A case-cluster of aseptic meningitis associated with a newly identified recombinant echovirus6/CoxsackievirusB1 enterovirus

ABSTRACT A daycare teacher presented to a local Emergency Department (ED) with complaints of headache, neck stiffness, and fever. Preliminary analysis of cerebral spinal fluid (CSF) raised concerns about meningococcal meningitis and prompted notification of the county health department, which then notified the daycare. Ten children presented to a University referral hospital for evaluation, four of whom were febrile. CSF from the teacher and nasal swabs from the febrile children were all RT-PCR positive for enterovirus. A novel recombinant enterovirus was cultured from the teacher’s CSF and from two of the nasal swabs. The amino-terminal portion of the recombinant virus was derived from an Echovirus E6 with the carboxy-terminal portion originating from a Coxsackievirus B1; recombinant segments were most closely related to similar segments from strains isolated in France. Recombination occurred within the C-2 gene which encodes a multifunctional protein that functions as an RNA-stimulated ATPase associated with virus replication and virion morphogenesis. Structural modeling predicted that the recombinant protein was capable of forming hexameric and heptameric assemblies. Our data highlight the ongoing potential for recombination among enteroviruses groups, leading to modifications within viral proteins which may impact virulence. Brief Article Summary After a daycare teacher was diagnosed with meningitis, ten children were referred by the county health department to a University Hospital for evaluation. Cerebral Spinal Fluid (CSF) from the teacher and nasal swabs from symptomatic children were positive for a novel recombinant enterovirus, with the amino-terminal portion of the virus derived from Echovirus E6 and the carboxy-terminal portion originating from a Coxsackievirus B1.