Jiang Chunmei, Xu Zhixiang, Li Jin, Zhang Jiaqi, Xue Xingkui, Jiang Jingxia, Jiang Guihua, Wang Xisheng, Peng Yun, Chen Tian, Liu Zhenzhen, Xie Liu, Gao Haibin, Liu Yingxia, Yang Yang
Department of Infectious Disease, The People's Hospital of Longhua, Shenzhen, China.
Shenzhen Key Laboratory of Pathogen and Immunity, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China.
Front Med (Lausanne). 2023 Jan 12;9:1094347. doi: 10.3389/fmed.2022.1094347. eCollection 2022.
Echovirus 18 has been recognized as an important causative pathogen of aseptic meningitis in young children worldwide, and echovirus 18-induced meningitis is rarely found in adults with immunocompetence. In this case study, we report the clinical and virological characteristics of aseptic meningitis caused by recombinant echovirus 18 in an adult with immunocompetence. A 31-year-old woman with immunocompetence was admitted to our hospital with fever, dizziness, severe headache, nausea, and vomiting for the past 1 day and was diagnosed with viral meningitis based on the clinical manifestations and laboratory results from cerebrospinal fluid (CSF). The patient received antiviral treatment with ribavirin and interferon as soon as the enterovirus infection was identified using qRT-PCR and was cured after 4 days. From the oropharyngeal swab and CSF samples, two echovirus 18 strains were isolated with a single nucleotide difference located at the 5' UTR. Phylogenetic analyses based on the VP1 gene showed that the two strains belonged to the subgenotype C2 and were clustered with sequences obtained from China after 2015, while the results from the 3D polymerase region showed that the two strains were closely related to the E30 strains. Bootscanning results using the 5' UTR to 2A region and the 2B to 3' UTR region showed that potential intertypic recombination had occurred in the 2B gene. Recombination analyses further confirmed that the two strains (echovirus 18) presented genome recombination with echovirus 30 in the nucleotide regions of the 2B gene. To the best of our knowledge, this is the first report of echovirus 18-induced meningitis in an adult with immunocompetence from mainland China, highlighting the need for close surveillance of echovirus 18 both in children and adults in the future.
肠道病毒18型已被公认为全球范围内幼儿无菌性脑膜炎的重要致病病原体，而在免疫功能正常的成年人中很少发现肠道病毒18型引起的脑膜炎。在本病例研究中，我们报告了一名免疫功能正常的成年人由重组肠道病毒18型引起的无菌性脑膜炎的临床和病毒学特征。一名31岁免疫功能正常的女性因过去1天出现发热、头晕、严重头痛、恶心和呕吐入院，根据临床表现和脑脊液（CSF）实验室检查结果被诊断为病毒性脑膜炎。使用qRT-PCR鉴定出肠道病毒感染后，患者立即接受了利巴韦林和干扰素抗病毒治疗，并在4天后治愈。从口咽拭子和脑脊液样本中分离出两株肠道病毒18型菌株，它们在5'UTR处存在一个单核苷酸差异。基于VP1基因的系统发育分析表明，这两株菌株属于C2亚型，与2015年后从中国获得的序列聚类，而3D聚合酶区域的结果表明这两株菌株与E30菌株密切相关。使用5'UTR至2A区域和2B至3'UTR区域的Bootscanning结果表明，在2B基因中发生了潜在的型间重组。重组分析进一步证实，这两株菌株（肠道病毒18型）在2B基因的核苷酸区域与肠道病毒30型存在基因组重组。据我们所知，这是中国大陆首例关于免疫功能正常的成年人由肠道病毒18型引起脑膜炎的报告，突出了未来对儿童和成年人肠道病毒18型进行密切监测的必要性。
