Outbreak of Enterovirus - 71 Meningitis in Calicut
Abstract
ABSTRACTObjective: Enterovirus 71(EV 71) causes wide spectrum of infections ranging from asymptomatic conditions to clinical syndromes like diarrhea, rash, hand-foot-and mouth disease (HFMD), herpangina, aseptic meningitis, encephalitis, myocarditis, acute flaccid paralysis, bulbar and brainstem encephalitis Guillain Barre syndrome, pulmonary haemorrhage. This study deals with an outbreak of aseptic meningitis in children caused by EV 71 virus. Methods: The authors report an outbreak of aseptic meningitis in children in and around Calicut in June 2008. Clinical and laboratory study was done in collaboration with National Centre for Disease Control, New Delhi. 149 children with aseptic meningitis were studied and followed up from June 2008 to May 2009.Result: All children had clinical features suggestive of aseptic meningitis and serology showed the rising antibody titre against EV 71 virus infection. CSF analysis also showed four fold rise in antibodies in one and ≥ 1:2 neutralising antibodies titer against EV- 71 in four samples indicating meningitis due to EV-71.Conclusion:EV 71 was identified as the causative agent of the outbreak of aseptic meningitis in the study and the fact that the EV 71 infection has evolved from minor illness like HFMD to major illness like aseptic meningitis from the same locality is truly alarming. Key words: Aseptic Meningitis, Enterovirus 71ÂReferences
References :
1. Schmidt NJ, Lennette EH, Ho HH. An apparently new enterovirus isolated from patients with disease of the central nervous system. J Infect Dis 1974;129:304-9.
2. Landry ML, Fonseca SNS, Cohen S, Bogue CY. Fatal enterovirus type 71 infection: rapid detection and diagnostic pitfalls. Pediatr infect Dis J 1995;14:1095 -100.
3. Monto Ho, Eng -Ring Chen, Kwo-Hsiung Hsu et al. An Epidemic of Enterovirus 71 infection in Taiwan.N Engl J Med. 1999;Sep.23;341(13):929-935.
4. Chen KT,Chang HL,Wang ST, et al: Epidemiologic features of hand-foot-mouth disease and herpangina caused by enterovirus 71 in Taiwan,1998 - 2008.Pediatrics 2007;120:e244-e252.
5. Ishimaru Y, Nakano S, Yamaoka K, Takami S. Outbreaks of hand, foot, and mouth disease by enterovirus 71: high incidence of complication disorders of central nervous system.Arch Dis Child 1980,55:583-8
6. Melnick JL. Enterovirus type 71 infections: a varied clinical pattern sometimes mimicking paralytic poliomyelitis. Rev infect Dis 1984;6Suppl2:S387 -S390
7. Alexander Jp Jr, Baden L, Pallansch MA, Anderson LJ.Enterovirus 71 infections and neurologic disease - United States, 1977 - 1991. J infect Dis 1994;169:905-8.
8. Chang LY, Huang YC,Lin TY.Fulminant neurogenic pulmonary oedema with hand, foot, and mouth disease. Lancet 1998;352:367-8.
9. Huan CC, Liu CC, Chang YC et al. Neurologic Complications in Children with Enterovirus 71 infection. N Engl Med 1999,Sep 23;341(13):936-42.
10. Sasidharan CK, Sugathan P, Ramesh Agarwal et al. Hand Foot and Mouth Disease in Calicut. Indian journal of pediatrics, January 2005;Col72;17-22.
11. Nelsons’ Text Book of Paediatrics, 20th Edition,2016 Non Polio Enterovirus , 1561-1568.
12. Lenette EH, Schmidt NJ. Cell Culture techniques. In Diagnostic Procedure for viral, rickettsial and chlamydial infections. American Public Health Association, Washington DC- 2005,5th Edn.1975.
13. Ho M, Chen ER,Hsu KH et al.New Eng J Med. 1999;929-935.
14. Wang VR, Tuan YC, Tsai HP et al. Change of Major genotype of Entero virus 71 in Out breaks of Hand Foot and mouth Disease in Taiwan between 1998 - 2000. J Clin Microbiol. 2002;40(1):10-15.
15. Hu Y, Jiang L, Peng HL.Clinical Analysis of 134 Children with Nervous System Damage caused by Enterovirus 71 infection . Pediatr Infect Dis J.2015 Jul;34(7):718-23.
16. Lee TC, Guo HR, Su HJJ, et al: Disease caused by enterovirus 71 infection. Pediatr Infect Dis J 2009;28:904-910
17. Dwibedi B, Kar BR, Kar SK. Hand, foot and mouth disease (HFMD): A newly emerging infection in Orissa, India. National Med J India. 2010;23:313.
18. Sarma N, Sarkar A, Mukherjee A, Ghosh A, Dhar S, Malakar R. Epidemic of hand, foot and mouth disease in West Bengal, India in August, 2007: A multicentric study. Indian J Dermatol. 2009;54:26-30.
19. Beig FK , Malik A , Rizvi M et al .Etiology and Clinico-epidemiological profile of Acute Viral Encephalitis in Children of Western Uttar Pradesh ,India .Int J Infect Dis .2010 Feb;14(2):e141-6.
20. Karmakar SA ,Aneja S ,Khare S et al.A Study of Acute Febrile Encephalopathy with special reference to viral etiology .Indian J Pediatr.2008 Aug;75(8):801-5.
21. Li J ,Chen F,Liu T,Wang L .MRI findings of neurological complications in hand-foot-mouth disease by enterovrus 71 infection .Int J Neurosci .2012 Jul; 122 (7):338-44.
22. Mao QY,Wang Y, Bian L et al . EV 71 vaccine , a new tool to control outbrealks of hand,foot and mouth disease (HFMD). Expert Rev Vaccines .2016 Jan 14:1-8.
1. Schmidt NJ, Lennette EH, Ho HH. An apparently new enterovirus isolated from patients with disease of the central nervous system. J Infect Dis 1974;129:304-9.
2. Landry ML, Fonseca SNS, Cohen S, Bogue CY. Fatal enterovirus type 71 infection: rapid detection and diagnostic pitfalls. Pediatr infect Dis J 1995;14:1095 -100.
3. Monto Ho, Eng -Ring Chen, Kwo-Hsiung Hsu et al. An Epidemic of Enterovirus 71 infection in Taiwan.N Engl J Med. 1999;Sep.23;341(13):929-935.
4. Chen KT,Chang HL,Wang ST, et al: Epidemiologic features of hand-foot-mouth disease and herpangina caused by enterovirus 71 in Taiwan,1998 - 2008.Pediatrics 2007;120:e244-e252.
5. Ishimaru Y, Nakano S, Yamaoka K, Takami S. Outbreaks of hand, foot, and mouth disease by enterovirus 71: high incidence of complication disorders of central nervous system.Arch Dis Child 1980,55:583-8
6. Melnick JL. Enterovirus type 71 infections: a varied clinical pattern sometimes mimicking paralytic poliomyelitis. Rev infect Dis 1984;6Suppl2:S387 -S390
7. Alexander Jp Jr, Baden L, Pallansch MA, Anderson LJ.Enterovirus 71 infections and neurologic disease - United States, 1977 - 1991. J infect Dis 1994;169:905-8.
8. Chang LY, Huang YC,Lin TY.Fulminant neurogenic pulmonary oedema with hand, foot, and mouth disease. Lancet 1998;352:367-8.
9. Huan CC, Liu CC, Chang YC et al. Neurologic Complications in Children with Enterovirus 71 infection. N Engl Med 1999,Sep 23;341(13):936-42.
10. Sasidharan CK, Sugathan P, Ramesh Agarwal et al. Hand Foot and Mouth Disease in Calicut. Indian journal of pediatrics, January 2005;Col72;17-22.
11. Nelsons’ Text Book of Paediatrics, 20th Edition,2016 Non Polio Enterovirus , 1561-1568.
12. Lenette EH, Schmidt NJ. Cell Culture techniques. In Diagnostic Procedure for viral, rickettsial and chlamydial infections. American Public Health Association, Washington DC- 2005,5th Edn.1975.
13. Ho M, Chen ER,Hsu KH et al.New Eng J Med. 1999;929-935.
14. Wang VR, Tuan YC, Tsai HP et al. Change of Major genotype of Entero virus 71 in Out breaks of Hand Foot and mouth Disease in Taiwan between 1998 - 2000. J Clin Microbiol. 2002;40(1):10-15.
15. Hu Y, Jiang L, Peng HL.Clinical Analysis of 134 Children with Nervous System Damage caused by Enterovirus 71 infection . Pediatr Infect Dis J.2015 Jul;34(7):718-23.
16. Lee TC, Guo HR, Su HJJ, et al: Disease caused by enterovirus 71 infection. Pediatr Infect Dis J 2009;28:904-910
17. Dwibedi B, Kar BR, Kar SK. Hand, foot and mouth disease (HFMD): A newly emerging infection in Orissa, India. National Med J India. 2010;23:313.
18. Sarma N, Sarkar A, Mukherjee A, Ghosh A, Dhar S, Malakar R. Epidemic of hand, foot and mouth disease in West Bengal, India in August, 2007: A multicentric study. Indian J Dermatol. 2009;54:26-30.
19. Beig FK , Malik A , Rizvi M et al .Etiology and Clinico-epidemiological profile of Acute Viral Encephalitis in Children of Western Uttar Pradesh ,India .Int J Infect Dis .2010 Feb;14(2):e141-6.
20. Karmakar SA ,Aneja S ,Khare S et al.A Study of Acute Febrile Encephalopathy with special reference to viral etiology .Indian J Pediatr.2008 Aug;75(8):801-5.
21. Li J ,Chen F,Liu T,Wang L .MRI findings of neurological complications in hand-foot-mouth disease by enterovrus 71 infection .Int J Neurosci .2012 Jul; 122 (7):338-44.
22. Mao QY,Wang Y, Bian L et al . EV 71 vaccine , a new tool to control outbrealks of hand,foot and mouth disease (HFMD). Expert Rev Vaccines .2016 Jan 14:1-8.
