title: Molecular characterisation of enteroviruses and clinical findings from a cluster of paediatric viral meningitis cases in Tshwane, South Africa 2010-2011.
abstract: BACKGROUND
  Human enteroviruses (HEVs) are the most common viral pathogen associated with paediatric aseptic meningitis. From October 2010 to February 2011 a cluster of HEV-associated meningitis cases was identified in paediatric patients who had presented at two large tertiary hospitals in Pretoria in the Tshwane Metropolitan Area, Gauteng, South Africa (SA).
  
  
  OBJECTIVE
  The aim of this study was to review the clinical features and to characterise the HEV strains associated with this cluster of meningitis cases.
  
  
  METHODS
  In this retrospective study HEVs, detected by real time reverse transcription-polymerase chain reaction in acute phase cerebrospinal fluid specimens from 30 patients with aseptic meningitis, were characterised and the clinical presentations of these patients were described.
  
  
  RESULTS
  Fever (83%), headache (70%) and vomiting (67%) were the most prominent symptoms with signs of meningeal irritation recorded in 67% of the patients. There was a neutrophil predominance in the cerebrospinal fluid of 57% of the patients with pleocytosis. Based on partial nucleotide sequence analysis of the HEV viral protein 1 gene, echovirus (E) serotype 4 (E-4) was identified in 80% (24/30) of specimens with E-9 (3/30) and coxsackie virus B5 (1/30) detected less frequently.
  
  
  CONCLUSIONS
  In this cluster of aseptic meningitis cases E-4 was the predominant strain with E-9, and to a lesser extent other HEVs, identified less frequently.
authors.affiliation: Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia 0007, South Africa. Electronic address: marianne.wolfaardt@up.ac.za.
authors.forename: Marianne
authors.initials: M
authors.lastname: Wolfaardt
authors.affiliation: Department of Paediatrics, Kalafong Academic Hospital and Faculty of Health Sciences, University of Pretoria, Private Bag X396, Pretoria 0001, South Africa. Electronic address: Ane.Buchner@up.ac.za.
authors.forename: Ané
authors.initials: A
authors.lastname: Büchner
authors.affiliation: Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia 0007, South Africa; Department of Medical Virology, National Health Laboratory Service, Tshwane Academic Division, Private Bag X323, Arcadia 0007, South Africa. Electronic address: myburghm@ampath.co.za.
authors.forename: Marcelle
authors.initials: M
authors.lastname: Myburgh
authors.affiliation: Department of Paediatrics, Kalafong Academic Hospital and Faculty of Health Sciences, University of Pretoria, Private Bag X396, Pretoria 0001, South Africa. Electronic address: theunis.avenant@up.ac.za.
authors.forename: Theunis
authors.initials: T
authors.lastname: Avenant
authors.affiliation: Department of Paediatrics, Kalafong Academic Hospital and Faculty of Health Sciences, University of Pretoria, Private Bag X396, Pretoria 0001, South Africa. Electronic address: nicolette.duplessis@up.ac.za.
authors.forename: Nicolette M
authors.initials: NM
authors.lastname: du Plessis
authors.affiliation: Department of Medical Virology, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Arcadia 0007, South Africa. Electronic address: maureen.taylor@up.ac.za.
authors.forename: Maureen B
authors.initials: MB
authors.lastname: Taylor
mesh_terms: D002555:Cerebrospinal Fluid / Q000821:virology; D002648:Child; D002675:Child, Preschool; D004770:Enterovirus / Q000145:classification* / Q000235:genetics* / Q000302:isolation & purification; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008587:Meningitis, Viral / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D017720:Molecular Epidemiology; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D013019:South Africa / Q000453:epidemiology; D062606:Tertiary Care Centers; D014505:Urban Population
keywords: Aseptic meningitis; Cerebrospinal fluid; Echovirus type 4; Real-time RT-PCR; South Africa