title: A severe pediatric infection with a novel enterovirus A71 strain, Thuringia, Germany.
abstract: Infection by Enterovirus A71 (EV-A71) is an important cause of hand, foot, and mouth disease (HFMD). Outbreaks including severe cases with neurological and cardiopulmonary complications have been reported particularly from Southeast Asia. In Europe, the epidemiology of EV-A71 is not well understood. In summer 2015, a two-year-old girl from Thuringia, Germany, presented with rhombencephalitis/brainstem encephalitis associated with severe neurological and cardiopulmonary complications. EV-A71 was detected in stool and almost the entire viral genome was amplified and sequenced. While the capsid protein VP1-encoding region belongs to the EV-A71 subgenogroup C1, the 3D polymerase encoding region represents a unique lineage. Thus, the data suggest that the Thuringian EV-A71 sequence likely represents a recombinant. The case underlines the importance of intensified EV-A71 surveillance in Germany and Europe including analysis of full-genome data.
authors: Institute of Medical Microbiology, Jena University Hospital, Jena, Germany. Electronic address: matthias.karrasch@med.uni-jena.de.
authors: Matthias
authors: M
authors: Karrasch
authors: Department of Pediatrics, Jena University Hospital, Jena, Germany. Electronic address: elisabeth.fischer@med.uni-jena.de.
authors: Elisabeth
authors: E
authors: Fischer
authors: Department of Pediatrics, Jena University Hospital, Jena, Germany.
authors: Martin
authors: M
authors: Scholten
authors: Institute of Virology and Antiviral Therapy, Jena University Hospital, Jena, Germany.
authors: Andreas
authors: A
authors: Sauerbrei
authors: Institute of Virology and Antiviral Therapy, Jena University Hospital, Jena, Germany.
authors: Andreas
authors: A
authors: Henke
authors: Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany.
authors: Diane M
authors: DM
authors: Renz
authors: Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany.
authors: Hans-Joachim
authors: HJ
authors: Mentzel
authors: Institute of Clinical Chemistry and Laboratory Medicine, Jena University Hospital, Jena, Germany.
authors: Klas
authors: K
authors: Böer
authors: National Reference Center for Poliomyelitis and Enteroviruses, Robert-Koch Institute, Berlin, Germany.
authors: Sindy
authors: S
authors: Böttcher
authors: National Reference Center for Poliomyelitis and Enteroviruses, Robert-Koch Institute, Berlin, Germany.
authors: Sabine
authors: S
authors: Diedrich
authors: Institute of Infection Medicine, Christian-Albrecht University and University Medical Center Schleswig-Holstein, Kiel, Germany.
authors: Andi
authors: A
authors: Krumbholz
authors: Institute of Virology and Antiviral Therapy, Jena University Hospital, Jena, Germany.
authors: Roland
authors: R
authors: Zell
mesh_terms: D036022:Capsid Proteins / Q000235:genetics; D002675:Child, Preschool; D004196:Disease Outbreaks; D018792:Encephalitis, Viral / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology*; D029821:Enterovirus A, Human / Q000145:classification / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D004769:Enterovirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology*; D005243:Feces / Q000821:virology; D005260:Female; D016679:Genome, Viral; D005858:Germany / Q000453:epidemiology; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D011995:Recombination, Genetic; D012621:Seasons
chemical_list: D036022:Capsid Proteins
keywords: Enterovirus A71; Germany; RNA recombination; Species