Direct Serotyping of Enteroviruses in Cerebrospinal Fluid of Children With Aseptic Meningitis

Background: Viral meningitis is an inflammation of the leptomeninges as a manifestation of central nervous system (CNS) infection. More than 85% of viral meningitis cases are caused by non-polio enteroviruses. This is the first study on the description of the enteroviruses and the related serotypes involved in viral meningitis in Iran. Objectives: This project was conducted to improve our knowledge about the role of enteroviruses and their circulating serotypes in viral meningitis in Iran. Patients and Methods: Cerebrospinal fluids from 118 children under 13 years old with primary clinical diagnosis of aseptic meningitis were collected in Children Medical Center in Tehran and sent to Department of Virology of Pasteur Institute of Iran. To investigate the enteroviruses, 5`-noncoding regions were amplified by Real-Time PCR method using Pan-EV primers and a specific probe. Serotype identification in enterovirus positive samples was conducted by RT-PCR. Results: Enterovirus detection rate in all 118 Cerebrospinal fluid specimens was 10.16%. Most patients were 0 - 2 years old (40.67%). Serotyping was achieved from 6 specimens with two polio viruses type 1 (vaccine type), two echoviruses 14, one echovirus 5 and one echovirus 30. Conclusions: Enteroviruses should be considered as the main cause of viral meningitis in Iran. Molecular detections of 5-'NCR and VP1-2A RT-PCR with sequence analysis were found to be better than the conventional methods, for direct diagnosis and EVs typing that may lead to decrease of the unnecessary hospitalizations.