV-A71 in case of enteroviral infection could provide additional data for enterovirus surveillance networks.
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Affiliation(s)
- Léa Luciani
- Unité des Virus Émergents (UVE: Aix-Marseille University, IRD 190, Inserm 1207), Marseille, France.,Laboratoire de microbiologie (Assistance Publique - Hôpitaux de Marseille (AP-HM), IHU Méditerranée Infection), Marseille, France
| | - Aurélie Morand
- Service de médecine infantile et pédiatrie spécialisée, CHU Timone, AP-HM, Marseille, France.,Aix Marseille University, IRD, MEPHI, AP-HM, IHU Méditerranée Infection, Marseille, France
| | - Christine Zandotti
- Unité des Virus Émergents (UVE: Aix-Marseille University, IRD 190, Inserm 1207), Marseille, France.,Laboratoire de microbiologie (Assistance Publique - Hôpitaux de Marseille (AP-HM), IHU Méditerranée Infection), Marseille, France
| | - Géraldine Piorkowski
- Unité des Virus Émergents (UVE: Aix-Marseille University, IRD 190, Inserm 1207), Marseille, France
| | - Aurélie Boutin
- Service des urgences pédiatriques, CHU Timone AP-HM, Marseille, France
| | - Julie Mazenq
- Service des urgences pédiatriques, CHU Timone AP-HM, Marseille, France
| | - Philippe Minodier
- Service des urgences pédiatriques, CHU Nord AP-HM, Marseille, France
| | - Laetitia Ninove
- Unité des Virus Émergents (UVE: Aix-Marseille University, IRD 190, Inserm 1207), Marseille, France.,Laboratoire de microbiologie (Assistance Publique - Hôpitaux de Marseille (AP-HM), IHU Méditerranée Infection), Marseille, France
| | - Antoine Nougairède
- Unité des Virus Émergents (UVE: Aix-Marseille University, IRD 190, Inserm 1207), Marseille, France.,Laboratoire de microbiologie (Assistance Publique - Hôpitaux de Marseille (AP-HM), IHU Méditerranée Infection), Marseille, France
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24
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Survey of diagnostic and typing capacity for enterovirus infection in Italy and identification of two echovirus 30 outbreaks. J Clin Virol 2021; 137:104763. [PMID: 33711692 DOI: 10.1016/j.jcv.2021.104763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/12/2021] [Accepted: 02/14/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Enterovirus infections can cause a variety of illnesses, ranging from asymptomatic infections to severe illness and death. AIM To support polio eradication activities, in February 2019, the WHO Regional Reference Laboratory for polio in Italy, at the National Institute of Public Health (Istituto Superiore di Sanità), promoted an investigation on non-polio enterovirus laboratory capacity, with the support of the Italian Ministry of Health. The aim was to collect data on the assays used routinely for diagnostic purposes and to characterize enterovirus outbreaks strains by sequence analysis of the Viral Protein 1 region. METHODS A questionnaire was administered to public health laboratories through all Italian Regions for 2018 and subsequently, an electronic form for lab-confirmed enterovirus infection reported from February 2019 to January 2020, including patients clinical characteristics, and laboratory data was distributed through 25 laboratories participating the survey. RESULTS Overall, a homogenous laboratory capacity for enterovirus infection diagnosis was found and 21,000 diagnostic tests were retrospectively reported in 2018. Then, in 2019, two outbreaks of Echovirus 30 were identified and confirmed by molecular analyses. CONCLUSION These results underline the need monitor the circulation of non-polio enterovirus to ascertain the real burden of the disease in the country.
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25
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Omland LH, Holm-Hansen C, Lebech AM, Dessau RB, Bodilsen J, Andersen NS, Roed C, Christiansen CB, Ellermann-Eriksen S, Midgley S, Nielsen L, Benfield T, Hansen ABE, Andersen CØ, Rothman KJ, Sørensen HT, Fischer TK, Obel N. Long-Term Survival, Health, Social Functioning, and Education in Patients With an Enterovirus Central Nervous System Infection, Denmark, 1997-2016. J Infect Dis 2021; 222:619-627. [PMID: 32236420 DOI: 10.1093/infdis/jiaa151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/31/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The long-term clinical course of patients with an enterovirus central nervous system infection (ECI) is poorly understood. METHODS We performed a nationwide population-based cohort study of all Danish patients with ECI diagnosed 1997-2016 (n = 1745) and a comparison cohort from the general population individually matched on date of birth and sex (n = 17 450). Outcomes were categorized into mortality and risk of cancer and likely measures of neurological sequelae: neuropsychiatric morbidities, educational landmarks, use of hospital services, employment, receipt of disability pension, income, number of sick leave days, and nursing home residency. RESULTS Mortality in the first year was higher among patients with ECI (mortality rate ratio [MRR] = 10.0; 95% confidence interval [CI], 4.17-24.1), but thereafter mortality was not higher (MMR = 0.94; 95% CI, 0.47-1.86). Long-term outcomes for patients with ECI were not inferior to those of the comparison cohort for risk of cancer, epilepsy, mental and behavioral disorders, dementia, depression, school start, school marks, high school education, use of hospital services, employment, receipt of disability pension, income, days of sick leave, or nursing home residency. CONCLUSIONS Diagnosis of an ECI had no substantial impact on long-term survival, health, or social/educational functioning.
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Affiliation(s)
- Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Holm-Hansen
- Department of Virus and Specialist Microbiological Diagnostics, Statens Serum Institute, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Jacob Bodilsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Nanna S Andersen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Casper Roed
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus B Christiansen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Sofie Midgley
- Department of Virus and Specialist Microbiological Diagnostics, Statens Serum Institute, Copenhagen, Denmark
| | - Lene Nielsen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ann-Brit E Hansen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian Ø Andersen
- Department of Clinical Microbiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kenneth J Rothman
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Boston University, Boston, Massachusetts, USA
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Boston University, Boston, Massachusetts, USA
| | - Thea K Fischer
- Department of Virus and Specialist Microbiological Diagnostics, Statens Serum Institute, Copenhagen, Denmark.,Department of Infectious Diseases, University of Southern Denmark, Odense, Denmark.,Centre for Global Health, University of Southern Denmark, Odense, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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26
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Faleye TOC, Driver E, Bowes D, Adhikari S, Adams D, Varsani A, Halden RU, Scotch M. Pan-Enterovirus Amplicon-Based High-Throughput Sequencing Detects the Complete Capsid of a EVA71 Genotype C1 Variant via Wastewater-Based Epidemiology in Arizona. Viruses 2021; 13:v13010074. [PMID: 33430521 PMCID: PMC7827028 DOI: 10.3390/v13010074] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/02/2021] [Accepted: 01/04/2021] [Indexed: 01/22/2023] Open
Abstract
We describe the complete capsid of a genotype C1-like Enterovirus A71 variant recovered from wastewater in a neighborhood in the greater Tempe, Arizona area (Southwest United States) in May 2020 using a pan-enterovirus amplicon-based high-throughput sequencing strategy. The variant seems to have been circulating for over two years, but its sequence has not been documented in that period. As the SARS-CoV-2 pandemic has resulted in changes in health-seeking behavior and overwhelmed pathogen diagnostics, our findings highlight the importance of wastewater-based epidemiology (WBE ) as an early warning system for virus surveillance.
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Affiliation(s)
- Temitope O. C. Faleye
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (T.O.C.F.); (E.D.); (D.B.); (S.A.); (R.U.H.)
| | - Erin Driver
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (T.O.C.F.); (E.D.); (D.B.); (S.A.); (R.U.H.)
| | - Devin Bowes
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (T.O.C.F.); (E.D.); (D.B.); (S.A.); (R.U.H.)
| | - Sangeet Adhikari
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (T.O.C.F.); (E.D.); (D.B.); (S.A.); (R.U.H.)
| | - Deborah Adams
- Biodesign Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA;
| | - Arvind Varsani
- Biodesign Center for Fundamental and Applied Microbiomics, Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA;
| | - Rolf U. Halden
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (T.O.C.F.); (E.D.); (D.B.); (S.A.); (R.U.H.)
- OneWaterOneHealth, Nonprofit Project of the Arizona State University Foundation, Tempe, AZ 85287, USA
| | - Matthew Scotch
- Biodesign Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (T.O.C.F.); (E.D.); (D.B.); (S.A.); (R.U.H.)
- Correspondence:
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27
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Huang KYA, Huang PN, Huang YC, Yang SL, Tsao KC, Chiu CH, Shih SR, Lin TY. Emergence of genotype C1 Enterovirus A71 and its link with antigenic variation of virus in Taiwan. PLoS Pathog 2020; 16:e1008857. [PMID: 32936838 PMCID: PMC7521691 DOI: 10.1371/journal.ppat.1008857] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/28/2020] [Accepted: 08/04/2020] [Indexed: 12/16/2022] Open
Abstract
An outbreak of the hand-foot-mouth disease with severe neurological cases, mainly caused by the genotype C1 enterovirus A71 (EV-A71), occurred in Taiwan between 2018 and early 2019. In the recent decade, the most dominant EV-A71 genotypes in Taiwan were B5 and C4 but changed to C1 in 2018. Antibody-mediated immunity plays a key role in limiting the EV-A71 illness in humans. However, the level of neutralizing activities against genotype C1 virus by human polyclonal and monoclonal antibodies (MAbs) remains largely unclear. In the study, we demonstrated that that 39% (9 in 23) of post-infection sera from the genotype B5- or C4-infected patients in 2014–2017 exhibit reduced titers with the 2018–2019 genotype C1 viruses than with the earlier B5 and C4 viruses tested. This finding with polyclonal sera is confirmed with human MAbs derived from genotype B5 virus-infected individuals. The 2018–2019 genotype C1 virus is resistant to the majority of canyon-targeting human MAbs, which may be associated with the residue change near or at the bottom of the canyon region on the viral capsid. The remaining three antibodies (16-2-11B, 16-3-4D, and 17-1-12A), which target VP1 S241 on the 5-fold vertex, VP3 E81 on the 3-fold plateau and VP2 D84 on the 2-fold plateau of genotype C1 viral capsid, respectively, retained neutralizing activities with variable potencies. These neutralizing antibodies were also found to be protective against a lethal challenge of the 2018–2019 genotype C1 virus in an hSCARB2-transgenic mice model. These results indicate that the EV-A71-specific antibody response may consist of a fraction of poorly neutralizing antibodies against 2018–2019 genotype C1 viruses among a subset of previously infected individuals. Epitope mapping of protective antibodies that recognize the emerging genotype C1 virus has implications for anti-EV-A71 MAbs and the vaccine field. EV-A71 is a cause of hand-foot-mouth disease, epidemics of which still regularly occur around the globe. Given that EV-A71 immune protection from the disease correlates with neutralizing antibody responses, but the responses in humans prior to an outbreak are still poorly understood. An outbreak of hand-foot-mouth disease among children emerged in Taiwan from 2018 to 2019, and genotype C1 EV-A71 caused most of the cases. Here, we characterized EV-A71-neutralizing antibody profiles in details at both the serological and monoclonal levels and showed that antibodies generated by humans prior to the emergence of genotype C1 EV-A71 less effectively neutralize C1 compared to the prior circulating genotypes, which implies the presence of antigenic variation in the EV-A71 genotypes. We further identified and mapped critical neutralizing epitopes of 2018–2019 genotype C1 EV-A71 on the top and margin of the viral capsid pentamer and demonstrated the in vivo protective effect of human monoclonal antibodies, which highlight the properties of human antibody-neutralizing sites on EV-A71 and the potential of human antibodies as antiviral agents.
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MESH Headings
- Animals
- Antibodies, Neutralizing/genetics
- Antibodies, Neutralizing/immunology
- Antibodies, Viral/genetics
- Antibodies, Viral/immunology
- Antigens, Viral/genetics
- Antigens, Viral/immunology
- Child
- Child, Preschool
- Enterovirus A, Human/genetics
- Enterovirus A, Human/immunology
- Enterovirus A, Human/isolation & purification
- Female
- Genetic Variation
- Genome, Viral
- Genotype
- Hand, Foot and Mouth Disease/epidemiology
- Hand, Foot and Mouth Disease/genetics
- Hand, Foot and Mouth Disease/immunology
- Humans
- Male
- Mice
- Mice, Transgenic
- Taiwan
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Affiliation(s)
- Kuan-Ying A. Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail: (KYAH); (TYL)
| | - Peng-Nien Huang
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Li Yang
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Chien Tsao
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shin-Ru Shih
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzou-Yien Lin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail: (KYAH); (TYL)
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28
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Midgley SE, Benschop K, Dyrdak R, Mirand A, Bailly JL, Bierbaum S, Buderus S, Böttcher S, Eis-Hübinger AM, Hönemann M, Jensen VV, Hartling UB, Henquell C, Panning M, Thomsen MK, Hodcroft EB, Meijer A. Co-circulation of multiple enterovirus D68 subclades, including a novel B3 cluster, across Europe in a season of expected low prevalence, 2019/20. ACTA ACUST UNITED AC 2020; 25. [PMID: 31964463 PMCID: PMC6976881 DOI: 10.2807/1560-7917.es.2020.25.2.1900749] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Enterovirus D68 (EV-D68) was detected in 93 patients from five European countries between 1 January 2019 and 15 January 2020, a season with expected low circulation. Patients were primarily children (n = 67, median age: 4 years), 59 patients required hospitalisation and five had severe neurologic manifestations. Phylogenetic analysis revealed two clusters in the B3 subclade and subclade A2/D. This circulation of EV-D68 associated with neurological manifestations stresses the importance of surveillance and diagnostics beyond expected peak years.
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Affiliation(s)
- Sofie Elisabeth Midgley
- Department for Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | - Kimberley Benschop
- Centre for Infectious Disease Research, Diagnostics and Laboratory Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Robert Dyrdak
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Audrey Mirand
- Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Laboratoire de Virologie, Clermont-Ferrand, France
| | - Jean-Luc Bailly
- Université Clermont Auvergne, CNRS, Laboratoire Microorganismes: Génome et Environnement, Clermont-Ferrand, France
| | - Sibylle Bierbaum
- Institute of Virology, University of Freiburg, Freiburg, Germany
| | - Stefan Buderus
- Department of General Pediatrics, St.-Marien-Hospital, Bonn, Germany
| | - Sindy Böttcher
- National Reference Center for Poliomyelitis and Enteroviruses, Robert Koch-Institute, Berlin, Germany
| | | | - Mario Hönemann
- Institute of Virology, University of Leipzig, Leipzig, Germany
| | - Veronika Vorobieva Jensen
- Department for Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | | | - Cécile Henquell
- CHU Clermont-Ferrand, Centre National de Référence des entérovirus et parechovirus - Laboratoire Associé, Laboratoire de Virologie, Clermont-Ferrand, France
| | - Marcus Panning
- Institute of Virology, University of Freiburg, Freiburg, Germany
| | | | - Emma B Hodcroft
- Swiss Institute of Bioinformatics, Basel, Switzerland.,Biozentrum, University of Basel, Basel, Switzerland
| | - Adam Meijer
- Centre for Infectious Disease Research, Diagnostics and Laboratory Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
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29
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Abstract
We report on the increased circulation of enterovirus A71 in Germany in 2019. Strains were mainly identified in hospitalised patients with suspected aseptic meningitis/encephalitis. Molecular analysis showed co-circulation of EV-A71 sub-genogroups C1 and C4, a signal for physicians and public health authorities to include/intensify EV diagnostic in patients showing signs of aseptic meningitis, encephalitis or acute flaccid paralysis/myelitis.
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Affiliation(s)
- Sindy Böttcher
- National Reference Centre for Poliomyelitis and Enteroviruses, Robert Koch Institute, Berlin, Germany
| | - Sabine Diedrich
- National Reference Centre for Poliomyelitis and Enteroviruses, Robert Koch Institute, Berlin, Germany
| | - Kathrin Keeren
- Secretary of the National Commission for Polio Eradication in Germany, Robert Koch Institute, Berlin, Germany
| | -
- The members of the network are listed at the end of the article
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30
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Sun H, Gao M, Cui D. Molecular characteristics of the VP1 region of enterovirus 71 strains in China. Gut Pathog 2020; 12:38. [PMID: 32818043 PMCID: PMC7427758 DOI: 10.1186/s13099-020-00377-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/11/2020] [Indexed: 01/08/2023] Open
Abstract
Background Enterovirus 71 (EV71) is the most commonly implicated causative agent of severe outbreaks of paediatric hand, foot, and mouth disease (HFMD).VP1 protein, a capsid protein of EV71, is responsible for the genotype of the virus and is essential for vaccine development and effectiveness. However, the genotypes of EV71 isolates in China are still not completely clear. Methods The VP1 gene sequences of 3712 EV71 virus strains from China, excluding repetitive sequences and 30 known EV71 genotypes as reference strains, between 1986 and 2019 were obtained from GenBank. Phylogenetic tree, amino acid homology, genetic variation and genotype analyses of the EV71VP1 protein were performed with MEGA 6.0 software. Results The amino acid identity was found to be 88.33%–100% among the 3712 EV71 strains, 93.47%–100% compared with vaccine strain H07, and 93.04%–100% compared with vaccine strains FY7VP5 or FY-23 K-B. Since 2000, the prevalent strains of EV71 were mainly of the C4 genotype. Among these, the C4a subgenotype was predominant, followed by the C4b subgenotype; other subgenotypes appeared sporadically between 2005 and 2018 in mainland China. The B4 genotype was the main genotype in Taiwan, and the epidemic strains were constantly changing. Some amino acid variations in VP1 of EV71 occurred with high frequencies, including A289T (20.99%), H22Q (16.49%), A293S (15.95%), S283T (15.11%), V249I (7.76%), N31D (7.25%), and E98K (6.65%). Conclusion The C4 genotype of EV71 in China matches the vaccine and should effectively control EV71. However, the efficacy of the vaccine is partially affected by the continuous change in epidemic strains in Taiwan. These results suggest that the genetic characteristics of the EV71-VP1 region should be continuously monitored, which is critical for epidemic control and vaccine design to prevent EV71 infection in children.
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Affiliation(s)
- Haiyan Sun
- Department of Clinical Laboratory, Shaoxing Second Hospital, Shaoxing, 312000 Zhejiang China
| | - Min Gao
- Department of Laboratory Medicine, Huzhou Central Hospital, Huzhou, 313003 Zhejiang China
| | - Dawei Cui
- Department of Blood Transfusion, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003 Zhejiang China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China
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31
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González-Sanz R, Casas-Alba D, Launes C, Muñoz-Almagro C, Ruiz-García MM, Alonso M, González-Abad MJ, Megías G, Rabella N, Del Cuerpo M, Gozalo-Margüello M, González-Praetorius A, Martínez-Sapiña A, Goyanes-Galán MJ, Romero MP, Calvo C, Antón A, Imaz M, Aranzamendi M, Hernández-Rodríguez Á, Moreno-Docón A, Rey-Cao S, Navascués A, Otero A, Cabrerizo M. Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016. ACTA ACUST UNITED AC 2020; 24. [PMID: 30782267 PMCID: PMC6381658 DOI: 10.2807/1560-7917.es.2019.24.7.1800089] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Introduction Enterovirus A71 (EV-A71) is an emerging pathogen that causes a wide range of disorders including severe neurological manifestations. In the past 20 years, this virus has been associated with large outbreaks of hand, foot and mouth disease with neurological complications in the Asia-Pacific region, while in Europe mainly sporadic cases have been reported. In spring 2016, however, an EV-A71 outbreak associated with severe neurological cases was reported in Catalonia and spread further to other Spanish regions. Aim Our objective was to investigate the epidemiology and clinical characteristics of the outbreak. Methods We carried out a retrospective study which included 233 EV-A71-positive samples collected during 2016 from hospitalised patients. We analysed the clinical manifestations associated with EV-A71 infections and performed phylogenetic analyses of the 3’-VP1 and 3Dpol regions from all Spanish strains and a set of EV-A71 from other countries. Results Most EV-A71 infections were reported in children (mean age: 2.6 years) and the highest incidence was between May and July 2016 (83%). Most isolates (218/233) were classified as subgenogroup C1 and 217 of them were grouped in one cluster phylogenetically related to a new recombinant variant strain associated with severe neurological diseases in Germany and France in 2015 and 2016. Moreover, we found a clear association of EV-A71-C1 infection with severe neurological disorders, brainstem encephalitis being the most commonly reported. Conclusion An emerging recombinant variant of EV-A71-C1 was responsible for the large outbreak in 2016 in Spain that was associated with many severe neurological cases.
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Affiliation(s)
- Rubén González-Sanz
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Cristian Launes
- CIBER de epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- CIBER de epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | - María Pilar Romero
- Translational Research Network in Paediatric Infectious Diseases (RITIP), IdiPaz, Madrid, Spain.,Hospital Universitario La Paz, Fundación IdiPaz, Madrid, Spain
| | - Cristina Calvo
- Translational Research Network in Paediatric Infectious Diseases (RITIP), IdiPaz, Madrid, Spain.,Hospital Universitario La Paz, Fundación IdiPaz, Madrid, Spain
| | - Andrés Antón
- Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | | | | | - Águeda Hernández-Rodríguez
- Microbiology Service, University Hospital "Germans Trias i Pujol", Department of Genetics and Microbiology, Autonomous University of Barcelona, Badalona, Spain
| | | | | | | | - Almudena Otero
- Translational Research Network in Paediatric Infectious Diseases (RITIP), IdiPaz, Madrid, Spain.,Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - María Cabrerizo
- Translational Research Network in Paediatric Infectious Diseases (RITIP), IdiPaz, Madrid, Spain.,CIBER de epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
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32
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Aubart M, Gitiaux C, Roux CJ, Levy R, Schuffenecker I, Mirand A, Bach N, Moulin F, Bergounioux J, Leruez-Ville M, Rozenberg F, Sterlin D, Musset L, Antona D, Boddaert N, Zhang SY, Kossorotoff M, Desguerre I. Severe Acute Flaccid Myelitis Associated With Enterovirus in Children: Two Phenotypes for Two Evolution Profiles? Front Neurol 2020; 11:343. [PMID: 32411086 PMCID: PMC7198806 DOI: 10.3389/fneur.2020.00343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/07/2020] [Indexed: 12/19/2022] Open
Abstract
Acute flaccid myelitis (AFM) is an acute paralysis syndrome defined by a specific inflammation of the anterior horn cells of the spinal cord. From 2014, worrying waves of life-threatening AFM consecutive to enterovirus infection (EV-D68 and EV-A71) have been reported. We describe 10 children displaying an AFM with an EV infection, the treatments performed and the 1 to 3-years follow-up. Two groups of patients were distinguished: 6 children (“polio-like group”) had severe motor disability whereas 4 other children (“brainstem group”) displayed severe brainstem weakness requiring ventilation support. Electrodiagnostic studies (n = 8) support the presence of a motor neuronopathy associated to myelitis. The best prognosis factor seems to be the motor recovery after the first 4 weeks of the disease.
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Affiliation(s)
- Melodie Aubart
- Department of Paediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France.,INSERM 1163, Imagine Institute, Paris, France
| | - Cyril Gitiaux
- Department of Paediatric Neurophysiology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France.,INSERM U955-Team 10, Department of Neurosciences, Mondor Biomedical Research Institute, Paris-Est University, Créteil, France
| | - Charles Joris Roux
- Department of Paediatric Radiology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Raphael Levy
- Department of Paediatric Radiology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Isabelle Schuffenecker
- Laboratory of Virology, National Reference Center for Enterovirus, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Audrey Mirand
- Laboratory of Virology, National Reference Center for Enterovirus Associated Laboratory, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Nathalie Bach
- Paediatric Department, CHU Caen-Normandie, Caen, France
| | - Florence Moulin
- Intensive Care Unit, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Jean Bergounioux
- Intensive Care Unit, CHU Raymond Poincaré, Paris Saclay University, AP-HP, Garches, France
| | - Marianne Leruez-Ville
- Laboratory of Virology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Flore Rozenberg
- Laboratory of Virology, Cochin Hospital, University of Paris, AP-HP, Paris, France
| | - Delphine Sterlin
- Laboratory of Immunology, Pitié-Salpétrière Hospital, Sorbonne University, AP-HP, Paris, France
| | - Lucile Musset
- Laboratory of Immunology, Pitié-Salpétrière Hospital, Sorbonne University, AP-HP, Paris, France
| | - Denise Antona
- Direction des maladies infectieuses, Santé publique France, Saint-Maurice, France
| | - Nathalie Boddaert
- INSERM U955-Team 10, Department of Neurosciences, Mondor Biomedical Research Institute, Paris-Est University, Créteil, France.,Department of Paediatric Radiology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | | | - Manoelle Kossorotoff
- Department of Paediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Isabelle Desguerre
- Department of Paediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
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33
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Leon KE, Schubert RD, Casas-Alba D, Hawes IA, Ramachandran PS, Ramesh A, Pak JE, Wu W, Cheung CK, Crawford ED, Khan LM, Launes C, Sample HA, Zorn KC, Cabrerizo M, Valero-Rello A, Langelier C, Muñoz-Almagro C, DeRisi JL, Wilson MR. Genomic and serologic characterization of enterovirus A71 brainstem encephalitis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/3/e703. [PMID: 32139440 PMCID: PMC7136061 DOI: 10.1212/nxi.0000000000000703] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/06/2020] [Indexed: 12/12/2022]
Abstract
Objective In 2016, Catalonia experienced a pediatric brainstem encephalitis outbreak caused by enterovirus A71 (EV-A71). Conventional testing identified EV in the periphery but rarely in CSF. Metagenomic next-generation sequencing (mNGS) and CSF pan-viral serology (VirScan) were deployed to enhance viral detection and characterization. Methods RNA was extracted from the CSF (n = 20), plasma (n = 9), stool (n = 15), and nasopharyngeal samples (n = 16) from 10 children with brainstem encephalitis and 10 children with meningitis or encephalitis. Pathogens were identified using mNGS. Available CSF from cases (n = 12) and pediatric other neurologic disease controls (n = 54) were analyzed with VirScan with a subset (n = 9 and n = 50) validated by ELISA. Results mNGS detected EV in all samples positive by quantitative reverse transcription polymerase chain reaction (qRT-PCR) (n = 25). In qRT-PCR-negative samples (n = 35), mNGS found virus in 23% (n = 8, 3 CSF samples). Overall, mNGS enhanced EV detection from 42% (25/60) to 57% (33/60) (p-value = 0.013). VirScan and ELISA increased detection to 92% (11/12) compared with 46% (4/12) for CSF mNGS and qRT-PCR (p-value = 0.023). Phylogenetic analysis confirmed the EV-A71 strain clustered with a neurovirulent German EV-A71. A single amino acid substitution (S241P) in the EVA71 VP1 protein was exclusive to the CNS in one subject. Conclusion mNGS with VirScan significantly increased the CNS detection of EVs relative to qRT-PCR, and the latter generated an antigenic profile of the acute EV-A71 immune response. Genomic analysis confirmed the close relation of the outbreak EV-A71 and neuroinvasive German EV-A71. A S241P substitution in VP1 was found exclusively in the CSF.
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Affiliation(s)
- Kristoffer E Leon
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Ryan D Schubert
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Didac Casas-Alba
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Isobel A Hawes
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Prashanth S Ramachandran
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Akshaya Ramesh
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - John E Pak
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Wesley Wu
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Carly K Cheung
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Emily D Crawford
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Lillian M Khan
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Cristian Launes
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Hannah A Sample
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Kelsey C Zorn
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Maria Cabrerizo
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Ana Valero-Rello
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Charles Langelier
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Carmen Muñoz-Almagro
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Joseph L DeRisi
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain
| | - Michael R Wilson
- From the Medical Scientist Training Program (K.E.L.), University of California, San Francisco; Biomedical Sciences Graduate Program (K.E.L., I.A.H.), University of California, San Francisco; Weill Institute for Neurosciences (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Department of Neurology (R.D.S., I.A.H., P.S.R., A.R., M.R.W.), University of California, San Francisco; Institut de Recerca Pediàtrica Hospital Sant Joan de Déu (D.C.-A., C.L., A.V.-R., C.M.-A.), Barcelona, Spain; Chan Zuckerberg Biohub (J.E.P., W.W., C.K.C., E.D.C., J.L.D.), San Francisco; Department of Biochemistry and Biophysics (L.M.K., H.A.S., K.C.Z., J.L.D.), University of California, San Francisco; CIBER Epidemiología y Salud Pública (CIBERESP) (C.L., M.C., C.M.-A.), Health Institute Carlos III; Department of Pediatrics (C.L.), Universitat de Barcelona, Barcelona; Enterovirus Unit (M.C.), Spanish National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases (C.L.), Department of Medicine, University of California, San Francisco; and Department of Medicine. Universitat Internacional de Catalunya (C.M.-A.), Barcelona, Spain.
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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 RESEARCH 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] [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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35
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Arbustini E, Narula N, Giuliani L, Di Toro A. Genetic Basis of Myocarditis: Myth or Reality? MYOCARDITIS 2020. [PMCID: PMC7122345 DOI: 10.1007/978-3-030-35276-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The genetic basis of myocarditis remains an intriguing concept, at least as long as the definition of myocarditis constitutes the definitive presence of myocardial inflammation sufficient to cause the observed ventricular dysfunction in the setting of cardiotropic infections. Autoimmune or immune-mediated myocardial inflammation constitutes a complex area of clinical interest, wherein numerous and not yet fully understood role of hereditary auto-inflammatory diseases can result in inflammation of the pericardium and myocardium. Finally, myocardial involvement in hereditary immunodeficiency diseases, cellular and humoral, is a possible trigger for infections which may complicate the diseases themselves. Whether the role of constitutional genetics can make the patient susceptible to myocardial inflammation remains yet to be explored.
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36
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Gilsdorf JR. Acute Flaccid Myelitis: Lessons From Polio. J Pediatric Infect Dis Soc 2019; 8:550-553. [PMID: 30888407 DOI: 10.1093/jpids/piz017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/08/2019] [Accepted: 02/19/2019] [Indexed: 01/30/2023]
Abstract
With the eradication of poliomyelitis in the United States, the appearance of acute flaccid myelitis outbreaks has raised questions regarding their causation. Review of the epidemiology, clinical aspects, and laboratory findings of bygone cases of poliomyelitis have revealed shows important similarities with those of newer cases of acute flaccid myelitis. Many occurrences are preceded by an apparent viral illness, and a number of viruses, particularly enteroviruses A71 and D68, can be isolated from respiratory or stool specimens. Our inability to detect these viruses in cerebrospinal fluid samples from these patients does not eliminate them as etiologic agents, because poliovirus is often not detected in cerebrospinal fluid samples of patients with paralysis caused by poliomyelitis.
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Affiliation(s)
- Janet R Gilsdorf
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor
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37
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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] [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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38
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Bubba L, Broberg EK, Jasir A, Simmonds P, Harvala H. Circulation of non-polio enteroviruses in 24 EU and EEA countries between 2015 and 2017: a retrospective surveillance study. THE LANCET. INFECTIOUS DISEASES 2019; 20:350-361. [PMID: 31870905 DOI: 10.1016/s1473-3099(19)30566-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/10/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Enteroviruses can cause severe infections, especially in young children. Non-polio enterovirus infections are not notifiable in most countries in the EU and European Economic Area (EEA) region, and surveillance varies substantially between countries. We collected and analysed available enterovirus data across EU and EEA countries to assess the current epidemiological situation and need for standardising surveillance. METHODS Aggregated data on any enterovirus detected between Jan 1, 2015, and Dec 31, 2017, through national enterovirus reference laboratories were requested from representatives in all 31 EU and EEA countries. Information collected included enterovirus types detected by month, patient age group, symptom, and specimen type. We also collected sequence data on viral capsid sequences for the three most clinically relevant enterovirus types, as identified from the data. FINDINGS Aggregated data were provided by representatives from 24 (77%) of 31 countries. 9914 (66%) of 14 999 enterovirus infections with information about age were in children younger than 5 years, and 3197 (45%) of 7139 individuals for whom symptoms were reported had neurological symptoms. Other symptoms were non-specific fever (in 1607 [23%] patients), respiratory symptoms (in 1197 [17%] patients), hand, foot, and mouth disease (in 528 [7% patients), and myocarditis (in 39 [1%] patients). 68 deaths were temporally associated with enterovirus infection. Typing for 11 559 (67%) of 17 136 specimens revealed 66 enterovirus types. Coxsackievirus A6 was the most frequently detected enterovirus type (in 1556 [13%] of 11 559 typed enteroviruses), and 292 (65%) of 448 patients with coxsackievirus A6 infection with available clinical data presented with hand, foot, and mouth disease. Echovirus 30 was the second most frequently detected enterovirus type, representing 1412 (12%) of 11 559 typed enteroviruses, and 384 (82%) of 467 individuals with echovirus 30 infection with available clinical data had neurological symptoms. Sequences available from 18 countries showed circulation of newly emerging strains of enterovirus A71 and enterovirus D68. INTERPRETATION To our knowledge, this study is the largest investigation of enterovirus circulation in EU and EEA countries and confirms the availability of non-polio enterovirus data in the region. Our study highlights the wide circulation of non-polio enteroviruses in Europe, mostly affecting young children and leading to neurological symptoms. Collecting data on morbidity and mortality related to enterovirus infections, as well as harmonising case definition for surveillance, should be encouraged. FUNDING None.
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Affiliation(s)
- Laura Bubba
- Bacteriology Reference Department, Public Health England, London, UK; European Programme for Public Health Microbiology Training, Solna, Sweden
| | - Eeva K Broberg
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Aftab Jasir
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Peter Simmonds
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Heli Harvala
- Microbiology Services, National Health Service (NHS) Blood and Transplant, London, UK; Division of Infection and Immunity, University College London, London, UK.
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39
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Gonzalez G, Carr MJ, Kobayashi M, Hanaoka N, Fujimoto T. Enterovirus-Associated Hand-Foot and Mouth Disease and Neurological Complications in Japan and the Rest of the World. Int J Mol Sci 2019; 20:ijms20205201. [PMID: 31635198 PMCID: PMC6834195 DOI: 10.3390/ijms20205201] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022] Open
Abstract
Enteroviruses (EVs) are responsible for extremely large-scale, periodic epidemics in pediatric cohorts, particularly in East and Southeast Asia. Clinical presentation includes a diverse disease spectrum, including hand-foot and mouth disease (HFMD), aseptic meningitis, encephalitis, acute flaccid paralysis, and acute flaccid myelitis. HFMD is predominantly attributable to EV-A types, including the major pathogen EV-A71, and coxsackieviruses, particularly CV-A6, CV-A16, and CV-A10. There have been multiple EV-A71 outbreaks associated with a profound burden of neurological disease and fatal outcomes in Asia since the early 1980s. Efficacious vaccines against EV-A71 have been developed in China but widespread pediatric vaccination programs have not been introduced in other countries. Encephalitis, as a consequence of complications arising from HFMD infection, leads to damage to the thalamus and medulla oblongata. Studies in Vietnam suggest that myoclonus is a significant indicator of central nervous system (CNS) complications in EV-A71-associated HFMD cases. Rapid response in HFMD cases in children is imperative to prevent the progression to a CNS infection; however, prophylactic and therapeutic agents have not been well established internationally, therefore surveillance and functional studies including development of antivirals and multivalent vaccines is critically important to reduce disease burden in pediatric populations.
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Affiliation(s)
- Gabriel Gonzalez
- Division of Bioinformatics, Research Center for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan.
- National Advanced Computing Collaboratory, National Center for High Technology, San Jose 1174-1200, Costa Rica.
| | - Michael J Carr
- National Virus Reference Laboratory, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland.
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo 001-0020, Japan.
| | | | - Nozomu Hanaoka
- Division 4, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
| | - Tsuguto Fujimoto
- Division 4, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
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40
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Nhan LNT, Hong NTT, Nhu LNT, Nguyet LA, Ny NTH, Thanh TT, Han DDK, Van HMT, Thwaites CL, Hien TT, Qui PT, Quang PV, Minh NNQ, van Doorn HR, Khanh TH, Chau NVV, Thwaites G, Hung NT, Tan LV. Severe enterovirus A71 associated hand, foot and mouth disease, Vietnam, 2018: preliminary report of an impending outbreak. ACTA ACUST UNITED AC 2019; 23. [PMID: 30458911 PMCID: PMC6247458 DOI: 10.2807/1560-7917.es.2018.23.46.1800590] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Since January 2018, over 53,000 hospitalisations and six deaths due to hand, foot and mouth disease (HFMD) have occurred across Vietnam with most cases from September onward. In a large tertiary referral hospital, Ho Chi Minh City, enterovirus A71 subgenogroup C4 was predominant, while B5 was only sporadically detected. The re-emergence of C4 after causing a severe HFMD outbreak with > 200 deaths in 2011–12 among susceptible young children raises concern of another impending severe outbreak.
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Affiliation(s)
| | | | | | - Lam Anh Nguyet
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Do Duong Kim Han
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - C Louise Thwaites
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Tinh Hien
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Phan Tu Qui
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | | | - H Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | - Guy Thwaites
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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41
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Masa-Calles J, Torner N, López-Perea N, Torres de Mier MDV, Fernández-Martínez B, Cabrerizo M, Gallardo-García V, Malo C, Margolles M, Portell M, Abadía N, Blasco A, García-Hernández S, Marcos H, Rabella N, Marín C, Fuentes A, Losada I, Gutiérrez JG, Nieto A, Ortúzar VG, Cenoz MG, Arteagoitia JM, Martínez ÁB, Rivas A, Castrillejo D. Acute flaccid paralysis (AFP) surveillance: challenges and opportunities from 18 years' experience, Spain, 1998 to 2015. ACTA ACUST UNITED AC 2019; 23. [PMID: 30482263 PMCID: PMC6341937 DOI: 10.2807/1560-7917.es.2018.23.47.1700423] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Acute flaccid paralysis (AFP) surveillance is key for global polio eradication. It allows detecting poliovirus (PV) reintroductions from endemic countries. This study describes AFP surveillance in Spain from 1998 to 2015. During this time, 678 AFP cases were reported to the Spanish National Surveillance Network. The mean notification rate was 0.58 AFP cases/100,000 population under 15 years old (range: 0.45/100,000–0.78/100,000). Two periods (P) are described: P1 (1998–2006) with the AFP notification rate ranging from 0.66/100,000 to 0.78/100,000, peaking in 2001 (0.84/100,000); and P2 (2007–2015) when the AFP rate ranged from 0.43/100,000 to 0.57/100,000, with the lowest rate in 2009 (0.31/100,000). No poliomyelitis cases were caused by wild PV infections, although two Sabin-like PVs and one imported vaccine-derived PV-2 were detected. Overall, 23 (3.4%) cases met the hot case definition. Most cases were clinically diagnosed with Guillain–Barré syndrome (76.9%; 504/655). The adequate stool collection rate ranged from 33.3% (7/21) to 72.5% (29/40). The annual proportion of AFP cases with non-polio enterovirus findings varied widely across the study period. AFP surveillance with laboratory testing for non-polio enteroviruses must be maintained and enhanced both to monitor polio eradication and to establish sensitive surveillance for prompt detection of other enteroviruses causing serious symptoms.
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Affiliation(s)
- Josefa Masa-Calles
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Nuria Torner
- Department of Medicine, University of Barcelona, Barcelona, Spain.,Public Health Agency of Catalonia, Generalitat of Catalonia, Spain.,Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Noemí López-Perea
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - María de Viarce Torres de Mier
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Fernández-Martínez
- Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - María Cabrerizo
- National Polio Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Carmen Malo
- Servicio de Vigilancia en Salud Pública, D.G. de Salud Pública, Departamento de Sanidad, Aragón, Spain
| | - Mario Margolles
- Servicio de Vigilancia Epidemiológica, Consejería de Sanidad, Instituto de Investigación Sanitaria del Principado de Asturias, Spain
| | - Margarita Portell
- Servicio de Vigilancia Epidemiológica, Conselleria de Salut, Família i Bienestar Social Baleares, Spain
| | - Natividad Abadía
- Servicio de Epidemiologia y Prevención, Dirección General Salud Pública, Servicio Canario de Salud, Canarias, Spain
| | - Aniceto Blasco
- Sección de Vigilancia Epidemiológica, D.G. de Salud Pública, Cantabria, Spain
| | - Sara García-Hernández
- Servicio de Epidemiología, D.G. de Salud Pública, Consejería de Sanidad, Castilla-La Mancha, Spain
| | - Henar Marcos
- Servicio de Vigilancia Epidemiológica y Enfermedades Transmisibles, D.G. de Salud Pública, Consejería de Sanidad, Castilla y León, Spain
| | - Núria Rabella
- Microbiology Department, Hospital de la Santa Creu i Sant Pau, Microbiology & Genetics Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Celia Marín
- Servei de Vigilància i Control Epidemiològic, Conselleria de Sanitat Universal i Salut Pública, Comunitat Valenciana, Spain
| | - Amelia Fuentes
- Subdirección de Epidemiología. D.G. de Salud Pública, Servicio Extremeño de Salud, Consejería de Salud y Políticas Sociales, Extremadura, Spain
| | - Isabel Losada
- Servizo de Epidemioloxía, Dirección Xeral de Saúde Pública, Consellería de Sanidade, Xunta de Galicia, Spain
| | - Juan García Gutiérrez
- Servicio de Epidemiología, Subdirección General de Epidemiología, Dirección General de Salud Pública, Comunidad Autónoma de Madrid, Spain
| | - Alba Nieto
- Servicio de Epidemiología, Subdirección General de Epidemiología, Dirección General de Salud Pública, Comunidad Autónoma de Madrid, Spain
| | - Visitación García Ortúzar
- Servicio de Epidemiología, D. G. de Salud Pública y Adicciones, Consejería de Salud, Región de Murcia, Spain
| | - Manuel García Cenoz
- Servicio de Epidemiología y Prevención Sanitaria, Instituto de Salud Pública de Navarra, IdiSNA, Spain.,Spanish Consortium for Research in Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - José María Arteagoitia
- Servicio de vigilancia epidemiológica y vacunas, Dirección de Salud Pública y Adicciones, Departamento de Salud, País Vasco, Spain
| | - Ángela Blanco Martínez
- Sección de Vigilancia Epidemiológica y Control de Enfermedades Transmisibles, D.G de Salud Pública y Consumo, Consejería de Salud, La Rioja, Spain
| | - Ana Rivas
- Servicio de Epidemiología, Consejería de Sanidad y Consumo, Ceuta, Spain
| | - Daniel Castrillejo
- Servicio de Epidemiología, D.G. de Sanidad y Consumo, Consejería de Presidencia y Salud Pública, Melilla, Spain
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42
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Liu W, Caglar MU, Mao Z, Woodman A, Arnold JJ, Wilke CO, Cameron CE. More than efficacy revealed by single-cell analysis of antiviral therapeutics. SCIENCE ADVANCES 2019; 5:eaax4761. [PMID: 31692968 PMCID: PMC6821460 DOI: 10.1126/sciadv.aax4761] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 09/16/2019] [Indexed: 05/11/2023]
Abstract
Because many aspects of viral infection dynamics and inhibition are governed by stochastic processes, single-cell analysis should provide more information than approaches using population averaging. We have developed a microfluidic device composed of ~6000 wells, with each well containing a microstructure to capture single, infected cells replicating an enterovirus expressing a fluorescent reporter protein. We have used this system to characterize enterovirus inhibitors with distinct mechanisms of action. Single-cell analysis reveals that each class of inhibitor interferes with the viral infection cycle in a manner that can be distinguished by principal component analysis. Single-cell analysis of antiviral candidates not only reveals efficacy but also facilitates clustering of drugs with the same mechanism of action and provides some indication of the ease with which resistance will develop.
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Affiliation(s)
- Wu Liu
- Department of Biochemistry and Molecular Biology, The Pennsylvania State University, University Park, PA 16801, USA
- Corresponding author. (W.L.); (C.E.C.)
| | - Mehmet U. Caglar
- Center for Computational Biology and Bioinformatics, Institute for Cellular and Molecular Biology, and Department of Integrative Biology, University of Texas at Austin, Austin, TX 78712, USA
| | - Zhangming Mao
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA 16802, USA
| | - Andrew Woodman
- Department of Biochemistry and Molecular Biology, The Pennsylvania State University, University Park, PA 16801, USA
| | - Jamie J. Arnold
- Department of Biochemistry and Molecular Biology, The Pennsylvania State University, University Park, PA 16801, USA
| | - Claus O. Wilke
- Center for Computational Biology and Bioinformatics, Institute for Cellular and Molecular Biology, and Department of Integrative Biology, University of Texas at Austin, Austin, TX 78712, USA
| | - Craig E. Cameron
- Department of Biochemistry and Molecular Biology, The Pennsylvania State University, University Park, PA 16801, USA
- Corresponding author. (W.L.); (C.E.C.)
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43
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Kramer R, Sabatier M, Wirth T, Pichon M, Lina B, Schuffenecker I, Josset L. Molecular diversity and biennial circulation of enterovirus D68: a systematic screening study in Lyon, France, 2010 to 2016. ACTA ACUST UNITED AC 2019; 23. [PMID: 30229724 PMCID: PMC6144471 DOI: 10.2807/1560-7917.es.2018.23.37.1700711] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Understanding enterovirus D68 (EV-D68) circulation patterns as well as risk factors for severe respiratory and neurological illness is important for developing preventive strategies. Methods: Between 2010 and 2016, 11,132 respiratory specimens from hospitalised patients in Lyon, France, were screened for EV-D68 by PCR. Phylogenetic relationships of the viral-protein-1 sequences were reconstructed using maximum-likelihood and Bayesian-Markov-Chain-Monte-Carlo approaches. Results: Overall, 171 infections with a biennial pattern were detected, including seven, one, 55, none, 42, one and 65 cases annually during 2010–16. Children (< 16 years-old; n = 150) were mostly affected and 71% (n = 121) of the total patients were under 5 years-old. In 146 patients with medical reviews, 73% (n = 107) presented with acute respiratory distress. Among paediatric patients with medical reviews (n = 133), 55% (n=73) had an asthma/wheezing history, while among adults (n = 13), 11 had underlying diseases. In total, 45 patients had severe infections and 28 patients needed intensive care unit stays. No acute flaccid myelitis (AFM) was detected. We found genotypes A, B1, B2 B3 and D circulating, and no associations between these and clinical presentations. During the study, new genotypes continuously emerged, being replaced over time. We estimated that ancestors of currently circulating genotypes emerged in the late-1990s to 2010. Rises of the EV-D68 effective population size in Lyon coincided with infection upsurges. Phylogenetic analyses showed ongoing diversification of EV-D68 worldwide, coinciding with more infections in recent years and increases of reported AFM paediatric cases. Conclusions: Reinforcement of diagnostic capacities and clinical-based surveillance of EV-D68 infections is needed in Europe to assess the EV-D68 burden.
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Affiliation(s)
- Rolf Kramer
- These authors contributed equally.,European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control, Stockholm, Sweden.,Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agents Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - Marina Sabatier
- These authors contributed equally.,Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agents Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - Thierry Wirth
- Institut Systématique Evolution Biodiversité (ISYEB), EPHE, MNHN, CNRS, Sorbonne Université, Paris, France.,Laboratoire Biologie Intégrative des Populations, Evolution Moléculaire, EPHE, PSL University, Paris, France
| | - Maxime Pichon
- Virpath, CIRI, Université de Lyon, INSERM U1111, CNRS 5308, ENS de Lyon, UCBL, Lyon, France.,Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agents Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - Bruno Lina
- Virpath, CIRI, Université de Lyon, INSERM U1111, CNRS 5308, ENS de Lyon, UCBL, Lyon, France.,Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agents Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - Isabelle Schuffenecker
- Virpath, CIRI, Université de Lyon, INSERM U1111, CNRS 5308, ENS de Lyon, UCBL, Lyon, France.,Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agents Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - Laurence Josset
- Virpath, CIRI, Université de Lyon, INSERM U1111, CNRS 5308, ENS de Lyon, UCBL, Lyon, France.,Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agents Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France
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44
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Enterovirus D68 Subclade B3 Circulation in Senegal, 2016: Detection from Influenza-like Illness and Acute Flaccid Paralysis Surveillance. Sci Rep 2019; 9:13881. [PMID: 31554908 PMCID: PMC6761155 DOI: 10.1038/s41598-019-50470-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/04/2019] [Indexed: 12/20/2022] Open
Abstract
Following the 2014 outbreak, active surveillance of the EV-D68 has been implemented in many countries worldwide. Despite subsequent EV-D68 outbreaks (2014 and 2016) reported in many areas, EV-D68 circulation remains largely unexplored in Africa except in Senegal, where low levels of EV-D68 circulation were first noted during the 2014 outbreak. Here we investigate subsequent epidemiology of EV-D68 in Senegal from June to September 2016 by screening respiratory specimens from ILI and stool from AFP surveillance. EV-D68 was detected in 7.4% (44/596) of patients; 40 with ILI and 4 with AFP. EV-D68 detection was significantly more common in children under 5 years (56.8%, p = 0.016). All EV-D68 strains detected belonged to the newly defined subclade B3. This study provides the first evidence of EV-D68 B3 subclade circulation in Africa from patients with ILI and AFP during a 2016 outbreak in Senegal. Enhanced surveillance of EV-D68 is needed to better understand the epidemiology of EV-D68 in Africa.
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45
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Berardi A, Sandoni M, Toffoli C, Boncompagni A, Gennari W, Bergamini MB, Lucaccioni L, Iughetti L. Clinical characterization of neonatal and pediatric enteroviral infections: an Italian single center study. Ital J Pediatr 2019; 45:94. [PMID: 31375127 PMCID: PMC6679433 DOI: 10.1186/s13052-019-0689-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background Enteroviruses (EVs) are an important cause of illness, especially in neonates and young infants. Clinical and laboratory findings at different ages, brain imaging, and outcomes have been inadequately investigated. Methods We retrospectively investigated EV infections occurring at an Italian tertiary care center during 2006–2017. Cases were confirmed with a positive polymerase chain reaction on blood or cerebrospinal fluid. Clinical and laboratory findings according to age at presentation were analyzed. Results Among 61 cases of EV infection, 56 had meningitis, 4 had encephalitis, and 1 had unspecific febrile illness. Forty-seven cases (77.0%) presented at less than 1 year of age, and most were less than 90 days of age (n = 44). Presentation with fever (p < 0.01), higher median temperature (p < 0.01), and irritability (p < 0.01) were significantly more common among infants aged less than 90 days, who also had significantly higher peak temperatures during the course of the disease (p < 0.01). In contrast, gastrointestinal symptoms were more common in infants and children aged over 90 days (p = 0.02). Only 4 of 61 infections (6.5%) were severe and all affected younger infants (p < 0.01). Conclusions We detail epidemiological, clinical, and laboratory findings in a cohort of 61 children. Infants aged less than 90 days have more severe disease; they are more likely to present with fever, higher median temperature, and irritability and less likely to develop gastrointestinal symptoms.
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Affiliation(s)
- Alberto Berardi
- Struttura Complessa di Neonatologia, Azienda Ospedaliero-Universitaria Policlinico, Via del Pozzo, 71, 41124, Modena, MO, Italy.
| | - Marcello Sandoni
- Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia, Modena, Italy
| | - Carlotta Toffoli
- Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia, Modena, Italy
| | - Alessandra Boncompagni
- Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia, Modena, Italy
| | - William Gennari
- Struttura Complessa di Microbiologia e Virologia-Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Maria Barbara Bergamini
- Struttura Complessa di Pediatria, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Laura Lucaccioni
- Struttura Complessa di Neonatologia, Azienda Ospedaliero-Universitaria Policlinico, Via del Pozzo, 71, 41124, Modena, MO, Italy
| | - Lorenzo Iughetti
- Scuola di Specializzazione in Pediatria, Università di Modena e Reggio Emilia, Modena, Italy.,Struttura Complessa di Pediatria, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
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46
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Enterovirus D68 Causing Acute Respiratory Infection: Clinical Characteristics and Differences With Acute Respiratory Infections Associated With Enterovirus Non-D68. Pediatr Infect Dis J 2019; 38:687-691. [PMID: 30985516 DOI: 10.1097/inf.0000000000002289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Enterovirus (EV) D68 is mainly associated with acute respiratory infection (ARI). Since 2014, when outbreaks in different countries were observed, this emerging virus was considered a potential threat to public health. METHODS During 2015-2017, the presence of enterovirus RNA was investigated in all respiratory samples of children younger than 15 years of age with ARI, obtained for virologic studies in the Pediatric Emergency Care Units and wards of 2 hospitals in Gipuzkoa (Spain), using a commercial multiplex real-time polymerase chain reaction. When enterovirus was detected, a polymerase chain reaction to amplify a specific viral polyprotein (VP1) gene region of EV-D68 was performed. RESULTS In 2016, EV-D68 circulation was associated to ARI, with the highest incidence in the spring months. EV-D68 was detected in 44 children, mean age 30.1 ± 31.7 months old, 23 (52.3%) of them females and 17 (38.6%) with underlying respiratory medical conditions. Thirty-two patients (72%) required hospital admission, receiving the discharge diagnosis of recurrent wheezing (37.5%), asthmatic crisis (37.5%) or bronchiolitis (12.5%). Seven children (15.9%) needed the support of the pediatric intensive care unit. When coinfections were excluded, children with EV-D68 infection presented with increased work of breathing, recurrent wheezing or asthmatic crisis, more frequently than those with ARI associated with EV non-D68. Moreover, clinical outcomes (hospitalization, respiratory support) were more severe. All 44 EV-D68 strains detected belonged to lineage B3. CONCLUSIONS EV-D68 circulated widely in Gipuzkoa during 2016 and was associated with severe ARI. In children with severe ARI of unknown etiology, the presence of EV-D68 should be considered.
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Martinón-Torres F, Bosch X, Rappuoli R, Ladhani S, Redondo E, Vesikari T, García-Sastre A, Rivero-Calle I, Gómez-Rial J, Salas A, Martín C, Finn A, Butler R. TIPICO IX: report of the 9 th interactive infectious disease workshop on infectious diseases and vaccines. Hum Vaccin Immunother 2019; 15:2405-2415. [PMID: 31158041 PMCID: PMC6816368 DOI: 10.1080/21645515.2019.1609823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Ninth Interactive Infectious Disease workshop TIPICO was held on November 22–23, 2018, in Santiago de Compostela, Spain. This 2-day academic experience addressed current and topical issues in the field of infectious diseases and vaccination. Summary findings of the meeting include: cervical cancer elimination will be possible in the future, thanks to the implementation of global vaccination action plans in combination with appropriate screening interventions. The introduction of appropriate immunization programs is key to maintain the success of current effective vaccines such as those against meningococcal disease or rotavirus infection. Additionally, reduced dose schedules might improve the efficiency of some vaccines (i.e., PCV13). New vaccines to improve current preventive alternatives are under development (e.g., against tuberculosis or influenza virus), while others to protect against infectious diseases with no current available vaccines (e.g., enterovirus, parechovirus and flaviviruses) need to be developed. Vaccinomics will be fundamental in this process, while infectomics will allow the application of precision medicine. Further research is also required to understand the impact of heterologous vaccine effects. Finally, vaccination requires education at all levels (individuals, community, healthcare professionals) to ensure its success by helping to overcome major barriers such as vaccine hesitancy and false contraindications.
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Affiliation(s)
- Federico Martinón-Torres
- Translational Paediatrics and Infectious Diseases, Department of Paediatrics, Hospital Clínico Universitario de Santiago de Compostela , Santiago de Compostela , Spain.,Genetics, Vaccines and Infections Research group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela , Santiago de Compostela , Spain
| | - Xavier Bosch
- Cancer Epidemiology Research Programme (e-oncología), Catalan Institute of Oncology, L'Hospitalet de Llobregat , Barcelona , Spain.,Cancer Prevention and Palliative Care Program, IDIBELL, L'Hospitalet de Llobregat , Barcelona , Spain
| | - Rino Rappuoli
- R&D Centre, GlaxoSmithKline , Siena , Italy.,Department of Medicine, Imperial College London , London , UK
| | - Shamez Ladhani
- Immunisation Department, Public Health England , London , UK
| | - Esther Redondo
- International Vaccination Center of Madrid , Madrid , Spain.,Grupo de Actividades Preventivas y Salud Pública SEMERGEN , Madrid , Spain
| | - Timo Vesikari
- Faculty of Medicine and Life Sciences, Vaccine Research Center, University of Tampere , Tampere , Finland
| | - Adolfo García-Sastre
- Department of Microbiology, Icahn School of Medicine at Mount Sinai , New York , NY , USA.,Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai , New York , NY , USA.,Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Irene Rivero-Calle
- Translational Paediatrics and Infectious Diseases, Department of Paediatrics, Hospital Clínico Universitario de Santiago de Compostela , Santiago de Compostela , Spain.,Genetics, Vaccines and Infections Research group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela , Santiago de Compostela , Spain
| | - José Gómez-Rial
- Genetics, Vaccines and Infections Research group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela , Santiago de Compostela , Spain
| | - Antonio Salas
- Genetics, Vaccines and Infections Research group (GENVIP), Instituto de Investigación Sanitaria de Santiago, Universidad de Santiago de Compostela , Santiago de Compostela , Spain.,Unidade de Xenética, Instituto de Ciencias Forenses (INCIFOR), Facultade de Medicina, Universidade de Santiago de Compostela, and GenPoB Research Group, of the Instituto de Investigación Sanitaria de Santiago (IDIS), Hospital Clínico Universitario de Santiago (SERGAS) , Galicia , Spain
| | - Carlos Martín
- Faculty of Medicine, Microbiology Department, University of Zaragoza , Zaragoza , Spain.,CIBER of Respiratory Diseases, Instituto de Salud Carlos III , Madrid , Spain
| | - Adam Finn
- Bristol Children's Vaccine Centre, Schools of Cellular and Molecular Medicine and Population Health Sciences, University of Bristol , Bristol , UK
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Shen L, Gong C, Xiang Z, Zhang T, Li M, Li A, Luo M, Huang F. Upsurge of Enterovirus D68 and Circulation of the New Subclade D3 and Subclade B3 in Beijing, China, 2016. Sci Rep 2019; 9:6073. [PMID: 30988475 PMCID: PMC6465342 DOI: 10.1038/s41598-019-42651-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/25/2019] [Indexed: 12/14/2022] Open
Abstract
We conducted a surveillance among acute respiratory tract infection (ARTI) cases to define the epidemiology, clinical characteristics and genetic variations of enterovirus D68 (EV-D68) in Beijing, China from 2015 to 2017. Nasopharyngeal swabs and sputum were collected from 30 sentinel hospitals in Beijing and subjected to EV and EV-D68 detection by real-time PCR. The VP1 gene region and complete genome sequences of EV-D68 positive cases were analyzed. Of 21816 ARTI cases, 619 (2.84%) were EV positive and 42 cases were EV-D68 positive. The detection rates of EV-D68 were 0 (0/6644) in 2015, 0.53% (40/7522) in 2016 and 0.03% (2/7650) in 2017, respectively. Two peaks of EV-D68 infections occurred in late summer and early-winter. Ten cases (23.81%) with upper respiratory tract infection and 32 cases (76.19%) presented with pneumonia, including 3 cases with severe pneumonia. The phylogenetic analysis suggested 15 subclade D3 strains and 27 subclade B3 strains of EV-D68 were circulated in China from 2016 to 2017. A total of 52 amino acid polymorphisms were identified between subclades D1 and D3. These data suggest an upsurge of EV-D68 occurred in Beijing in 2016, the new subclade D3 emerged in 2016 and co-circulated with subclade B3 between 2016 and 2017.
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Affiliation(s)
- Lingyu Shen
- School of Public Health, Capital Medical University, Beijing, 100069, P.R. China
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Cheng Gong
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Zichun Xiang
- MOH Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, IPB, CAMS-Foundation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing, 100730, P.R. China
| | - Tiegang Zhang
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Maozhong Li
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Aihua Li
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Ming Luo
- School of Public Health, Capital Medical University, Beijing, 100069, P.R. China
| | - Fang Huang
- School of Public Health, Capital Medical University, Beijing, 100069, P.R. China.
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China.
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49
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Twenty-nine Cases of Enterovirus-D68-associated Acute Flaccid Myelitis in Europe 2016: A Case Series and Epidemiologic Overview. Pediatr Infect Dis J 2019; 38:16-21. [PMID: 30234793 PMCID: PMC6296836 DOI: 10.1097/inf.0000000000002188] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Enterovirus-D68 (EV-D68) is a respiratory virus within the genus Enterovirus and the family of Picornaviridae. Genetically, it is closely related to rhinovirus that replicates in the respiratory tract and causes respiratory disease. Since 2014, EV-D68 has been associated with the neurologic syndrome of acute flaccid myelitis (AFM). METHODS In October 2016, questionnaires were sent out to a European network including 66 virologists and clinicians, to develop an inventory of EV-D68-associated AFM cases in Europe. Clinical and virologic information of case patients was requested. In addition, epidemiologic information on EV testing was collected for the period between March and October 2016. RESULTS Twenty-nine cases of EV-D68-associated AFM were identified, from 12 different European countries. Five originated from France, 5 from Scotland and 3 each from Sweden, Norway and Spain. Twenty-six were children (median age 3.8 years), 3 were adults. EV-D68 was detected in respiratory materials (n = 27), feces (n = 8) and/or cerebrospinal fluid (n = 2). Common clinical features were asymmetric flaccid limb weakness, cranial nerve deficits and bulbar symptoms. On magnetic resonance imaging, typical findings were hyperintensity of the central cord and/or brainstem; low motor amplitudes with normal conduction velocities were seen on electromyography. Full clinical recovery was rare (n = 3), and 2 patients died. The epidemiologic data from 16 European laboratories showed that of all EV-D68-positive samples, 99% was detected in a respiratory specimen. CONCLUSIONS For 2016, 29 EV-D68-related AFM cases were identified in mostly Western Europe. This is likely an underestimation, because case identification is dependent on awareness among clinicians, adequate viral diagnostics on respiratory samples and the capability of laboratories to type EVs.
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50
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Cassidy H, Poelman R, Knoester M, Van Leer-Buter CC, Niesters HGM. Enterovirus D68 - The New Polio? Front Microbiol 2018; 9:2677. [PMID: 30483226 PMCID: PMC6243117 DOI: 10.3389/fmicb.2018.02677] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/19/2018] [Indexed: 12/20/2022] Open
Abstract
Enterovirus D68 (EV-D68) has emerged over the recent years, with large outbreaks worldwide. Increased occurrence has coincided with improved clinical awareness and surveillance of non-polio enteroviruses. Studies showing its neurotropic nature and the change in pathogenicity have established EV-D68 as a probable cause of Acute Flaccid Myelitis (AFM). The EV-D68 storyline shows many similarities with poliovirus a century ago, stimulating discussion whether EV-D68 could be ascertaining itself as the "new polio." Increasing awareness amongst clinicians, incorporating proper diagnostics and integrating EV-D68 into accessible surveillance systems in a way that promotes data sharing, will be essential to reveal the burden of disease. This will be a necessary step in preventing EV-D68 from becoming a threat to public health.
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Affiliation(s)
| | | | | | | | - Hubert G. M. Niesters
- Department of Medical Microbiology and Infection Prevention, Division of Clinical Virology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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