title: An echovirus 18-associated outbreak of aseptic meningitis in Taiwan: epidemiology and diagnostic and genetic aspects.
abstract: In 2006, an outbreak of aseptic meningitis was noted in Taiwan. From January to October 2006, a total of 3283 specimens collected from patients with viral infection, including 173 cerebrospinal fluid (CSF) samples, were examined for virus isolation and identification. Overall, 339 enterovirus (EV)-positive cases were identified by virus culture: echovirus 18 (E18) formed the majority (27.4 %, 93 cases), followed by coxsackievirus B2 (13.8 %, 47 cases) and coxsackievirus A2 (10.8 %, 37 cases). The manifestations of the 93 E18 cases were aseptic meningitis (44.1 %), viral exanthema (23.6 %), acute tonsillitis (15.1 %), acute pharyngitis (14.0 %), acute gastritis (11.8 %), herpangina (7.5 %) and bronchopneumonia (5.3 %). Of 107 E18 isolates identified, 100, 62.5 and 19 % were obtained following culture in RD, MRC-5 and A549 cells, respectively. E18 was identified most frequently from throat swabs (67.2 %) and less frequently from stool samples (15.9 %) and CSF (16.8 %). The detection rate of E18 was 78.2 % from CSF, 50 % from stool samples and 22.9 % from throat swabs. Phylogenetic relationships among the E18 strains were examined. Analysis of the partial VP1 gene showed 3.7-23.8 % variation in sequence compared with sequences from GenBank and, notably, the amino acid change V152S was detected in a protruding loop within the VP1 protein. These results indicate that a genetic variant of E18 was circulating and caused an outbreak of aseptic meningitis in Taiwan in 2006.
authors.affiliation: Department of Pathology, National Cheng Kung University Medical Center, Tainan, Taiwan, ROC.
authors.forename: Huey-Pin
authors.initials: HP
authors.lastname: Tsai
authors.affiliation: Institute of Basic Medical Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC.
authors.forename: Sheng-Wen
authors.initials: SW
authors.lastname: Huang
authors.affiliation: Department of Pathology, National Cheng Kung University Medical Center, Tainan, Taiwan, ROC.
authors.forename: Feng-Ling
authors.initials: FL
authors.lastname: Wu
authors.affiliation: Department of Pathology, National Cheng Kung University Medical Center, Tainan, Taiwan, ROC.
authors.forename: Pin-Hwa
authors.initials: PH
authors.lastname: Kuo
authors.affiliation: Division of Infectious Diseases, National Health Research Institutes, Tainan, Taiwan, ROC.|Department of Emergency, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC.
authors.forename: Shih-Min
authors.initials: SM
authors.lastname: Wang
authors.affiliation: Division of Infectious Diseases, National Health Research Institutes, Tainan, Taiwan, ROC.|Department of Pediatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC.
authors.forename: Ching-Chuan
authors.initials: CC
authors.lastname: Liu
authors.affiliation: Division of Infectious Diseases, National Health Research Institutes, Tainan, Taiwan, ROC.|Department of Pathology, National Cheng Kung University Medical Center, Tainan, Taiwan, ROC.
authors.forename: Ih-Jen
authors.initials: IJ
authors.lastname: Su
authors.affiliation: Department of Pathology, National Cheng Kung University Medical Center, Tainan, Taiwan, ROC.|Institute of Basic Medical Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC.|Division of Infectious Diseases, National Health Research Institutes, Tainan, Taiwan, ROC.|Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC.
authors.forename: Jen-Ren
authors.initials: JR
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019943:Amino Acid Substitution; D036022:Capsid Proteins / Q000235:genetics; D002460:Cell Line; D002555:Cerebrospinal Fluid / Q000821:virology; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D004196:Disease Outbreaks; D004457:Echovirus Infections / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D029822:Enterovirus B, Human / Q000302:isolation & purification*; D005243:Feces / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008582:Meningitis, Aseptic / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D008875:Middle Aged; D008969:Molecular Sequence Data; D020125:Mutation, Missense; D010614:Pharynx / Q000821:virology; D010802:Phylogeny; D012367:RNA, Viral / Q000235:genetics; D017422:Sequence Analysis, DNA; D013624:Taiwan / Q000453:epidemiology; D014776:Virus Cultivation / Q000379:methods; D055815:Young Adult
chemical_list: D036022:Capsid Proteins; D012367:RNA, Viral