title: Molecular detection and genotyping of enteroviruses from CSF samples of patients with suspected sepsis-like illness and/or aseptic meningitis from 2012 to 2015 in West Bank, Palestine.
abstract: BACKGROUND
  Human enteroviruses (HEVs) are the most frequently reported cause of aseptic meningitis with or without CSF pleocytosis in childhood. Rapid detection and genotype of HEVs is essential to determine the causative agent and variant causing sepsis-like illness and/or aseptic meningitis.
  
  
  OBJECTIVE
  To investigate the molecular epidemiology of enteroviruses (EVs) among patients with sepsis-like illness and/or aseptic meningitis admitted to three major hospitals in West Bank, Palestine from 2012 to 2015.
  
  
  METHODS
  During the study period, 356 CSF samples were collected from patients with sepsis-like illness and/or aseptic meningitis. Two RT-nested PCR assays targeting a partial part of 5'UTR for direct diagnosis and the VP1 region for genotyping by sequence analysis of the viral genome were used.
  
  
  RESULTS
  HEV RNA was detected in 66 of 356 (18.5%) of CSF samples. Age distribution showed that 64% (42/66) were infants (<1 year), 18% were children between 1 and 5 years old, 12% were children between 5 and 10 years old, and 6% were more than 10 years old. Of the 66 EV cases, 12 were successfully genotyped. Five different EV genotypes were identified. All of them belonged to HEV-B species. The study showed that echovirus 6 genotype accounted for 42% of the sequenced cases. The HEV infections in the present study tended to show slight seasonal pattern with more cases occurring during spring and summer, yet still significant numbers were also reported in fall and winter seasons.
  
  
  CONCLUSIONS
  HEV was isolated from a significant number of children with sepsis-like illness and/or aseptic meningitis. In addition, the molecular method utilized for direct diagnosis and genotyping of HEV from CSF revealed that more than one HEV type circulated in the West Bank, Palestine during the study period.
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Arab American University in Jenin, Jenin, Palestine.
authors.forename: Kamal
authors.initials: K
authors.lastname: Dumaidi
authors.affiliation: Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Arab American University in Jenin, Jenin, Palestine.|Al-Quds Public Health Society, Jerusalem, Palestine.
authors.forename: Amer
authors.initials: A
authors.lastname: Al-Jawabreh
mesh_terms: D002648:Child; D002675:Child, Preschool; D004770:Enterovirus / Q000235:genetics / Q000302:isolation & purification*; D005260:Female; D016679:Genome, Viral; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D008582:Meningitis, Aseptic / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000821:virology; D008877:Middle East; D025202:Molecular Diagnostic Techniques; D012367:RNA, Viral; D018805:Sepsis / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000821:virology
chemical_list: D012367:RNA, Viral