Analysis of the vaccination status of enterovirus type 71 inactivated vaccine in China from 2017 to 2021 / 中华流行病学杂志

Objective: To understand the vaccination status of enterovirus type 71 (EV71) inactivated vaccines in China from 2017 to 2021 and provide evidence for making policy on immunization strategy against hand, foot and mouth disease (HFMD). Methods: Using the reported dose number of EV71 vaccination and birth cohort population data collected by the China immunizaiton program information system to estimate the cumulative coverage of EV71 vaccine by the end of 2021 among the birth cohorts since 2012 at national, provincial, and prefecture levels, and analyze the correlation between the vaccination coverage and the potential influencing factors. Results: As of 2021, the estimated cumulative vaccination coverage of the EV71 vaccine was 24.96% in birth cohorts since 2012. The cumulative vaccination coverage was between 3.09% and 56.59% in different provinces, between 0 and 88.17% in different prefectures. There was a statistically significant correlation between vaccination coverage in different regions and the region's previous HFMD prevalence and disposable income per capita. Conclusions: Since 2017, the EV71 vaccines have been widely used nationwide, but the coverage of EV71 vaccination varies greatly among regions. Vaccination coverage is higher in relatively developed regions, and the intensity of previous epidemic of HFMD may have a certain impact on the acceptance of the vaccine and the pattern of immunization service. The impact of EV71 vaccination on the epidemic of HFMD requires further studies.

Analysis of enterovirus infection type among acute respiratory tract infection cases in Luohe City, Henan Province from 2017 to 2021 / 中华预防医学杂志

Objective: To understand the infection status of Enterovirus (EV) in cases of acute respiratory infections (ARIs) in Luohe City, Henan Province from 2017 to 2021, and analyze the prevalence and type composition of EV in ARIs. Methods: From October 2017 to May 2021, pharyngeal swab samples were collected from 1 828 patients with ARIs in Luohe Central Hospital and the clinical epidemiological data of these cases were also collected. EV-positive samples were identified by Quantitative Real-time Polymerase Chain Reaction (qPCR). The 5'-untranslated region (5'UTR) was amplified by Reverse Transcription-Polymerase Chain Reaction (RT-PCR). The results of 5'UTR region were initially typed by Enterovirus Genotyping Tool Version 1.0. Based on the typing results, the full-length of VP1 region was amplified by RT-PCR. The EV typing was identified again by VP1 region. Results: Among 1 828 cases of ARIs, 56.7% (1 036) were males. The median (Q1, Q3) age was about 3 (1, 5) years. Patients under 5 years old accounted for 71.6% (1 309 cases). Among all cases, a total of 71 EV-positive samples were identified by qPCR, with a detection rate of 3.88% (71/1 828). The EV detection rates for men and women were 3.28% (34/1 036) and 4.67% (37/792), without statistically significant differences (χ2=2.32, P=0.14). The EV detection rates for 2 to <6 years, 6 months to <2 years, 6 to <10 years, and <6 months were 6.29% (48/763), 3.00% (18/600), 2.52% (4/159), and 1.67% (1/60) (χ2=27.91, P<0.001). The EV detection rate was 0.92% (3/326) in autumn and winter of 2017. The EV detection rates were 1.18% (6/508), 2.47% (12/485) and 8.31% (34/409) in each year from 2018 to 2020, with an increasing trend year by year(χ2trend=29.76, P<0.001). The main prevalent seasons were summer and autumn. The detection rate in spring of 2021 was 4.00% (4/100). A total of 12 types were identified and classified as CVA2, CVA4, CVA5, CVA6, CVA10, CVB3, CVB5, E5, E11, E30, PV-1, and EV-D68. The types of CVA2, CVA10, CVA6, and CVB3 were the dominant phenotypes. In 59 sample of EV typing, the main clinical manifestation was upper respiratory tract infection (36/59, 61.01%). The dominant types detected in upper respiratory tract infections were CVA10 (10/36, 27.78%), CVA6 (9/36, 25.00%) and CVB3 (8/36, 22.22%). The dominant type detected in lower respiratory tract infections was CVA2 (7/19, 36.84%). Conclusion: In Luohe City, Henan Province from 2017 to 2021, EV infection in ARIs cases has clear seasonal and age-specific patterns, and the dominant types of upper and lower respiratory tract infections are different.

A cross-sectional study of enterovirus nucleic acid test with throat swabs for term late neonates during coronavirus disease 2019 / 中国当代儿科杂志

OBJECTIVES@#To investigate the positive rate of enterovirus (EV) nucleic acid in throat swabs of term late neonates hospitalized during the coronavirus disease 2019 (COVID-19) epidemic and the clinical characteristics of the neonates.@*METHODS@#A single-center cross-sectional study was performed on 611 term late infants who were hospitalized in the neonatal center from October 2020 to September 2021. Throat swabs were collected on admission for coxsackie A16 virus/EV71/EV universal nucleic acid testing. According to the results of EV nucleic acid test, the infants were divided into a positive EV nucleic acid group (8 infants) and a negative EV nucleic acid group (603 infants). Clinical features were compared between the two groups.@*RESULTS@#Among the 611 neonates, 8 tested positive for EV nucleic acid, with a positive rate of 13.1‰, among whom 7 were admitted from May to October. There was a significant difference in the proportion of infants contacting family members with respiratory infection symptoms before disease onset between the positive and negative EV nucleic acid groups (75.0% vs 10.9%, P<0.001). There were no significant differences between the two groups in demographic data, clinical symptoms, and laboratory test results (P>0.05).@*CONCLUSIONS@#There is a certain proportion of term late infants testing positive for EV nucleic acid in throat swabs during the COVID-19 epidemic, but the proportion is low. The clinical manifestations and laboratory test results of these infants are non-specific. Transmission among family members might be an important cause of neonatal EV infection.

Etiology and epidemiology of hand, foot and mouth disease in China / 中华流行病学杂志

Hand, foot and mouth disease (HFMD) has been widespread in the world, and caused fever, rashes and other clinical symptoms of children, and sometimes inducing respiratory failure, brainstem encephalitis, and other complications, even death. The disease is mainly caused by enterovirus 71 (EV-A71) and coxsackievirus 16 (CV-A16). Since 2013, the proportion of HFMD cases caused by other enteroriruses has gradually increased, causing severe and even fatal cases. This paper summarizes the research progress in the epidemiological and etiological characteristics of HFMD in China since 2008.

Epidemiological characteristics of hand, foot and mouth disease among people aged 6 and over in Beijing, 2011-2020 / 中华流行病学杂志

Objective: To analyze the epidemiological characteristics of hand, foot and mouth disease (HFMD) among people ≥6 years old in Beijing from 2011 to 2020. Methods: The incidence data of HFMD cases from 2011 to 2020 were collected from the National Notifiable Infectious Disease Reporting System of China Information for Disease Control and Prevention and the etiological surveillance of HFMD in 29 sentinel hospitals from 16 districts of Beijing. Descriptive epidemiological methods were used to analyze the distributions, pathogen constituents, and changes of HFMD cases in Beijing people ≥6 years old. Results: From 2011 to 2020, a total of 38 183 cases of HFMD were reported among people ≥6 years old in Beijing, of which 46 (0.12%) cases were severe. The average annual reported incidence was 19.04/100 000. The ratio of males to females were 1.37∶1(22 064∶16 119). The proportion of HFMD in people ≥6 years old increased from 7.56%(2 606/34 488) in 2011 to 24.54% (546/2 225) in 2020. The average incidence of HFMD was higher in Shunyi district, Yanqing district, and Tongzhou district than in other districts in Beijing. The positive rate of enterovirus in sentinel surveillance was 66.78% (1 976/2 959), the proportion of enterovirus group A 71 (EV-A71) was 45.29% (101/223) in 2014, no EV-A71 positive was detected in 2020, and the proportion of Coxsackievirus A 6 (CV-A6) increased from 15.11% (34/225) in 2016 to 81.08% (60/74) in 2020. Conclusions: From 2011 to 2020, the proportion of cases with HFMD in people ≥6 years old in Beijing increased yearly, and the proportion of EV-A71 positive patients decreased basically. Since 2016, CV-A6 has gradually become the dominant pathogen. More attention should be paid to the epidemic situation and dynamic pathogen changes of hand foot mouth disease in people ≥6 years old.

Epidemiological and etiological characteristics of hand, foot and mouth disease among children aged 5 years and younger in Ningbo (2016 to 2019) / 北京大学学报(医学版)

OBJECTIVE@#To describe the epidemiological and etiological characteristics of hand, foot and mouth disease (HFMD) among children aged 5 years and younger in Ningbo after the access of entero-virus-A71 vaccine (2016 to 2019).@*METHODS@#A retrospective cohort study were performed in children aged 5 years and younger in Ningbo from 2016 to 2019. Data for incidence of HFMD was collected from the National Notifiable Disease Surveillance Reporting System and the Electronic Medical Records (EMRs) System, while the demographic information was derived from the Immunization Information System. Speci-mens were detected by real-time fluorescence quantitative PCR and the Wilson method was used to estimate the incidence rate and 95% confidence interval.@*RESULTS@#From 2016 to 2019, a total of 1 044 800 residential children were observed in this population-based cohort. In the study, 102 471 cases of HFMD were diagnosed in 2 651 081 person-years, revealing an overall incidence density of 3 865.25/100 000 person-years. There was no significant decline in the number of the cases after the vaccine was available. The number of the patients of hand foot mouth disease during the four years was 93 421, of whom 84 875 (90.85%) had only one incident record, while 8 946 (9.15%) had 2 or more cases in this period; there were 69 771 (66.06%) patients who only needed to see a doctor once for each disease, 19.92% of the patients needed to be treated twice, and 14 801 (14.02%) patients needed to go to the hospital or clinic three times or more. The incidence of HFMD showed obvious seasonality and periodicity, which mainly concentrated in April to July each year, and the epidemic cycle was 2 years; most of the cases were 1 to 3-year old children, with more cases in male. The incidence density varied across the region, with the highest density observed in Ninghai (4 524.76/100 000 person-years), followed by Xiangshan (3 984.22/100 000 person-years). In 3 748 library-conformed cases, 2 834(75.61%) were detected positive, among which enterovirus-A71, Cox-A16 and other enteroviruses accounted for 9.03%, 31.55% and 59.42%, respectively. During the study period, the cumulative coverage of enterovirus-A71 vaccine increased year by year, with the proportion of enterovirus-A71 and severe cases both gradually decreasing.@*CONCLUSION@#The current status of hand, foot and mouth disease in Ningbo is still serious. Children under 3-year old (especially male children aged 1 year) were the key population for prevention and control. Vaccination might lead to changes in major pathogenic virus type, of which more attention should be paid to the potential impact on disease surveillance, prevention and control.

Arbovirus, herpesvirus, and enterovirus associated with neurological syndromes in adult patients of a university hospital, 2017-2018

Abstract INTRODUCTION: Herpesviruses, enteroviruses, and arboviruses are important because of their clinical relevance and ability to cause meningitis, encephalitis, meningoencephalitis, and other diseases. The clinical virology associated with diagnostic technologies can reduce the morbidity and mortality of such neurological manifestations. Here we aimed to identify the genomes of agents that cause neurological syndromes in cerebrospinal fluid (CSF) samples from patients with suspected nervous system infections admitted to the University Hospital of the University of Campinas, São Paulo, Brazil, in 2017-2018. METHODS: CSF samples collected from adult patients with neurological syndrome symptoms and negative CSF culture results were analyzed using polymerase chain reaction (PCR), reverse transcriptase-PCR, and real-time PCR, and their results were compared with their clinical symptoms. One CSF sample was obtained from each patient. RESULTS: Viral genomes were detected in 148/420 (35.2%) CSF samples: one of 148 (0.2%) was positive for herpes simplex virus-1; two (0.5%) for herpes simplex virus-2; eight (1.9%) for varicella-zoster virus; four (1%) for Epstein-Barr virus; one (0.2%) for cytomegalovirus; 32 (7.6%) for human herpesvirus-6; 30 (7.1%) for non-polio enterovirus; 67 (16.0%) for dengue virus, three (0.7%) for yellow fever virus, and 21 (5%) for Zika virus. CONCLUSIONS: The viral genomes were found in 35.2% of all analyzed samples, showing the high prevalence of viruses in the nervous system and the importance of using a nucleic acid amplification test to detect viral agents in CSF samples.

Agentes infecciosos en muestras biológicas de pacientes con síndrome de Guillain-Barré en Perú, 2018-2019 / Infectious agents in biological samples from patients with Guillain-Barré syndrome in Peru, 2018-2019

RESUMEN Objetivo: Describir los resultados de los exámenes de laboratorio realizados en muestras biológicas de pacientes con síndrome de Guillain-Barré (SGB), recibidas en el Instituto Nacional de Salud (INS) entre los años 2018 y 2019. Materiales y métodos: Se realizó un estudio observacional en pacientes con SGB notificados en el sistema de vigilancia epidemiológica. Se obtuvieron muestras biológicas analizadas en el INS para investigar arbovirus, virus respiratorios, enterovirus y enterobacterias, entre otros. Resultados: Se recibió un total de 2051 especímenes clínicos de 906 pacientes con SGB. Tres pacientes dieron positivo al dengue y tres pacientes al Zika. En 19 pacientes, el cultivo en heces fue positivo para Campylobacter jejuni. El análisis filogenético de diez cepas de Campylobacter jejuni las clasificó como genotipo ST2993, reportado previamente en China y asociado a un brote de SGB. En 2018, hubo 12 muestras que habían dado positivo al PCR para enterovirus en el líquido cefalorraquídeo, pero ninguna pudo corroborarse con el cultivo respectivo ni con secuenciamiento de genoma completo. Un paciente dio positivo por virus de la influenza A, dos por virus de la influenza B, dos por adenovirus, cinco por virus respiratorio sincicial, y diez por rinovirus. Conclusión: Se han encontrado diversos agentes patógenos en especímenes de pacientes con SGB, sin embargo, la presencia de Campylobacter jejuni genotipo ST2993, un patógeno relacionado a brotes de SGB en varios continentes, sería el probable agente causal. Es necesario confirmar esta hipótesis con estudios analíticos y determinar la cadena de transmisión de este agente para implementar las medidas de prevención y control.

ABSTRACT Objective: To describe the results of laboratory tests performed on biological samples from patients with Guillain-Barré syndrome (GBS) submitted to the Instituto Nacional de Salud (INS) between 2018 and 2019. Materials and methods: We conducted an observational study on patients with GBS, by using data from the epidemiological surveillance system. Biological samples, previously analyzed at the INS, were obtained to study arboviruses, respiratory viruses, enteroviruses and enterobacteria, among others. Results: A total of 2,051 specimens were obtained from 906 patients with GBS. Three patients tested positive for dengue and three for Zika. In 19 patients, the stool culture was positive for Campylobacter jejuni. Phylogenetic analysis of 10 Campylobacter jejuni strains classified them as genotype ST2993, which was previously reported in China and associated to a GBS outbreak. Twelve cerebrospinal fluid samples tested positive for enterovirus by PCR in 2018, but none could be verified by culture or complete genome sequencing during the study. One patient was positive for influenza A, two for influenza B, two for adenovirus, five for respiratory syncytial virus, and ten for rinovirus. Conclusion: Several pathogens were found in samples from patients with GBS. However, we found that the genotype ST2993 of Campylobacter jejuni was the most likely causal agent, a pathogen that is related to GBS outbreaks in different continents. It is necessary to confirm this hypothesis with additional analytical studies and it is important to describe the transmission mechanism of C. jejuni genotype ST2993 in order to implement prevention and control measures.

Clinical features of neonatal enterovirus infection / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features of neonatal enterovirus infection, especially severe enterovirus infection.@*METHODS@#A retrospective analysis was performed for the clinical data of 244 neonates with enterovirus infection. According to the severity of infection, they were divided into a common infection group with 231 neonates and a severe infection group with 13 neonates. Clinical features were compared between the two groups.@*RESULTS@#Of the 244 neonates, 207 (84.8%) developed the disease in May to October, with the highest number of patients in June to July. Compared with the common infection group, the severe infection group had a significantly lower gestational age at birth and a significantly higher proportion of preterm infants (P<0.05). Compared with the common infection group, the severe infection group had a significantly earlier onset time (P<0.05) and significantly higher incidence rates of skin petechiae and ecchymosis, respiratory symptoms, sepsis-like manifestations (poor appetite, crying less, and less movement), concomitant diseases (such as pneumonia, myocarditis, necrotic hepatitis, and coagulation disorder), thrombocytopenia, prolonged prothrombin time, elevated creatine kinase-MB, and elevated alanine aminotransferase (P<0.05). The severe infection group had a significantly higher mortality rate than the common infection group (P<0.05).@*CONCLUSIONS@#There are significant differences in onset time, common clinical manifestations, and concomitant diseases between the neonates with common and severe enterovirus infection. In the enterovirus epidemic season, if the neonates have rashes and/or sepsis-like manifestations such as poor appetite and less movement, especially if the laboratory tests suggest liver damage and coagulation dysfunction, it is necessary to pay particular attention to the possibility of severe enterovirus infection.

Parálisis fláccida aguda por enterovirus con resolución completa del cuadro neurológico. A propósito de un caso pediátrico / Acute flaccid paralysis related to enterovirus with complete resolution of the neurological symptoms. A pediatric case report

Desde la eliminación de la circulación del virus polio salvaje, disminuyeron los casos de parálisis fláccida aguda. Sin embargo, continúan ocurriendo casos asociados a otros enterovirus no polio y virus neurotropos. Se presenta el caso de una paciente de 9 años con diagnóstico de meningitis y mielitis con compromiso motor en los miembros inferiores y vejiga neurogénica asociado a enterovirus, con resolución completa del cuadro neurológico posterior a la administración de gammaglobulina hiperinmune.

Since the wild poliovirus no longer circulates, the number of cases of acute flaccid paralysis decreased. However, cases related to non-polio enteroviruses and neurotrope viruses continue to occur. We present a nine-year-old patient with meningitis and myelitis with motor involvement in the lower limbs and neurogenic bladder associated with enterovirus, with complete resolution of the neurological symptoms following the administration of hyperimmune gammaglobulin.

Enfermedad de mano-pie-boca atípica causada por virus Coxsackie A6 en Argentina, 2015 / Atypical hand, foot, and mouth disease caused by Coxsackievirus A6 in Argentina in 2015

We present two groups of cases of atypical hand, foot, and mouth disease (HFMD) caused by Coxsackievirus A6 (CV-A6) detected in Argentina in 2015. The first group involved 14 patients from Chubut province and the second group affected 12 patients from San Luis province. Molecular analysis of the complete VP1 protein gene revealed the circulation of E2 sublineage, the most predominant worldwide. To our knowledge, this is the first report of CV-A6 infections associated with atypical HFMD in Argentina and South America.

Se describen dos grupos de casos de enfermedad de mano-pie-boca (HFMD) atípica causada por el virus Coxsackie A6 (Coxsackievirus A6, CV-A6) detectados en Argentina en el año 2015. El primero de los grupos involucró a 14 pacientes de Chubut y el segundo a 12 pacientes de San Luis. El análisis molecular del gen de la proteína VP1 completa reveló la circulación del sublinaje E2, el predominante a nivel global. Hasta donde sabemos, este es el primer reporte de infecciones CV-A6 asociadas con HFMD atípica en Argentina y Sudamérica.

Caracterización del síndrome de Guillain-Barré en pacientes pediátricos / Characterization of the Guillain-Barré syndrome in pediatric patients

El Síndrome de Guillain Barré (SGB) se caracteriza por la manifestación de manera aguda o subaguda de un conjunto de signos y síntomas que demuestran la afectación del sistema nervioso periférico, expresada en parálisis fláccida y arreflexia, que eventualmente pueden complicarse amenazando la vida y/o posteriormente cronificarse si no se instauran tratamientos específicos de manera oportuna. Las causas más importantes del SGB se atribuyen a agentes infecciosos los cuales desencadenan un mecanismo de respuesta autoinmune que afectan tanto la mielina como el axón. La presente investigación caracterizó el SGB en los pacientes ingresados en el Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga entre los años 2010 y 2016(AU)

Guillain Barré Syndrome (GBS) is characterized by acute or subacute manifestation of peripheral nervous system alterations such as flaccid paralysis and arreflexia, which can eventually be life-threatening and/or become chronic if specific treatments are not established in a timely manner. The main causes of GBS are attributed to infectious agents which trigger an autoimmune response that affect both the myelin and the axon. GBS is the most frequent cause of flaccid paralysis in the pediatric population. The present investigation characterized the GBS in patients admitted to the Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga in the period 2010 to 2016(AU)

Enterovirus asociados a Afecciones del Sistema Nervioso Central confirmados por biología molecular / Enteroviruses associated with Central Nervous System Infections confirmed by molecular biology

Aproximadamente 90% de las meningitis asépticas son causadas por enterovirus (EV), miembro de la familia de los picornavirus. Los EV son ubicuos, se diseminan por vía fecal-oral y contacto directo, responsables de brotes o casos esporádicos con importante morbilidad. El diagnóstico se basa en la presentación clínica, imágenes, estudio citoquímico del líquido cefalorraquídeo (LCR) y la Reacción en Cadena de la Polimerasa (PCR), gold estándard que reemplaza al aislamiento viral y la serología. El objetivo de este estudio descriptivo de corte transversal fue determinar la presencia de EV por RT-PCR en el LCR de pacientes con sospecha clínica de meningitis aséptica, internados en servicios públicos y privados de Asunción y departamento Central del Paraguay de noviembre de 2007 a noviembre de 2014. El material genético fue extraído mediante el mini kit ADN y ARN Qiagen® que fue sometido a RT-PCR. Se incluyeron LCR de 203 pacientes, 124 (61%) niños (4 días-15 años) y 79 (39%) adultos (16-81 años). Setenta y siete (38%) provenían de servicios públicos y 126 (62%) de privados; 115 (57%) fueron varones. Se detectó RNA de EV en 166 (82%) pacientes, 90 niños y 76 adultos, y mayor número de casos entre los meses de octubre a abril. Este es el primer trabajo en el país y muestra una importante participación del EV en pacientes por infecciones del SNC compatibles con meningitis asépticas de etiología viral. La sospecha clínica fue mayor en niños, sin embargo la proporción de resultados positivos fue mayor en adultos. Se observó mayor circulación en los meses cálidos(AU)

Enfermedad boca-mano-pie atípica infantil con rasgos de eczema herpetico y de acrodermatitis / Infantile atypical hand-foot-mouth disease with features of eczema herpeticum and acrodermatitis

La enfermedad boca-mano-pie puede presentarse con formas atípicas, con lesiones más generalizadas y morfología diferente a la forma clásica. A veces, incluso simula otras enfermedades víricas. En las formas atípicas, existe la tendencia a afectar a las zonas de traumatismo o inflamación. Se presenta el caso de un niño de 2 años con antecedente de atopia, que consultó por presentar lesiones papulosas y vesiculosas umbilicadas que afectaban a la zona perioral, los miembros superiores e inferiores, con predominio en las zonas de presión y de dermatitis atópica previa. Aunque clínicamente se diagnosticó eczema herpético, las pruebas complementarias fueron negativas para herpes virus. Sin embargo, la reacción en cadena de la polimerasa del contenido de una vesícula, del exudado faríngeo y de heces fue positiva para enterovirus.

Hand-foot-mouth disease can present atypically, including forms with more numerous lesions and/or morphologically different from the classic presentation. It may even mimic other viral diseases. We present the case of a 2-year-old child previously diagnosed with atopic dermatitis, who presented with papules and umbilicated vesicles affecting the perioral area and limbs, predominantly in pressure areas, as well as in areas with previous atopic lesions. Although he was clinically diagnosed with herpetic eczema, tests results were negative for herpes virus. However, positive entorovirus polymerase chain reaction results were obtained from the content of a vesicle, a pharyngeal exudate and a stool sample.

Evaluation of the Real-Q RV Detection Kit for the Identification of Viruses That Result in Respiratory Infections

Viral respiratory infections are one of the most common infections worldwide. It is important to detect the virus early and precisely. In this study, we evaluated the limit of detection (LoD) and usefulness of the Real-Q RV Detection kit (BioSewoom, Seoul, Korea). We measured the LoD of the Real-Q RV Detection kit using 10 strains of standard viruses. We then compared the detection results by the Allplex Respiratory Panel Assay kit (Seegene, Seoul, Korea) using 123 clinical specimens. The discrepant results were confirmed by sequencing. Among the 10 standard viruses, the LoD of human rhinovirus (HRV) was the lowest and that of parainfluenza virus 2 and 3 was relatively high as detected by Real-Q RV Detection kit. Agreements of the two kits ranged from 95.9% to 100%. Three specimens detected negative by the Allplex Respiratory Panel kit were detected as adenovirus (AdV) by the Real-Q RV Detection kit and were confirmed by sequencing. Similarly, a specimen detected negative by the Allplex Respiratory Panel kit was detected as HRV by the Real-Q RV Detection kit and was confirmed by sequencing. A specimen detected as human enterovirus by the Allplex Respiratory Panel kit was detected as HRV by the Real-Q RV Detection kit and was confirmed by sequencing. Real-Q RV Detection kit showed good diagnostic performance and can be useful for detecting major viruses that cause respiratory infections.

Early Detection and Successful Treatment of Vertically Transmitted Fulminant Enteroviral Infection Associated with Various Forms of Arrhythmia and Severe Hepatitis with Coagulopathy

Enteroviral infections are common in neonates. One important infection pathway is vertical transmission from an infected mother to her neonate. Here, we report the early detection and successful treatment of a vertically transmitted fulminant enteroviral infection associated with myocarditis and hepatitis. The patient had a sudden onset of high fever on the fourth day of life and developed severe, rapidly progressing symptoms of disseminated intravascular coagulopathy (DIC), hepatitis, and myocarditis accompanied by tachyarrhythmia. As it was the peak season for enteroviral infections and both the mother and the patient's 36-month-old sibling had a high fever around the time of delivery, we suspected an enteroviral infection. Thus, we initiated prompt evaluation of enteroviral infection, as well as close observation and intensive care of the neonate. We strongly recommend evaluation for the possibility of vertical enterovirus infection in neonates when the mother is suspected of having a viral infection (e.g., high fever and negative results from bacterial infectious studies) around the time of delivery and when the neonate shows some early symptoms of infectious diseases such as thrombocytopenia, DIC, hepatitis, and myocarditis. Early detection of enteroviral infections and prompt implementation of proper treatment are key to reduce the risk of complications and mortality associated with enteroviral infections in neonates.

Comparison of Multiplex Real-Time Polymerase Chain Reaction Assays for Detection of Respiratory Viruses in Nasopharyngeal Specimens / 대한임상미생물학회지

BACKGROUND: Respiratory tract infections are major public health threats, and the identification of their causative microbes helps clinicians to initiate timely and appropriate antimicrobial therapy and prevent the secondary spread of infection. The main goal of this study was to compare two multiplex real-time polymerase chain reaction (PCR) assays used to detect respiratory viral pathogens in nasopharyngeal swab specimens. METHODS: Between September and October 2017, a total of 84 nasopharyngeal specimens were obtained consecutively from patients in a tertiary hospital using a flocked swab with 3 mL universal transport medium (COPAN Diagnostics, USA). A total of 64 positive and 20 negative sample results from the LG AdvanSure RV real-time RT-PCR kit (LG Life Sciences, Korea) were further retested using a new AdvanSure RV-plus a real-time RT-PCR kit to compare their performance. RESULTS: Statistical analysis of positive and negative agreement between the two different kits was conducted between the newly introduced AdvanSure RV-plus real-time RT-PCR kit and the AdvanSure RV real-time RT-PCR. The overall agreement was 96.4%, with positive agreement of 98.4% and negative agreement of 90%. The evaluated sensitivity and specificity of AdvanSure RV-plus real-time RT-PCR were 96.9% and 94.7%, respectively, with a kappa value of 0.9 (P<0.001). CONCLUSION: The performances of LG AdvanSure RV real-time RT-PCR and the new AdvanSure RV-plus real-time RT-PCR kit showed strong overall agreement. AdvanSure RV-plus real-time RT-PCR had a better detection rate and could detect coronavirus 229E and enterovirus, especially with a high detection rate in coinfection. AdvanSure RV-plus real-time RT-PCR can be considered a useful tool for respiratory virus diagnosis in clinical laboratories.

Prevalence and molecular characterization of novel recombinant enterovirus G isolates in Jeju Province of South Korea / 대한수의학회지

Enterovirus species G (EV-G) is highly diverse, and is ubiquitous in pig populations, usually without diarrhea. The present study aimed to investigate the presence of novel EV-G recombinants with the torovirus papain-like cysteine protease (PLCP) in Jeju pig herds. EV-G1-PLCP mono-infections were most prevalent in diarrheic weaned piglets. The PLCP genes of the Jeju isolates varied in size and junction sequences, and were greatly heterogeneous, with 77.0–90.7% homology amongst all recombinants. Our results suggest that the exogenous PLCP gene has undergone continuous rapid mutation in the individual EV-G genomes following cross-order recombination, thereby causing clinical disease in swine.

Identification of enteric viruses circulating in a dog population with low vaccine coverage

ABSTRACT Although the use of vaccines has controlled enteric diseases in dogs in many developed countries, vaccine coverage is still under optimal situation in Brazil. There is a large population of nonimmunized dogs and few studies about the identification of the viruses associated with diarrhea. To address this situation, stool samples from 325 dogs were analyzed by polymerase chain reaction for the detection of common enteric viruses such as Canine adenovirus (CAdV), Canine coronavirus (CCoV), Canine distemper virus (CDV), Canine rotavirus (CRV) and Carnivorous protoparvovirus 1 (canine parvovirus 2; CPV-2). At least one of these species was detected in 56.6% (184/325) of the samples. The viruses detected most frequently in either diarrheic or nondiarrheic dog feces were CPV-2 (54.3% of the positive samples), CDV (45.1%) and CCoV (30.4%), followed by CRV (8.2%) and CAdV (4.9%). Only one agent was detected in the majority of the positive samples (63%), but co-infections were present in 37% of the positive samples and mainly included CDV and CPV-2. The data presented herein can improve the clinical knowledge in regions with low vaccine coverage and highlight the need to improve the methods used to control these infectious diseases in domestic dogs.

Encefalitis por enterovirus: análisis clínico y paraclínico en pacientes pediátricos de un hospital de tercer nivel en Quito-Ecuador, de enero a diciembre de 2016 / Enterovirus encephalitis: clinical and paraclinical analysis in pediatric patients in a tertiary hospital in Quito-Ecuador, from January to December 2016

La encefalitis es una entidad rara con manifestaciones clínicas variables. En los niños es usualmente leve y autolimitada. En 30 a 75% se desconoce la etiología y cuando el patógeno se identifica por PCR (reacción en cadena de la polimerasa), el 80% son enterovirus. En América Latina no están disponibles métodos específicos de diagnóstico. En nuestro país muy pocos centros realizan el examen y tampoco están disponibles estadísticas reales de su incidencia. Objetivo: correlacionar la etiología con los síntomas, resultados de laboratorio, imagen y electroencefalograma. Métodos: estudio transversal; de enero a diciembre de 2016 se revisaron las historias clínicas de 63 niños de 0 a 18 años hospitalizados con sospecha de encefalitis. Una vez identificado el enterovirus por PCR, se correlacionó con los hallazgos de los exámenes de laboratorio e imagen. Resultados: se confirmó encefalitis viral en 35 pacientes, enterovirus en 49%, predominio en la edad preescolar. Síntomas más comunes: fiebre, cefalea, signos meníngeos y síntomas digestivos, 24% alteraciones de la conciencia. Biometría hemática normal en 71%, proteina C reactiva alterada en 71%. De los pacientes con estudios de imagen, 6% tuvo resultado anormal y en aquellos con electroencefalograma 80% fue anormal. Se utilizó la U de Mann Whitney para el análisis estadístico, la relación entre enterovirus y alteración de estado de conciencia y síntomas digestivos fue significativa (p=0.029). Conclusión: en los pacientes con diagnóstico de encefalitis que presenten síntomas digestivos y alteración del estado de conciencia, se debe sospechar que el enterovirus es el agente etiológico.

Encephalitis is a rare entity with variable clinical manifestations. In children it is usually mild and self-limited. In 30-75% of cases, the etiology is unknown and when the pathogen is identified by PCR (polymerase chain reaction), 80% are enteroviruses. In Latin America specific diagnostic methods are not available. In our country very few centers carry out the specific test, real statistics of their incidence are not available Objective: To correlate etiology with symptoms, laboratory results, imaging and electroencephalogram. Methods: Cross-sectional study, clinical records of 63 children between 0 and 18 years hospitalized with suspected encephalitis from January to December 2016 were reviewed. Once Enterovirus was identified by PCR, it was correlated with the findings of laboratory and imaging tests. Results: Viral encephalitis was confirmed in 35 patients, Enterovirus in 49%, predominance in pre-school age. Most common symptoms: fever, headache, meningeal signs and digestive symptoms, 24% alterations of consciousness. Normal blood count in 71%, Protein C Reactive altered in 71%. In patients with imaging studies, 6% had an abnormal result and in those who underwent electroencephalography, 80% were abnormal. The Mann Whitney U was used for the statistical analysis, the relationship between enterovirus and alteration of consciousness and digestive symptoms was significant (p: 0.029) Conclution: In patients with a diagnosis of encephalitis presenting digestive symptoms and altered state of consciousness, Enterovirus should be suspected as an etiologic agent.