title: Echoviruses are a major cause of aseptic meningitis in infants and young children in Kuwait.
abstract: BACKGROUND
  The etiologic agents of aseptic meningitis (AM) often include human enteroviruses. The role of enteroviruses causing AM in young children was investigated during a 3-year period in Kuwait.
  
  
  RESULTS
  Enteroviral RNA was detected in cerebrospinal fluid (CSF) by reverse transcription-PCR and specific genotypes of enteroviruses were identified by direct DNA sequencing of VP4-VP2 region. Enteroviral RNA was detected in 92 of 387 (24%) suspected AM cases and the results were confirmed by hybridization of amplicons with an internal, enterovirus-specific probe. The CSF samples from 75 of 281 (27%) children < 2 years old but only from 3 of 38 (8%) 4-12 year-old children were positive for enteroviral RNA (p = 0.011). Majority of infections in children < 2 years old (49 of 75, 65%) were due to three echoviruses; echovirus type 9 (E9), E11 and E30. Only three other enteroviruses, namely coxsackievirus type B4, coxsackievirus type B5 and enterovirus 71 were detected among AM cases in Kuwait.
  
  
  CONCLUSIONS
  Our data show that three types of echoviruses (E9, E11 and E30) are associated with the majority of AM cases in Kuwait. To the best of our knowledge, this is the first report to characterize different enterovirus genotypes associated with AM in the Arabian Gulf region.
authors.affiliation: Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.
authors.forename: Ajmal
authors.initials: A
authors.lastname: Dalwai
authors.forename: Suhail
authors.initials: S
authors.lastname: Ahmad
authors.forename: Widad
authors.initials: W
authors.lastname: Al-Nakib
mesh_terms: D002555:Cerebrospinal Fluid / Q000821:virology; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D029822:Enterovirus B, Human / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000821:virology; D005838:Genotype; D006801:Humans; D007223:Infant; D007730:Kuwait / Q000453:epidemiology; D008582:Meningitis, Aseptic / Q000453:epidemiology* / Q000821:virology*; D008969:Molecular Sequence Data; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D020133:Reverse Transcriptase Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D015678:Viral Structural Proteins / Q000235:genetics
chemical_list: D012367:RNA, Viral; D015678:Viral Structural Proteins