Journal of Clinical Virology - Volume 82 - Supplement 1 - September 2016

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Abstracts / Journal of Clinical Virology 82S (2016) S1–S142 S9
Abstract no: 214
Presentation at ESCV 2016: Oral 15
Detection of a novel EV-A71 subgenogroup C1
recombinant variant emerging in Germany,
2015
S. Böttcher ∗, K. Neubauer , P. Obermeier ,
S. Diedrich , on behalf of the LaNE
1 National Reference Centre for Poliomyelitis and
Enteroviruses, Robert Koch Institute, Berlin, Germany
2 Secretary of the National Commission for Polio
Eradication in Germany, Robert Koch Institute,
Berlin, Germany
Enterovirus A71 (EV-A71) belongs to the family Picornaviri-
dae and different genogroups have been described circulating
worldwide. It was first detected in 1969 in California and in two
outbreaks with severe neurological diseases including polio-like
symptoms in Bulgaria (1975) and Hungary (1978). In the Southeast
Asia region, EV-A71 is mainly associated with large outbreaks of
hand, foot, and mouth disease (HFMD) every year, but in Europe
detection of increased EV-A71 circulation associated with menin-
gitis/encephalitis or acute flaccid paralysis has been reported less
frequently. Unlike in Asia, HFMD is not a reportable disease in
Europe.
The enterovirus surveillance (EVSurv) in Germany is based
on investigation of stool and CSF samples from hospitalized
patients with suspected meningitis/encephalitis (M/E) or acute
flaccid paralysis (AFP) within a laboratory network (LaNED).
During enterovirus season 2015, a new recombinant variant of
subgenogroup C1 was detected. Overall, 419 stool and CSF sam-
ples were tested EV positive (19.5%, 419/2158). Of the 392 strains
typed, 43 stools and one CSF sample from M/E patients hospital-
ized in 25 secondary and tertiary care hospitals from 13 out of
16 federal states in Germany were tested EV-A71 positive (11.2%).
Thirty-seven strains were further characterized at the National Ref-
erence Centre for Poliomyelitis and Enteroviruses (NRZ PE) by using
molecular and virological methods. While 18 strains could clearly
be assigned to subgenogroup C2 by the RIVM Enterovirus typ-
ing tool based
on the VP1 region, 19 strains could not be assigned by the RIVM
tool but showed 90–93% nucleotide identity to recently circulat-
ing C1 strains in the BLAST search. Amplification and sequencing
of the near entire genome and subsequent phylogenetic analyses
of the individual genomic regions (5’non coding region, P1, P2, P3)
revealed different clustering of the German C1 group in these four
dendrograms. No specific amino acid changes in the conserved
major antigenic sites were found. However, discrete amino acid
changes were identified in the capsid as well as nucleotide changes
and deletions within the 5’non coding region.
Our findings underline the need for molecular surveillance of
enteroviruses to identify new variants with potential for increased
virulence and pathogenicity. During the previous years of EVSurv
(2006–2014), C1 strains were only sporadically detected (n = 8) and
C2 has been the predominant subgenogroup (n = 168) of a total of
196/259 EV-A71 characterized. Data from the current enterovirus
season will be included in the analyses and it will be interesting to
see, whether this new variant dominates or disappears.
1 German Laboratory Network for Enterovirus Diagnostics.
Abstract no: 104
Presentation at ESCV 2016: Oral 16
Preadolescent patients with atypical course of
Zika virus (ZIKV) infection: Clinical findings and
quantitative viral detection in saliva and plasma
Svetoslav Nanev Slavov ∗,
Alessandra Kimie Matsuno ,
Fernanda Ursoli de Melo , Katia Kaori Otaguiri ,
Viviane da Mata Pasti Balbão ,
Dimas Tadeu Covas , Simone Kashima
1 Regional Blood Center of Ribeirão Preto, Faculty of
Medicine of Ribeirão Preto, University of São Paulo,
Brazil
2 Pediatric Emergency Room, Department of
Pediatrics, Faculty of Medicine of Ribeirão Preto,
University of São Paulo, Brazil
Zika virus (ZIKV), a mosquito-borne flavivirus, is currently caus-
ing a large outbreak in South America, where Brazil is the most
affected country. Serious clinical conditions like fetal microcephaly
and Guillain-Barre syndrome have already been attributed to ZIKV,
yet many aspects of the viral pathogenesis remain unclear. We
describe an unusual clinical presentation of ZIKV infection in
two preadolescent patients hospitalized in the Emergency Unit
of the Clinical Hospital of Ribeirão Preto, University of São Paulo,
Brazil. Initially, dengue hemorrhagic fever was suspected in both
patients due to the acute myalgia, severe abdominal pain, and ele-
vated hematocrit values. The patients, a male infant with eight
years of age and a female 12 years old patient were adynamic
and complained of muscular and retro orbital pain, high fever
(approximately 39◦ C), headache, vomiting and abdominal pain.
Additionally, once the male infant complained of a diffuse abdom-
inal pain without specific localization, ultrasound diagnosis of the
abdomen was performed, revealing acute mesenteric lymphadeni-
tis. The performed real-time PCR for Dengue and Chikungunya
fevers in plasma was negative, and saliva and blood samples were
also tested for ZIKV RNA due to the outbreak in the city. Both
specimens were positive for ZIKV RNA, as quantitatively the viral
load in saliva was higher (median, 2.1× 103 copies/mL) than in
plasma (median, 1.5 ×10 4 copies/mL). Up to now, the clinical pic-
ture described for the ZIKV infection, beyond microcephaly and
Guillain-Barre syndromes, includes in general low-grade fever,
itching exanthema and conjunctivitis. In these two cases we
demonstrate that despite the clinical suspicion of dengue hem-
orrhagic fever (regional endemicity) the patients were positive
for ZIKV. Interestingly, both cases were characterized by vomiting
and abdominal pain, in one case accompanied by mesenteric lym-
phadenitis. These findings point out that ZIKV might be involved
in a broader range of clinical symptoms, than previously demon-
strated and that differential diagnosis for ZIKVmay be performed in
pediatric cases demonstrating acute abdominal symptomatology.
Moreover, the detection of ZIKV in saliva with a higher viral load
than in blood demonstrates that this sample is suitable for diag-
nosis of the infection in pediatric patients and opens the question
for the routes of ZIKV transmission. Financial support: FUNDHERP,
FAPESP, CNPq, CAPES.