Molecular characterisation of enteroviruses and clinical findings from a cluster of paediatric viral meningitis cases in Tshwane, South Africa 2010-2011

Abstract

BACKGROUND : Human enteroviruses (HEVs) are the most common viral pathogen associated with paediatricaseptic meningitis. From October 2010 to February 2011 a cluster of HEV-associated meningitis caseswas identified in paediatric patients who had presented at two large tertiary hospitals in Pretoria in theTshwane Metropolitan Area, Gauteng, South Africa (SA).OBJECTIVES : The aim of this study was to review the clinical features and to characterise the HEV strainsassociated with this cluster of meningitis cases. STUDY DESIGN : In this retrospective study HEVs, detected by real time reverse transcription-polymerasechain reaction in acute phase cerebrospinal fluid specimens from 30 patients with aseptic meningitis,were characterised and the clinical presentations of these patients were described. RESULTS : Fever (83%), headache (70%) and vomiting (67%) were the most prominent symptoms with signsof meningeal irritation recorded in 67% of the patients. There was a neutrophil predominance in thecerebrospinal fluid of 57% of the patients with pleocytosis. Based on partial nucleotide sequence analysisof the HEV viral protein 1 gene, echovirus (E) serotype 4 (E-4) was identified in 80% (24/30) of specimenswith E-9 (3/30) and coxsackie virus B5 (1/30) detected less frequently. CONCLUSION : In this cluster of aseptic meningitis cases E-4 was the predominant strain with E-9, and to alesser extent other HEVs, identified less frequently.