Complete genome sequence characteristics of human echovirus 9 strain isolated in Yunnan, China / 病毒学报

To analyze the genomic sequence characteristics of a human Echovirus 9(ECHO-9) strain isolated from a child with Hand-foot-mouth disease (HFMD) in Kunming, Yunnan Province, in 2010. The complete genome sequence of a human echovirus 9 strain, MSH-KM812-2010 was determined. As other human enterovirus, its genome was 7,424 nucleotides (nts) in length and encoded for 2,203 amino acids (aas). In comparison to other human enteroviruses, MSH-KM812-2010 strain had the highest homology with other strains of human echovirus 9 in structural genomic regions and more homologous to other serotypes of B specie than to human echovirus 9 in non-structural genomic regions. Phylogenetic analysis based on complete VP1 gene revealed that the sequences of human echovirus 9 segregated into three distinct clades A, B and C with more than 15. 0% diversity between clades. All Chinese isolates belonged to the same clade. RDP3 and Blast revealed evident recombination in non-structural genomic regions. This report is the first to, describe the complete genome of the human echovirus 9 in China and provide an overview of the diversity of genetic characteristics of a circulating human echovirus 9.

Epidemiology and Clinical Characteristics of Enterovirus Infections in Children: A Single Center Analysis from 2006 to 2010 / 소아감염

PURPOSE: This study was performed to investigate the epidemiology of enterovirus (EV) infections in children at a secondary hospital during recent 5 years. METHODS: We collected the cerebrospinal fluid, stool and throat swab samples from the pediatric patients with suspected EV infections in KEPCO Medical Center, Seoul, Korea from July 2006 to September 2010. EV detection and genotype identification were performed by RT-PCR at Korea Centers for Disease Control and Prevention. RESULTS: A total of 386 samples were collected from 277 patients during study period. Ninety-eight patients (35.4%) were diagnosed with EV infections. The RT-PCR positive rate was the highest in throat swab samples (48.3%). The median age of patient was 4.7 years (range, 0.1-12.5 years). Aseptic meningitis (50, 51.0%) was the most common clinical manifestation; herpangina (22, 22.4%) and hand-foot-mouth disease (18, 18.4%). One hundred EVs were isolated from 98 patients and 20 genotypes of EV were identified; Echovirus 30 (28 cases, 28%), Enterovirus 71 (12 cases, 12%), Echovirus 25 (10 cases, 10%), Echovirus 9 (9 cases, 9%) and Coxsackievirus A6 (8 cases, 8%). Aseptic meningitis caused by Echovirus 30 was the most common manifestation in 2008. There was no complicated case caused by Enterovirus 71. CONCLUSION: This study showed the epidemiology of confirmed EV infection in children from 2006 to 2010. There is a need for continuous surveillance of EV infections and its clinical manifestations.

Epidemiologic and Clinical features of Enteroviral Infections in Children, a Single Center Study in Korea: 2009 / 소아감염

PURPOSE: Enteroviral infection is a common viral illness in children. We undertook this study in attempt to comprehend the epidemiologic and clinical features of enteroviral infections, particularly EV71 in children. METHODS: We enrolled 63 children with enteroviral infection at Severance Children's Hospital in Seoul between May and August 2009. Reverse transcriptase-polymerase chain reaction (RT-PCR) was performed from stool or cerebrospinal fluid samples, which were then tested for enteroviral infection. Viral isolation and serotype identification also were performed by RT-PCR. RESULTS: A total of 63 patients with clinical diagnosis of enteroviral infections were enrolled; of those, 38 (60%) were positive for enterovirus. The mean age of the patients was 2 years and 7 months and the sex ratio of male to female was 0.9:1. Their clincal manifestations included aseptic meningitis (21 cases, 55%), HFMD (16 cases, 42%), herpangina (5 cases, 13%), neonatal fever (2 cases, 5%), encephalitis (1 case, 3%), and myocarditis (1 case, 3%). Serotypes of isolated enteroviruses were EV71 (8 cases, 21%), coxsackievirus B1 (8 cases, 21%), coxsackievirus A16 (2 cases, 6%), coxsakievirus A2 (1 case, 3%), coxsakievirus A5 (1 case, 3%), and echovirus 9 (1 case, 3%). Clinical symptoms of EV71 infection included HFMD (5 cases, 63%), aseptic meningitis (3 cases, 38%), encephalitis (1 case, 13%), and myocarditis (1 case, 13%). A positive rate of C-reactive protein in EV71 was higher than those in other enterviral infections. However, there was no statistically significant difference in other laboratory findings. CONCLUSION: We reported on identified enteroviruses, including EV71, during a period of 3 months in the summer of 2009. In this study, EV71 infection frequently occurred in male and clinical manifestation caused by EV71 was a more severe disease than that due to other enterviral infections. There is a need for continuous surveillance of enteroviral infection and its clinical manifestations for diagnosis and treatment of enteroviral infection.

Cause of enteroviral infection in children in chungnam area summer, 2005 / 소아과

PURPOSE: Enterovirus infection is a type of viral infection that occurs relatively frequently in children during summer. It has clinical symptoms of non-specific fever, aseptic encephalomeningitis, gastrointestinal diseases, skin rash and, hand-foot-mouth disease. However, it can also occcaisionally, result in fatal symptoms like myocarditis, epicardial inflammation, transverse myelitis, quadriplegia and etc. There have been epidemic enterovirus studies, but not in the Chungnam area. Therefore, we undertook this study in order to comprehend the cause viruses in this area. Methods: We enlisted 157 children hospitalized with enteroviral infections at Soonchunhyang University hospital in Cheonan between May and August 2005. Cerebrospinal fluids or feces were collected during the acute phase after hospitalization, and observed the cytopathic effects caused by enterovirus and using reverse transcription polymerase chain reaction (RT-PCR). RESULTS: The number of children hospitalized due to possible enteroviral infection during the period of study was 157. The number of children who tested positive with the reverse transcription polymerase chain reaction totalled 32 cases (20.4 percent). Among the children with entroviral diseases, 20 were male and 12 were female, thus the sex ratio of male to female was 1.67:1. Their clinical symptoms included fever most frequently (93.7 percent), was followed by headaches (90.0 percent), meningeal irritation signs (65.0 percent), and abdominal pain (30.0 percent). As for the type of isolated enterovirus, there were 17 cases of echovirus 18 and 6 cases of coxsackievirus B5. Furthermore, there were 2 cases of echovirus 9, 1 case of coxsackievirus A6 and coxsackievirus B3, respectively. But 5 cases were not determined by genotype. CONCLUSION: Echovirus 18 is circulating in Korea. We reported on identified enteroviruses, including echovirus 18, using RT-PCR in the Chungnam area during the summer of 2005.

A Clinical Study of Aseptic Meningitis in the Busan Area in 2002

PURPOSE: There was a outbreak of aseptic meningitis in Busan, 2002. We report the clinical features and causative viruses. METHODS: Two hundred seventy six children with aseptic meningitis who were admitted to the Department of Pediatrics, Maryknoll Hospital between January and December, 2002 were included. CSF, stool and throat swab viral cultures were done in 244 of these children. RESULTS: The male to female ratio was 1.4 : 1. Age of patients varied from five months to fourteen years old. Average age was 5.7+/-6.2 years old and mostly between one and four years.(41.3%) Monthly distribution revealed that the number of patients increased from May to July. The main symptoms were fever, headache and vomiting in this order. Respiratory tract infection symptom was associated from June to July and headache and nausea without fever were characteristically observed in children more than 10 years old from November to December. In peripheral blood examination, leukocytosis(WBC>10,000/mm3) showed in 34.8%, ESR was increased in 56.1%, and CRP was positive value in 61%. Therefore differential diagnosis was difficult through peripheral blood examination. CSF findings revealed mean leukocyte count 86.5+/-180.2/mm3, protein 41.7+/-32.9 mg/dL, glucose 56.4+/-9.9 mg/dL. Median hospitalized period was 4.7+/-7.2 days and compared with non-tapping group, hospitalized period was shorter and subsidance of symptoms was faster, therefore antibiotics injection period was shorter in the spinal tapping group. Virus was isolated in 31 cases of 244. The causative agents were echovirus 6, echovirus 9, echovirus 25, coxsakie virus B3, B4. CONCLUSION: There was an epidemics of aseptic meningitis in Busan, 2002; the causative agent was echovirus 6, 9, 25, coxsakie virus B3, B4.

A Clinical Study of Aseptic Meningitis in Ulsan from May to July, 2002

PURPOSE: There occurred an explosive outbreak of aseptic meningitis in Ulsan, in the year of 2002. In this study, we report clinical manifestations, laboratory data and causative viruses of the outbreak. METHODS: Were assessed 371 children with aseptic meningitis who were admitted to the Department of Pediatrics, Ulsan University Hospital in Ulsan between May and July, 2002. We reviewed the sex, age, clinical manifestations, peripheral blood examinations and CSF examinations of the patients. Virus isolation and serotype identification were performed by cell cultures of cerebrospinal fluid and stool. RESULTS: The ratio of males to females was 1.9:1. The majority of aseptic meningitis occurred in children between 1 and 5 years of age with a mean age of 6.8+/-5.1 years. The clinical manifestations was fever, headache, vomiting, and abdominal pain and 16.2% of the patients developed neck stiffness. The mean duration of fever was 3.2 days. The mean value of peripheral blood leukocytes was 10,355+/-4,800/mm3 and the mean value of CRP was 0.96+/-1.67 mg/dL. Initial CSF findings revealed leukocytes 212+/-385/mm3, protein 37.0+/-18.9 mg/dL and glucose 68.3+/-17.6 mg/dL. Viruses were isolated 67(18.1%) out of 371 patients and the serotypes were echovirus 6 in 10 cases, echovirus 9 in 15 cases, echovirus 11 in 4 cases, echovirus 13 in 18 cases, and unclassified enterovirus in 20 cases. CONCLUSION: Aseptic meningitis was prevalent in Ulsan, in the year of 2002. The clinical manifestations and the laboratory findings of the patients were compatible with those of previous reports. The causative viruses were echovirus 6, echovirus 9, echovirus 11, echovirus 13 and unclassified enterovirus.

A Clinical Study of Aseptic Meningitis in Busan and Kyoungsangnamdo from April to July, 2002

PURPOSE: There was an outbreak of aseptic meningitis in Busan and Kyoungsangnamdo area from April to July, 2002. In this study, we reported the clinical manifestations, laboratory data and causative viruses. METHODS: 184 children with aseptic meningitis who had been admitted to Department of Pediatrics, Inje Paik Hospital in Kaegum and Dongrae between April and July 2002 were assessed. Virus isolation and serotype identification were performed by cell culture and reverse transcription-polymerase chain reaction(RT-PCR) of cerebrospinal fluid. RESULTS: The peak incidence was noted in May. Male-to-female ratio was 2:1. The age ranged from 2 years to 16 years. Mean age was 8.7+/-7.1 years. Clinical manifestations were fever(95.1%), headache(91.8%) and vomiting(89.7%). Mean duration of fever was 2.6 days. The numbers of peripheral blood leukocytes were 1,400-20,000/mm3 and mean value was 9,829/mm3. On cerebrospinal fluid examinations, leukocyte count was in range of 10-2,000(mean 301)/mm3, protein level in range of 10-196(mean 36.7)mg/dL and glucose level from 17 to 155(mean 58.3)mg/dL. Viruses were isolated 13(8.4%) out of 154 patients and serotypes were 6 cases of echovirus 6, 3 cases of echovirus 9, 1 case of echovirus 13, 2 cases of echovirus 25 and 1 case of echovirus 30. CONCLUSION: Aseptic meningitis was prevalent in Busan and Kyoungsangnamdo area from April to July, 2002. We thought that causative viruses were echovirus 6, 9, 13, 25, 30.

Isolation of Causative Viruses from Patients with Aseptic Meningitis in Gwangju Area / 감염

BACKGROUND: Aseptic meningitis is a common illness of children. It seems that viruses are the usual etiologic agents. The distribution of these agents mainly depends on the isolated time and region area. This study was performed to isolate the causative viruses from patients with aseptic meningitis in Gwangju area during recent one year. METHODS:A total of 130 patients with aseptic meningitis were evaluated. Stool and/or cerebrospinal fluid specimens from patients were inoculated into rhabdomyosarcoma (RD), HEp2 and Vero cell lines. The virus propagation was examined by the presence of cytopathic effects. Neutralizing tests using enterovirus serum pool were done on each viral isolates. RESULTS: The isolation rate of enterovirus was 24.6% (32/130). The enterovirus isolates were obtained mostly from stool specimens (29/32). Twenty-two isolates were identified by neutralizing test. Ten isolates disclosed 'untyping' by neutralizing test. The distribution of isolates was coxsackievirus group B2 (11 stains, 34.4%), echovirus 30 (4 strains, 12.5%), echovirus 6 (3 strains, 9.4%), echovirus 9, 11, 25 and coxsackievirus group A16 (1 strain, respectively). These strains were predominantly isolated during summer season (June to July). CONCLUSIONS: The causative viruses from patients with aseptic meningitis in Gwangju area during recent 1 year were coxsackievirus group B2, echovirus 30, 6, 9, 11, 25 and coxsackievirus group A16 which were mostly isolated from stool specimens in summer season.

Utility of 293 Cells in Culture of Enteroviruses / 대한임상미생물학회지

BACKGROUND: Viral isolation in cell culture remains as a reference method for diagnosis of enteroviral infection. Enteric adenoviruses are cultivated in 293 cells. Enteroviral and enteroadenovrial tropisms for the gastrointestinal tract lead to the assumption that 293 cells would be useful in enteroviral isolation. We evaluated usefulness of 293 cells in the diagnosis of enteroviral infection. METHODS: Human embryonic lung fibroblasts (HEL), HeLa, RD and 293 cells were used to evaluate viral isolation from clinical specimens, susceptibilities of the cell lines to reference enteroviral strains and influence to stool extracts on the viral isolation. Forty-four stool specimens collected from patients during the epidemic period of type 9 echoviral aseptic meningitis and type 30 echoviral culture-positive 33 stool and 58 cerebrospinal fluid (CSF) specimens were inoculated onto cell lines. RESULTS: Echovirus type 9 was isolated from 31 of 44 stool specimens. Of 31 echovirus 9 isolates, 22 (71.0%), 21 (67.7%), 6 (19.4%) and 3 (9.7%) were detected in HEL, 293, RD and HeLa, respectively. Of 33 echovirus 30 isolates from stool specimens, 32 (97.0%) were detected in 293; 17 (51.5%) were detected in RD. Of 58 echovirus 30 isolates from CSF specimens, 39 (67.2%) were detected in 293; 30 (51.7%) were detected in RD. 293 cells were sensitive for coxsackievirus A9 reference strain and echovirus 7 reference strain. Stool extracts induced enhanced cytopathic effect by echovirus 9 infection in 293 and HEL. CONCLUSIONS: 293 cells are useful in the diagnosis of echoviral and some enteroviral infection.

Clinical Studies of Aseptic Meningitis in Pusan Area in 1996

PURPOSE: We report clinical features and viral studies on 153 children with aseptic meningitis in the Pusan area in 1996 and compare the results of this study with those of other reports in 1990 and 1993. METHODS: One hundred fifty-three children with aseptic meningitis who have been admitted to the Department of Pediatrics, St. Benedict Hospital between July and October 1996 were included. We described age and sex distribution, monthly distribution, clinical manifestations, laboratory data and complication. RESULTS: The male to female ratio was 2.32:1 and the most age was 4.21 years. It occurred mostly in July, August and October. It was later than the peak incidence between May and July in 1990 and 1993. The main symptoms were fever, headache and vomiting in this order. Rash was mostly maculopapular form and frequent in those younger than 4 years-old. No specific results were not found in peripheral blood and CSF studies. We failed to isolate the causative agent in the viral culture, but Echovirus 9 was suspected as a causative agent by its clinical features and other similar reports. The duration of clinical symptoms in the early diagnostic group was significantly shorter that in late diagnostic group. CONCLUSIONS: Aseptic meningitis was prevalent in children in the Pusan area, during the summer of 1996. It was frequent in male and the mean age was 4.21 years. It occurred mostly in July, August and October. Peak incidence was later than in 1990 and 1993. The main symptoms: fever, headache, vomiting and rash were observed frequently.

Molecular biological characterization of enterovirus variant isolated from patients with aseptic meningitis

In Korea, there was a big outbreak of aseptic meningitis in 1993. Six clinical isolates of enterovirus were obtained from patients with aseptic meningitis and were identified as echovirus type 9 by serotyping with a pool of neutralizing antisera. For molecular characterization of the isolates, the nucleotide sequences of 5'-noncoding region (NCR), VP4, VP2, VP1, 2A and 2C regions of the isolates were compared with the corresponding regions of echovirus type 9 Hill and Barty strains. Unlike Hill strain, Barty strain contained a C-terminal extension to the capsid protein VP1 with an RGD (argnine-glycine-aspartic acid) motif. To determine whether similar structural features were present in our isolates, their nucleotide sequences including the VP1 region were analyzed. All isolates exhibited the VP1 extension with the RGD motif. We concluded the Korean isolates in the year of 1993 as the echovirus type 9 Barty strain although the isolates showed 15-20% nucleotide sequence differences in the several genomic regions.

Isolation of Enterovirus in Patients with Aseptic Meningitis in Spring, 1996 / 감염

BACKGROUND: Aseptic meningitis is an acute viral infection of the central nervous system that occurs commonly in childhood. Although the etiologic agent is not always identified, the human enteroviruses are responsible for most cases of aseptic meningitis in which a cause can be identified. Enterovirus causes approximately 80% of all cases of aseptic meningitis. In 1993, there was a nationwide epidemic of aseptic meningitis by echovirus 9 and 30. We reported that the cause of aseptic meningitis in 1994 was echovirus 3 and coxsackievirus B3 and echovirus 7 in 1995. This study was done to detect the causative agent of aseptic meningitis in spring, 1996. METHODS: To isolate the causative viruses, stool and cerebrospinal fluid specimens from the patients with aseptic meningitis, who were admitted to Severance Hospital in 1996, were collected. Cultured RD cells and HEp-2 cells were inoculated with specimens to see the cytopathic effects. Neutralizing antibody tests using enterovirus serum pool were done on the specimens with the cytopathic effects. RNA was isolated from the cultured supernatants of the infected cells. Oligonucleotide was synthesized by PCR, which was run on polyacrylamide gel after purification with HPLC. After running the DNA produced by using Geneamp RNA PCR kit, electrophoresis was done. RESULTS: Enteroviruses were isolated from 14 out of 17 patients. Among these fourteen, Coxsackievirus B1 was isolated in 13 patients and poliovirus in one patient. PCR product from these viruses showed a 152bp band on electrophoresis. CONCLUSION: The causative virus of aseptic meningitis in patients who were admitted to Severance Hospital during the spring season of 1996 was Coxsackievirus B1.

An Epidemic of Aseptic Meningitis in Summer 1996 and Global Analysis and Comparision of It with 1993

PURPOSE: In the Summer 1996, there was an outbreak of aseptic meningitis without sequele. 116 cases who were admitted to our Department during a six month period from May to October, 1996. Therefore, we report epidemic of aseptic meningitis in 1996 and analyze and compare it with a epidemic of aseptic meningitis in 1993. METHODS: We studies about clinical manefestation and laboratory finding by retrospective study on 116 patients diagnosed as aseptic meningitis who had been admitted at Department of Pediatrics, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University. RESULTS: 1) Aseptic meningitis affected mostly children between the ages of 1 to 5 in 1996. Male-to-female ratio was 1.2 : 1 in aseptic meningitis in 1996. 2) The outbreak of aseptic meningitis was from middle to late August in 1996.3) Common chief complaints were fever, headache, vomiting, abdominal pain, upper respiratory tract infection, diarrhea, and irritibility in order. On physical examination, pharyngeal injection, neck stiffness, Kernig's sign were detected in decreasing frequency. 4) Values of WBC on peripheral blood were 5000-10,000/mm3 (60 cases, 51.7%) and values of ESR were more than 20mm/Hr (70 cases, 60.3%) and values of CRP positivity were 58 cases (50.0%) in 1996. In comparision with its in 1996, more than 10,000/mm3 in values of WBC and less than 20mm/hr in values of ESR and negativity in CRP values were detected mostly in 1993. 5) 176 cerebrospinal fluid studies were done. WBC count in cerebrospinal fluid were 6-75,000/mm3 (754+/-2351/mm3) and peaked on eighth days of onset of illness and decreased afterwards. Pleocytosis of cerebrospinal fluid were had of mean value 27.2% and peaked on first days of onset of aseptic meningitis. On virus culture, six cases were cultured in that one case of coxsakie virus, two cases of echo virus and six cases of nonspecific enterovirus and on enterovirus PCR, the positivity were 49 cases (41.0%). 6) 76 cases of who were diagnosed as aseptic meningitis were treated with antibiotics and 18 cases treated with mannitol for severe headache. None cases reported with seizure or decreased consciousness. The disease course mostly were three to seven days. CONCLUSIONS: We concluded that the causative agents of outbreak of aseptic meningitis in our hospital in 1996 were enterovirus and on virus culture, echo virus 9 and coxsackie virus A24 were cultured. Recently in our state, outbreak of aseptic meningitis epidemically in summer season and the causative viruses are cultured variably and various clinical symptoms and signs are manafested as well as.

Report of Nationwide Epidemiology of Aseptic Meningitis Outbreak in 1993 in Korea

PURPOSE: There has been no nationwide report pertaining to the epidemiology of aseptic meningitis, although a great numer of patients have been diagnosed of the illness. Therefore, we report an explosive outbreak of aseptic meningitis occured in a nationwide scale in 1993. METHODS: Aseptic meningitis epidemiology surveillence was performed retrospectively on the patients diagnosed of aseptic meinigitis from January 1993 to December 1993 at 60 hospitals (the third graded medical centers and comparable training hospitals) located in 9 districts. The data pertaining to the patients were obtained through the questionnaire answered by the pediatricians or pediatric houseofficers. Monthly and geographical distributions, age and sex distributions, clinical manifestations, laboratory data, complications, and the causative virus of aseptic meningitis were described. RESULTS: 1) The total number of cases reported in 1993 aseptic meningitis epidemiology surveillence was 5,090. Geographically the greatest number of patients was reported from Seoul (2,693), followed by Kyungnam (851), Chunbook (497), Kyungi (492), Chungnam (189), Kangwon (133), Kyungbook (127), Chunnam (82), and Cheju (26). 2) Monthly distribution revealed that the number of patients was increased from April to August and 95.4% (4,858 cases) of the totoal were diagnosed from May to July. The median dates for the diagnosis of aseptic meningitis in various districts were May 8 in Cheju, followed by Chunbook, Kyungnam, Chunnam, Kyungbook, Chungnam, Kyungi, Seoul in June and July 3 in Kangwon. 3) Average age of the study population was 4.7+/-2.9 years and male to female ratio 2.1:1. 4) Subjective symptoms consisted of headache, abdominal pain, poor appetite, irritability, etc, and physical findings fever, local neurological signs, etc in order of frequency. Duration of temperature elevation was 6.1+/-3.7 days in average and 22 cases had no temperature elevation at all. 5) Initial CSF findings revealed pressure of 132 66 mmH2O, leukocytes 594+/-890/mm3 with PMNL 25.6+/-24.7% and lymphocytes 72.3+/-26.1%, protein 47.0+/-37.6 mg/dl, and glucose 60.3+/-14.9 mg/dl. In 35.7% of the patients, CSF leukocytes were more than 500/mm3 and in 19.9% were greater than 1000/mm3. Thirty five patients did not have pleocytosis in the initial CSF examination. 6) The associated illnesses were pharyngotonsillitis (1,285 cases, 31.3%), pneumonia (104 cases, 2.7%), sinusitis (74 cases, 1.9%), etc. 7) While almost all the patients (99.0%) were reported to be improved without complications, 48 cases had complications with 7 encephalitis, 2 neurogenic bladder, 2 Guillian-Barr syndrome, 5 paralysis, and 32 unspecified. Six cases were reported to be deceased. 8) Virus was isolated from 25 out of 55 cases from Seoul and Kyungnam areas on whom virus isolation was tried, and all were echovirus 9. CONCLUSIONS: Aseptic meningitis outbreak in 1993 was nationwide, geographically begun in the southern part of the peninsula spreading rapidly northward, and seasonally occurred from April to August with the peak in June. The average age was 4.7+/-.9 years and male to female ratio 2.1:1. Clinical manifestations and laboratory findings of the study patients were comparable to the reported previoulsy. The causative virus for the nationwide aseptic meningitis outbreak in 1993 was echovirus 9.

Clinical and Epidemic Studies of Aseptic Meningitis

The folling results were obtained through the clinical review and Virology Laboratory of 100 cases of meningitis seen at ward of the pediatric department of Has Sung Hospital during the period from May to June, 1993. 1) Early childhood period was the most frequent age group and male was predominant in aseptic meningitis. 2) The common chief complaints were fever, vomiting, headache in order. 3) On physical examination meningeal irritation signs were not prominent. 4) On admission, leukocytosis (WBC count>10.000/mm(3)) on peripheral blood was showed in 36%. 5) The findings of cerebrospinal fluid showed that cells (Mean WBC count 671.8/mm(3)) were increased in all cases, and protein and sugar were mostly within normal limit. 6) Echovirus 9 was thought to be main causative agent according to the cerebrospinal fluid culture and antibody test. 7) On follow up study 2 months after discharge, 14 cases showed minimal abnormalities of EEG but no abnormal finding in BERA.