title: Isolation of Coxsackievirus A24 variant from patients with hemorrhagic conjunctivitis in Cuba, 2008-2009.
abstract: BACKGROUND
  An outbreak of acute hemorrhagic conjunctivitis occurred in Cuba in 2008 and 2009.
  
  
  OBJECTIVE
  To determinate the etiological agent associated with the Cuban outbreaks of acute hemorrhagic conjunctivitis during 2008 and 2009.
  
  
  METHODS
  Conjunctival swabs and/or faecal samples from 382 patients with clinical diagnosis suggestive of acute hemorrhagic conjunctivitis were subject to viral culture in HEp-2 human laryngeal epidermoid carcinoma cells. Positive samples were identified by a specific Coxsackievirus A24 variant PCR and the 3C protease region of 16 isolates was sequenced for phylogenetic analysis.
  
  
  RESULTS
  Enterovirus cytopathic effect was observed in 138 cases (36%). A higher percent of CA24v was recovered from faecal samples, 19 out of 45 cases (42.2%), than from conjunctival swabs, 127 out of 355 samples (35.8%). All isolates were identified as Coxsackievirus A24 variant. Phylogenetic analysis revealed that 2008 and 2009 Cuban outbreaks were caused by the same virus strains and that isolates were closely related to those from Taiwan (2006-2007), China (2007-2008) and Singapore (2005) with a bootstrap value of 71%.
  
  
  CONCLUSIONS
  Outbreaks of acute hemorrhagic conjunctivitis occurred in Cuba in 2008 and 2009 were caused by Coxsackievirus A24 variant. The faecal-oral route is another mode of transmission of CA24v in the acute hemorrhagic conjunctivitis outbreaks. Phylogenetic analysis of Cuban CA24v strains involved in an acute hemorrhagic conjunctivitis outbreak in 2008 and 2009 confirms a new introduction of the CA24 variant into the Americas from South-east Asia.
authors.affiliation: Department of Virology, Pedro Kourí Tropical Medicine Institute (IPK), Autopista Novia del Mediodía km. 6 1/2, Marianao 13, Havana, Cuba. magile@ipk.sld.cu
authors.forename: Magilé C
authors.initials: MC
authors.lastname: Fonseca
authors.forename: Luis
authors.initials: L
authors.lastname: Sarmiento
authors.forename: Sonia
authors.initials: S
authors.lastname: Resik
authors.forename: Niurka
authors.initials: N
authors.lastname: Pereda
authors.forename: Hermis
authors.initials: H
authors.lastname: Rodríguez
authors.forename: Vivian
authors.initials: V
authors.lastname: Kourí
authors.forename: Pedro Ariel
authors.initials: PA
authors.lastname: Martínez
authors.forename: Alexander
authors.initials: A
authors.lastname: Piñón
authors.forename: Daniel
authors.initials: D
authors.lastname: Limonta
authors.forename: Pedro
authors.initials: P
authors.lastname: Más
authors.forename: Lai Heng
authors.initials: LH
authors.lastname: Hung
mesh_terms: D001483:Base Sequence; D045744:Cell Line, Tumor; D003232:Conjunctivitis, Acute Hemorrhagic / Q000175:diagnosis / Q000453:epidemiology / Q000635:transmission / Q000821:virology*; D003384:Coxsackievirus Infections / Q000453:epidemiology / Q000635:transmission / Q000821:virology*; D003462:Cuba / Q000453:epidemiology; D030015:Enterovirus C, Human / Q000145:classification / Q000302:isolation & purification* / Q000472:pathogenicity; D005243:Feces / Q000821:virology; D005838:Genotype; D006801:Humans; D010802:Phylogeny; D012367:RNA, Viral / Q000235:genetics
chemical_list: D012367:RNA, Viral