Molecular identification of enteroviruses responsible for an outbreak of aseptic meningitis; implications in clinical practice and epidemiology.

Abstract

An outbreak of aseptic meningitis was recorded in Greece during the year 2001. Detection of the clinical strains was achieved by performing reverse transcription-polymerase chain reaction (RT-PCR) on RNA isolated from cell cultures inoculated with treated faecal material from the patients. Serotypic identification of the isolates with mixed equine antisera pools followed and the RT-PCR amplicons were further studied by restriction fragment length polymorphism analysis and sequencing. Fifty-three clinical enterovirus strains were isolated from respective cases of suspected enterovirus infection, most of which showed the clinical symptoms of aseptic meningitis. Echovirus (ECV) 6 was the most frequently isolated serotype, followed by coxsackie B viruses, ECV13, poliovirus type 1 (PV1) vaccine strain and ECV30. Nucleotide sequence analysis showed the existence of different genetic groups on the basis of the 5'-untranslated region (5'-UTR) of the genome, which circulated in the population during the same time period. Different serotypes belonged to the same genetic group and vice versa. The 5'-UTR seems to be appropriate for the investigation of enterovirus evolution and epidemiology.