title: Comparative analysis of viral shedding in pediatric and adult subjects with central nervous system-associated enterovirus infections from 2013 to 2015 in Switzerland.
abstract: Several enterovirus (EV) genotypes can result in aseptic meningitis, but their routes of access to the central nervous system remain to be elucidated and may differ between the pediatric and adult populations.
  
  
  
  To assess the pattern of viral shedding in pediatric and adult subjects with acute EV meningitis and to generate EV surveillance data for Switzerland.
  
  
  
  All pediatric and adult subjects admitted to the University Hospitals of Geneva with a diagnosis of EV meningitis between 2013 and 2015 were enrolled. A quantitative EV real-time reverse transcriptase (rRT)-PCR was performed on the cerebrospinal fluid (CSF), blood, stool, urine and respiratory specimens to assess viral shedding and provide a comparative analysis of pediatric and adult populations. EV genotyping was systematically performed.
  
  
  
  EV positivity rates differed significantly between pediatric and adult subjects; 62.5% of pediatric cases (no adult case) were EV-positive in stool and blood for subjects for whom these samples were all collected. Similarly, the EV viral load in blood was significantly higher in pediatric subjects. Blood C-reactive protein levels were lower and the number of leucocytes/mm3in the CSF were higher in non-viremic than in viremic pediatric subjects, respectively. A greater diversity of EV genotypes was observed in pediatric cases, with a predominance of echovirus 30 in children ≥3 years old and adults.
  
  
  
  In contrast to adults, EV-disseminated infections are predominant in pediatric subjects and show different patterns of EV viral shedding. This observation may be useful for clinicians and contribute to modify current practices of patient care.
authors.affiliation: Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland; University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland. Electronic address: samuel.cordey@hcuge.ch.
authors.forename: S
authors.initials: S
authors.lastname: Cordey
authors.affiliation: Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland; University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Schibler
authors.affiliation: University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland; Pediatric Infectious Diseases Unit, Division of General Pediatrics, Department of Pediatrics, University Hospitals of Geneva, 6 Rue Willy-Donzé, 1211 Geneva 14, Switzerland.
authors.forename: A G
authors.initials: AG
authors.lastname: L'Huillier
authors.affiliation: University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland; Pediatric Infectious Diseases Unit, Division of General Pediatrics, Department of Pediatrics, University Hospitals of Geneva, 6 Rue Willy-Donzé, 1211 Geneva 14, Switzerland.
authors.forename: N
authors.initials: N
authors.lastname: Wagner
authors.affiliation: Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland; University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland.
authors.forename: A R
authors.initials: AR
authors.lastname: Gonçalves
authors.affiliation: Infectious Diseases Service, Hospital Clinic-IDIBAPS, University of Barcelona, 149 Carrer del Rosselló, 08036 Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Ambrosioni
authors.affiliation: Pediatric Infectious Diseases and Vaccinology Unit, Department of Pediatrics, University Hospital Center, 46 Rue du Bugnon, 1011 Lausanne, Switzerland; Service of Infectious Diseases, Department of Internal Medicine, University Hospital Center, 46 Rue du Bugnon, 1011 Lausanne, Switzerland.
authors.forename: S
authors.initials: S
authors.lastname: Asner
authors.affiliation: Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland; University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Turin
authors.affiliation: University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland; Pediatric Infectious Diseases Unit, Division of General Pediatrics, Department of Pediatrics, University Hospitals of Geneva, 6 Rue Willy-Donzé, 1211 Geneva 14, Switzerland.
authors.forename: K M
authors.initials: KM
authors.lastname: Posfay-Barbe
authors.affiliation: Laboratory of Virology, Infectious Diseases Service, University Hospitals of Geneva, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland; University of Geneva Medical School, 1 Rue Michel-Servet, 1211 Geneva 4, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Kaiser
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D012634:Bodily Secretions / Q000821:virology; D001826:Body Fluids / Q000821:virology; D002648:Child; D002675:Child, Preschool; D004769:Enterovirus Infections / Q000821:virology*; D005243:Feces / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008582:Meningitis, Aseptic / Q000821:virology*; D008875:Middle Aged; D011446:Prospective Studies; D060888:Real-Time Polymerase Chain Reaction; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013557:Switzerland; D017201:Virus Shedding; D055815:Young Adult
keywords: CNS infection; Enterovirus; Epidemiology; Viral shedding