title: Acute meningoencephalitis associated with echovirus 9 infection in Sri Lanka, 2009.
abstract: The aetiology of acute meningoencephalitis in Sri Lankan children and adults is poorly understood. This study was carried out to determine pathogens responsible for meningoencephalitis in Sri Lanka. A hospital-based cross-sectional study was performed using cerebrospinal fluid samples (22 adult and 17 pediatric) collected from August to December 2009 from patients clinically diagnosed with acute meningoencephalitis at two tertiary care hospitals in Sri Lanka. Routine microbiology for bacterial pathogens together with in-house RT-PCR and PCR assays for the detection of dengue viruses, Japanese encephalitis virus, West Nile virus, chikungunya virus, enteroviruses, mumps virus, measles virus, herpes simplex viruses types 1 and 2, and varicella zoster virus were performed. Bacterial pathogens were not isolated from any patient specimens. However, from nine of the paediatric patients aged 1 month to 10 years (mean age 5.2 years) echovirus 9 (E-9; family Picornaviridae, genus Enterovirus,species Enterovirus B ) was detected by RT-PCR. All nine patients presented with fever, six had headache, and seven had vomiting. Neck stiffness indicating meningitis was present in six of the patients. Phylogenetic analysis of partial VP1 and VP4-VP2 genes showed these E-9 strains to be most closely related to E-9 strains detected in CSF from Korea and France in 2005 and 2006. The remaining patients were negative for all other viruses tested. E-9 was the most common cause of acute meningoencephalitis in the tested paediatric population from Sri Lanka in 2009, which likely reflects circulation of this E-9 strain between Europe and Asia over several years.
authors.affiliation: Medical Research Institute, Colombo 08, Sri Lanka.|Teaching Hospital Karapitiya, Galle, Sri Lanka.
authors.forename: Nayomi
authors.initials: N
authors.lastname: Danthanarayana
authors.affiliation: PathWest Laboratory Medicine, Nedlands, Western Australia, Australia.|CSIRO, Australian Animal Health Laboratory, Geelong, Victoria, Australia.
authors.forename: David T
authors.initials: DT
authors.lastname: Williams
authors.affiliation: PathWest Laboratory Medicine, Nedlands, Western Australia, Australia.
authors.forename: Simon Hedley
authors.initials: SH
authors.lastname: Williams
authors.affiliation: Department of Microbiology, Faculty of Medicine, University of Peradeniya, Sri Lanka.
authors.forename: Vasanthi
authors.initials: V
authors.lastname: Thevanesam
authors.affiliation: PathWest Laboratory Medicine, Nedlands, Western Australia, Australia.|School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Speers
authors.affiliation: Lady Ridgeway Children's Hospital, Colombo 08, Sri Lanka.
authors.forename: M S S
authors.initials: MS
authors.lastname: Fernando
mesh_terms: D002555:Cerebrospinal Fluid / Q000821:virology; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D004459:Echovirus 9 / Q000302:isolation & purification*; D004457:Echovirus Infections / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008590:Meningoencephalitis / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D010802:Phylogeny; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D017385:Sequence Homology; D013188:Sri Lanka / Q000453:epidemiology; D062606:Tertiary Care Centers; D015678:Viral Structural Proteins / Q000235:genetics
chemical_list: D015678:Viral Structural Proteins
keywords: Sri Lanka; children; echovirus 9; enterovirus; meningoencephalitis