Publication: Türkiye’deki çocuklarda enterovirüs ve parechovirüse bağlı viral aseptik menenjit sürveyansı
Abstract
TÜRKİYE’ DEKİ ÇOCUKLARDA ENTEROVİRÜS VE PARECHOVİRÜSE BAĞLI VİRAL ASEPTİK MENENJİT SÜRVEYANSI Amaç: Enterovirüsler, aseptik menenjit olgularının %85-95’ ine neden olur. Enterovirüslere bağlı viral aseptik menenjit (VAM) çocuklarda uzun dönemde sekellere neden olabilir. Son yıllarda parechovirüse bağlı olarak da VAM olguları tanımlanmıştır. Ülkemizde VAM‘ ye neden olan etkenlere yönelik tek merkezli bölgesel küçük çalışmalar yapılmış olmasına rağmen ülke genelini yansıtacak enterovirüse bağlı VAM sürveyansı mevcut değildir. Parechovirüs epidemiyolojisi ile ilgili ise ülkemizde henüz epidemiyolojik araştırma rapor edilmemiştir. Bu nedenle çalışmamızda ülkemizdeki enterovirüs ve parechovirüse bağlı VAM sıklığını göstermeyi amaçladık. Gereç ve Yöntem: Ülkemizdeki 37 merkezde, Mayıs 2006- Ocak 2009 tarihleri arasında menenjitten şüphelenilen hastalardan beyin omurilik sıvısı (BOS) örnekleri toplanmıştır. BOS kültüründe ve polimeraz zincir reaksiyonu (PZR) yöntemi ile etken olarak bakteri tanımlanmamış ve Dünya Sağlık Örgütü’ nün bakteriyel menenjit tanımına uymayan olgulara ait toplam 657 BOS örneği çalışmaya alınmıştır. Enterovirüs ve parechovirüs RNA BOS’ da reverz transkriptaz-PZR yöntemi ile çalışılmıştır. VP1 bölgesinin direkt DNA dizisi aracılığıyla da enterovirüsl Sonuç: İncelenen BOS örneklerinde parechovirüs saptanamamıştır. Enterovirüs sıklığı ise literatüre göre daha düşük saptanmıştır. Bu sonucun nedeni olarak, çalışmaya alınan hastaların büyük kısmının ateş odağı araştırması açısından lomber ponksiyon yapılan hastalardan oluşması olarak düşünülmüştür. Bu çalışma ülkemizde yapılan ilk enterovirüs ve parechovirüse bağlı VAM sürveyansıdır. Ülkemizde enterovirüs ve parechovirüse bağlı VAM sıklığı, dolaşan enterovirüs ve parechovirüslerin yaygınlığı ve filogenetik analizinin yapılması ve bu saye
ÖZET (ABSTRACT) VIRAL ASEPTIC MENINGITIS SURVEILLANCE DUE TO ENTEROVIRUSES AND PARECHOVIRUSES AMONG CHILDREN IN TURKEY Background and Objectives: Enteroviruses are responsible for 85-95% of cases of aseptic meningitis. Viral aseptic meningitis (VAM) due to enteroviruses can cause long-term sequelae in children. VAM cases caused by parechoviruses also identified recently. Although there are small-scale or single-center regional studies about the causative agents of VAM, there is not enough data related with epidemiology of enteroviruses and parechoviruses in our country. Therefore in the present study, we aimed to show the frequency of VAM due to enteroviruses and parechoviruses through whole country. Methods: Cerebrospinal fluid (CSF) samples were collected from patients with suspected meningitis between May 2006 and January 2009 from 37 centers in Turkey. A total of 657 CSF samples of cases who not meet the definition of bacterial meningitis identified by World Health Organization and were negative by bacteriological culture and polymerase chain reaction (PCR) were enrolled in the study. Enteroviruses and parechoviruses RNA were investigated in CSF by reverse transcription-PCR and specific genotypes of enteroviruses were identified by direct DNA sequencing of the VP1 region. Results: A total of 657 CSF samples were negative for parechovirus. Enteroviruses were detected in 13 (2%) of 657 CSF specimens analyzed. Identified enteroviruses were echovirus 14 (n:1), echovirus 9 (n:1), coxsackievirus B 4 (n:1), and unknown serotype (n:10). The patients’ ages ranged from 1 month to 126 months. Frequency of symptoms and findings in enteroviruses positive cases were as follows; fever (69%), nuchal rigidity (38%), Kernig sign (23%), Brudzinski sign (23%) lethargy (23%), rash (15%), and focal neurologic signs (7%). Conclusion: Parechoviruses were not detected in CSF specimens analyzed. The frequency of enteroviruses was lower than literature. Since most of the patients participated in the study consist of the patients who had lumbar puncture in terms of research focus of the fever but not considered the forefront of meningitis. This study is the first surveillance of VAM due to enteroviruses and parechoviruses in our country. In order to early recognition of possible epidemics of aseptic meningitis especially due to enteroviruses and parechoviruses continuous national surveillance studies are needed. This surveillance may also help obtaining phylogenetic data related with those viruses. Key Words: Viral aseptic meningitis, enteroviruses, parechoviruses, surveillance, child.
ÖZET (ABSTRACT) VIRAL ASEPTIC MENINGITIS SURVEILLANCE DUE TO ENTEROVIRUSES AND PARECHOVIRUSES AMONG CHILDREN IN TURKEY Background and Objectives: Enteroviruses are responsible for 85-95% of cases of aseptic meningitis. Viral aseptic meningitis (VAM) due to enteroviruses can cause long-term sequelae in children. VAM cases caused by parechoviruses also identified recently. Although there are small-scale or single-center regional studies about the causative agents of VAM, there is not enough data related with epidemiology of enteroviruses and parechoviruses in our country. Therefore in the present study, we aimed to show the frequency of VAM due to enteroviruses and parechoviruses through whole country. Methods: Cerebrospinal fluid (CSF) samples were collected from patients with suspected meningitis between May 2006 and January 2009 from 37 centers in Turkey. A total of 657 CSF samples of cases who not meet the definition of bacterial meningitis identified by World Health Organization and were negative by bacteriological culture and polymerase chain reaction (PCR) were enrolled in the study. Enteroviruses and parechoviruses RNA were investigated in CSF by reverse transcription-PCR and specific genotypes of enteroviruses were identified by direct DNA sequencing of the VP1 region. Results: A total of 657 CSF samples were negative for parechovirus. Enteroviruses were detected in 13 (2%) of 657 CSF specimens analyzed. Identified enteroviruses were echovirus 14 (n:1), echovirus 9 (n:1), coxsackievirus B 4 (n:1), and unknown serotype (n:10). The patients’ ages ranged from 1 month to 126 months. Frequency of symptoms and findings in enteroviruses positive cases were as follows; fever (69%), nuchal rigidity (38%), Kernig sign (23%), Brudzinski sign (23%) lethargy (23%), rash (15%), and focal neurologic signs (7%). Conclusion: Parechoviruses were not detected in CSF specimens analyzed. The frequency of enteroviruses was lower than literature. Since most of the patients participated in the study consist of the patients who had lumbar puncture in terms of research focus of the fever but not considered the forefront of meningitis. This study is the first surveillance of VAM due to enteroviruses and parechoviruses in our country. In order to early recognition of possible epidemics of aseptic meningitis especially due to enteroviruses and parechoviruses continuous national surveillance studies are needed. This surveillance may also help obtaining phylogenetic data related with those viruses. Key Words: Viral aseptic meningitis, enteroviruses, parechoviruses, surveillance, child.