title: Variations in cerebrospinal fluid viral loads among enterovirus genotypes in patients hospitalized with laboratory-confirmed meningitis due to enterovirus.
abstract: BACKGROUND
  Acute enterovirus (EV) meningitis is a major cause of hospitalization among adults and children. It is caused by multiple EV genotypes assigned to 4 species (EV-A, EV-B, EV-C, and EV-D).
  
  
  METHODS
  We determined viral loads in the cerebrospinal fluid (CSF) of 156 patients of all ages with EV meningitis during a 5-year observational prospective study. The virus strains were genotyped, and their time origin was determined with Bayesian phylogenetic methods.
  
  
  RESULTS
  The CSF viral loads ranged between 3.4 and 7.5 log10 copies/mL (median, 4.9 log10 copies/mL). They were higher in neonates than in infants and children (P = .02) but were comparable in adults. Viral loads were associated with EV genotypes (P < .001). The EV strains were identified in 152 of 156 patients and assigned to 23 genotypes within the EV-A and EV-B species. The most frequent genotypes, echoviruses 6 and 30, were associated with different viral loads (P < .001). The highest viral loads were in meningitis cases caused by coxsackievirus A9, B4, and B5 genotypes. Most patients infected by a same genotype were infected by a major virus variant of recent emergence.
  
  
  CONCLUSIONS
  The variations in CSF viral loads in patients at the onset of EV meningitis are related to genotypic differences in the virus strains involved.
authors.affiliation: Epidémiologie et pathogénie des infections à entérovirus, Université d'Auvergne, Clermont Université
authors.forename: Romain
authors.initials: R
authors.lastname: Volle
authors.affiliation: Epidémiologie et pathogénie des infections à entérovirus, Université d'Auvergne, Clermont Université CNR Enterovirus/Parechovirus laboratoire associé, Service de Virologie.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Bailly
authors.affiliation: Epidémiologie et pathogénie des infections à entérovirus, Université d'Auvergne, Clermont Université CNR Enterovirus/Parechovirus laboratoire associé, Service de Virologie.
authors.forename: Audrey
authors.initials: A
authors.lastname: Mirand
authors.affiliation: Délégation Recherche Clinique Innovation, CHU Clermont-Ferrand, Clermont-Ferrand.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: CH Versailles, Laboratoire de Microbiologie, Le Chesnay, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Marque-Juillet
authors.affiliation: Epidémiologie et pathogénie des infections à entérovirus, Université d'Auvergne, Clermont Université CNR Enterovirus/Parechovirus laboratoire associé, Service de Virologie.
authors.forename: Martine
authors.initials: M
authors.lastname: Chambon
authors.affiliation: CNR Enterovirus/Parechovirus laboratoire associé, Service de Virologie.
authors.forename: Christel
authors.initials: C
authors.lastname: Regagnon
authors.affiliation: Epidémiologie et pathogénie des infections à entérovirus, Université d'Auvergne, Clermont Université CNR Enterovirus/Parechovirus laboratoire associé, Service de Virologie.
authors.forename: Amélie
authors.initials: A
authors.lastname: Brebion
authors.affiliation: CNR Enterovirus/Parechovirus laboratoire associé, Service de Virologie.
authors.forename: Cécile
authors.initials: C
authors.lastname: Henquell
authors.affiliation: Epidémiologie et pathogénie des infections à entérovirus, Université d'Auvergne, Clermont Université CNR Enterovirus/Parechovirus laboratoire associé, Service de Virologie.
authors.forename: Hélène
authors.initials: H
authors.lastname: Peigue-Lafeuille
authors.affiliation: Epidémiologie et pathogénie des infections à entérovirus, Université d'Auvergne, Clermont Université CNR Enterovirus/Parechovirus laboratoire associé, Service de Virologie.
authors.forename: Christine
authors.initials: C
authors.lastname: Archimbaud
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004770:Enterovirus / Q000235:genetics / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000134:cerebrospinal fluid* / Q000821:virology*; D005838:Genotype; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid* / Q000821:virology*; D008875:Middle Aged; D010802:Phylogeny; D011446:Prospective Studies; D019562:Viral Load; D055815:Young Adult
keywords: CSF viral load; Enterovirus genotypes; Enterovirus meningitis; adults; children; infants; meningitis pathophysiology; neonates; pleocytosis