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Volume: 6, Issue: 3, May-June, 2018
DOI: 10.7324/JABB.2018.60303

Research Article

Human enterovirus A71 (EV-A71) isolated from acute flaccid paralysis patients without symptoms of hand foot and mouth disease

Mohd Apandi Yusof, Mohd Samsul Samsudin, Syarifah Nur Ashatun, Jasinta Anak Denis, Amry Khursany Ismail, Zarina Mohd Zawawi, Ravindran Thayan

  Author Affiliations


Abstract

Background: Human enterovirus A-71 (EV-A71) is one of the causative agents for hand, foot, and mouth disease (HFMD). It is also reported to cause acute flaccid paralysis (AFP) during HFMD outbreaks and very rare to isolate them from non-HFMD cases. Materials and Methods: A total of 2809 stool samples from AFP cases were cultured on RD and L20B cells. Positive on L20B was screened for poliovirus and those only positive on RD were subjected to non-polio EV (NPEV) screening by real-time polymerase chain reaction. Phylogenetic analysis using VP1 and VP4 gene was constructed. Results: A total of 74 EVs were isolated, 61 were NPEV and 13 were poliovirus Sabin like. The NPEVs were identified as coxsackieviruses, echoviruses, and EV-A71. Phylogenetic analysis showed that this EV-A71 belong to subgenogroup B5. Conclusions: The discovery of EV-A71 which caused AFP in patients but not related or associated with HFMD outbreaks showed that this virus could circulate independently. It should be investigated thoroughly as their ability to cause paralysis on the eradication of polio.

Keywords:

Human enterovirus, EV-A71, Acute flaccid paralysis, Hand, foot, Mouth disease, Gene sequences.



Citation: Yusof MA, Samsudin MS, Ashatun SN, Denis JA, Ismail AK, Zawawi ZM, Thayan R. Human enterovirus A71 (EV-A71) isolated from acute flaccid paralysis patients without symptoms of hand foot and mouth disease. J App Biol Biotech. 2018;6(3):15-19. DOI: 10.7324/JABB.2018.60303


Copyright: Author(s). This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

1. Minor PD, Brown F, Domingo E, Hoey E, King A, Knowles N, et al. The Picornaviridae. Virus taxanomy. Sixth Report of the International Committee on Taxanomy of Viruses, New York: Springer-Verlag; 1995, p. 268-74.

2. Chan LG, Parashar UD, Lye MS, Ong FGL, Zaki SR, Alexander JP, et al. Deaths of children during an outbreak of hand, foot and mouth disease in Sarawak, Malaysia: Clinical and pathological characteristics of the disease. Clin Infect Dis 2000;31:678-83. https://doi.org/10.1086/314032

3. Wang JR, Tuan YC, Hsai HP, Yan JJ, Liu CC, Su IJ. Change of major genotype of Enetrovirus 71 in outbreaks of hand foot and mouth disease in Taiwan between 1998 and 2000. J Clin Virol 2002;40:10-5.

4. Zhang Y, Tan XJ, Wang HY, Yan DM, Zhu SL, Wang DY, et al. An outbreak of hand, foot, and mouth disease associated with subgenotype C4 of human Enterovirus 71 in shandong, china. J Clin Virol 2009;44:262-7. https://doi.org/10.1016/j.jcv.2009.02.002

5. Zhang Y, Zhu Z, Yang W, Ren J, Tan X, Wang Y, et al. An emerging recombinant human Enterovirus 71 responsible for the 2008 outbreak of Hand Foot and Mouth Disease in Fuyang city of China. Virol J 2010;7:1-9. https://doi.org/10.1186/1743-422X-7-94

6. Tu PV, Thao NT, Perera D, Huu TK, Tien NT, Thuong TC, et al. Epidemiologic and virologic investigation of hand, foot, and mouth disease, Southern Vietnam, 2005. Emerg Infect Dis 2007;13:1733-41. https://doi.org/10.3201/eid1311.070632

7. Apandi MY, Fazilah R, Maizatul AA, Liyana AZ, Hariyati MA, Fauziah MK, et al. Molecular epidemiology of human Enterovirus71 (HEV71) strains isolated in Peninsular Malaysia and Sabah from year 2001 to 2009. J Gen Mol Virol 2011;1:18-26. Available from: http://www.academicjournals.org/JGMV ISSN 2141-6648 ©2011 Academic Journals. [Last accessed on 2017 Mar].

8. Blomberg J, Lycke E, Ahlfors K, Johnsson T, Wolontis S, von Zeipel G, et al. Letter: New Enterovirus type associated with epidemic of aseptic meningitis and-or hand, foot, and mouth disease. Lancet 1974;2:112. https://doi.org/10.1016/S0140-6736(74)91684-5

9. Shindarov LM, Chumakov MP, Voroshilova MK, Bojinov S, Vasilenko SM, Iordanov I, et al. Epidemiological, clinical and pathomorphological characteristics of epidemic poliomyelitis-like disease caused by Enterovirus 71. J Hyg Epidemiol Microbiol Immunol. 1979;23:284-95.

10. Lum LC, Wong KT, Lam SK, Chua KB, Goh AY. Neurogenic pulmonary oedema and Enterovirus 71 encephalomyelitis. Lancet 1998;352:1391. https://doi.org/10.1016/S0140-6736(05)60789-1

11. McMinn PC, Stratov I, Nagarajan L, Davis S. Neurological manifestations of Enterovirus 71 infection in children during a hand, foot and mouth disease outbreak in Western Australia. Clin Infect Dis 2001;31:236-42. https://doi.org/10.1086/318454

12. Kehle J, Roth B, Metzger C, Pfitzner A, Enders G. Molecular characterization of an Enterovirus 71 causing neurological disease in Germany. J Neurovirol 2003;9:126-8. https://doi.org/10.1080/13550280390173364

13. Melnick JL. Enterovirus Type 71 infections: A varied clinical pattern sometimes mimicking paralytic poliomyelitis. Rev Infect Dis 1984;6:387-90. https://doi.org/10.1093/clinids/6.Supplement_2.S387

14. Chen F, Li JJ, Liu T, Wen GQ, Xiang W. Clinical and neuroimaging features of Enterovirus71 related acute flaccid paralysis in patients with hand-foot-mouth disease. Asian Pac J Trop Med 2013;6:68-72. https://doi.org/10.1016/S1995-7645(12)60203-X

15. World Health Organization. Polio Eradication in the WESTERN Pacific Region. 1st ed. Geneva: WHO; 2002.

16. World Health Organization. WHO-Recommended Standards for Surveillance of Selected Vaccine-Preventable Diseases. Vaccines and Biologicals. Geneva: World Health Organization; 2003.

17. Tao Z, Wang H, Liu Y, Li Y, Jiang P, Liu G, et al. Non-polio Enterovirus from acute flaccid paralysis surveillance in Shandong Province, China, 1988-2013. Sci Rep 2014;4:6167. https://doi.org/10.1038/srep06167

18. Chen CY, Chang YC, Huang CC, Lui CC, Lee KW, Huang SC. Acute flaccid paralysis in infants and young childrens with Enterovirus71 infection: MR imaging findings and clinical correlates. Am J Neuroradiol 2001;22:200-5.

19. Deshpande JM, Nadkarni SS, Francis PP. Enterovirus 71 isolated from a case of acute flaccid paralysis in India represents a new genotype. Curr Sci 2003;84:1350-3.

20. Shahmahmoodi S, Mehrabi Z, Eshraghian MR, Azad TM, Tabatabaie H, Yousefi M, et al. First detection of Enterovirus 71 from an acute flaccid paralysis case with residual paralysis in Iran. First detection of Enterovirus 71 from an acute flaccid paralysis case with residual paralysis in Iran. J Clin Virol 2008;42:409-11. https://doi.org/10.1016/j.jcv.2008.02.013

21. Bessaud M, Pillet S, Ibrahim W, Joffret ML, Pozzetto B, Delpeyroux F, et al. Molecular characterization of human Enteroviruses in the central african republic: Uncovering wide diversity and identification of a new human Enterovirus A71 genogroup. J Clin Microbiol 2012;50:1650-8. https://doi.org/10.1128/JCM.06657-11

22. Bessaud M, Razafindratsimandresy R, Nougairede A, Joffret ML, Deshpande JM, Dubot-Peres A, et al. Molecular comparison and evolutionary analyses of VP1 nucleotide sequences of new African Human Enterovirus 71 isolates reveal a wide genetic diversity. PLoS ONE 2014;9:3-9. https://doi.org/10.1371/journal.pone.0090624

23. Saxena VK, Sane S, Nadkarni SS, Sharma DK, Deshpande M. Genetic diversity of Enterovirus A71, India. Emerg Infect Dis 2015;21:123-6. https://doi.org/10.3201/eid2101.140743

24. Brown BA, Oberste MS, Alexander JP, Kennett ML, Pallansch MA. Molecular epidemiology and evolution of Enterovirus 71 strains isolated from 1970 to 1998. J Virol 1999;73:9969-75.

25. World Health Organization. WHO Polio Laboratory Manuals. 4th ed. Geneva: Department of vaccines and Biologicals; 2004.

26. World Health Organization. Poliovirus rRT-PCR ITD 4.1 Kits. Polio Global Eradication Initiative, Expanded Program on Immunization. Genève: WHO; 2016.

27. Chua BH, McMinn PC, Lam SK, Chua KB. Comparison of complete nucleotide sequences of Echovirus 7 strains UMMC and the prototype (Wallace) strain demonstrates significant genetic drift over time. J Gen Virol 2001;82:2629-39. https://doi.org/10.1099/0022-1317-82-11-2629

28. Ishiko H, Shimada Y, Yonaha M, Hashimoto O, Hayashi A, Sakae K, et al. Molecular diagnosis of human Enteroviruses by phylogeny-based classification by use of the VP4 sequence. J Infect Dis 2002;185:744-54. https://doi.org/10.1086/339298

29. World Health Organization. Poliovirus rRT-PCR ITD. Polio Global Eradication Initiative, Expanded Program on Immunization. Geneva: WHO; 2013.

30. 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. https://doi.org/10.1093/infdis/129.3.304

31. Brown BA, Pallansch MA. Complete nucleotide sequence of Enterovirus 71 is distinct from poliovirus. Virus Res 1995;39:195-205. https://doi.org/10.1016/0168-1702(95)00087-9

32. Yu H, Chen W, Chang H, Tang R, Zhao J, Gan L, et al. Genetic analysis of the VP1 region of Enterovirus 71reveals the emergence of genotype A in central China in 2008. Virus Genes 2010;41:1-4. https://doi.org/10.1007/s11262-010-0472-9

33. Cardosa MJ, Perera D, Brown BA, Cheon D, Chan HM, Chan KP, et al. molecular epidemiology of human Enterovirus 71 strains and recent outbreaks in the Asia-Pacific Region: Comparative analysis of the VP1 and VP4 Genes. Emerg Infect Dis 2003;9:461-8. https://doi.org/10.3201/eid0904.020395

34. Solomon T, Willison H. Infectious causes of acute flaccid paralysis. Curr Opin Infect Dis 2003;16:375-81. https://doi.org/10.1097/00001432-200310000-00002

35. Apandi MY, Hariyati MA, Hamadah MS, Noor KR, Zarina MZ, Syarifah NA, et al. Subgenogroup B5 maintains its supremacy over other human Enterovirus 71 strains that circulated in Malaysia from 2010 to 2012. J Gen Mol Virol 2014;6:1-5. https://doi.org/10.5897/JGMV2013.0054

36. Australia: Detection of Enterovirus 71 sub-Genogroup C4a in Specimens from Cases of Acute Flaccid Paralysis. Promed Report; 2013.

37. Alexander JP, Baden L, Pallansch MA, Anderson LJ. Enterovirus 71 infections and neurological disease in United States, 1977-1991. J Infect Dis 1994;169:905-8. https://doi.org/10.1093/infdis/169.4.905

38. Huang CC, Liu CC, Cheng YC, Chen CY, Wang ST, Yeh TF. Nuerologic complications in children with Enterovirus 71 infection. N Engl J Med 1999;341:936-42. https://doi.org/10.1056/NEJM199909233411302

39. Shen WC, Tsai C, Chiu H, Chow K. MRI of Enterovirus 71 myelitis with monoplegia. Neuroradiology 2000;42:124-7. https://doi.org/10.1007/s002340050030

40. Wang YF, Chou CT, Lei HY, Liu CC, Wang SM, Yan JJ, et al. A mouse-adapted Enterovirus 71 strain causes neurological disease in mice after oral infection. J Virol 2004;78:7916-24. https://doi.org/10.1128/JVI.78.15.7916-7924.2004

41. Modlin F. Poliomyelitis and poliovirus immunization. In: Rotbart HA, editors. Human Enterovirus Infections. Ch. 9. Washington DC: ASM Press. p. 195-220. https://doi.org/10.1128/9781555818326.ch9

42. Maloney JA, Mirsky DM, Messacar K, Dominguez SR, Schreiner T, Stence NV. MRI findings in children with acute flaccid paralysis and cranial nerve dysfunction occurring during the 2014 Enterovirus D68 outbreak. Am J Neuroradiol 2015;36:1-6. https://doi.org/10.3174/ajnr.A4188

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