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Case Reports
. 2003 Oct;41(10):4605-10.
doi: 10.1128/JCM.41.10.4605-4610.2003.

Molecular evidence of persistent echovirus 13 meningoencephalitis in a patient with relapsed lymphoma after an outbreak of meningitis in 2000

Christine Archimbaud  1 , Jean-Luc Bailly, Martine Chambon, Olivier Tournilhac, Philippe Travade, Hélène Peigue-Lafeuille
Affiliations
Case Reports

Molecular evidence of persistent echovirus 13 meningoencephalitis in a patient with relapsed lymphoma after an outbreak of meningitis in 2000

Christine Archimbaud et al. J Clin Microbiol. 2003 Oct.

Abstract

Enteroviral meningoencephalitis was diagnosed in a patient with an immunodeficiency syndrome acquired after treatment with rituximab for a relapsed primary B-cell lymphoma. A second meningoencephalitic episode was diagnosed 6 months later and was successfully treated with a combination of immunoglobulins and pleconaril. The infection was persistent since the enterovirus genome was detected in five sequential specimens of cerebrospinal fluid collected over 9 months. An echovirus 13 isolate was isolated in the first three samples. The viral sequence encoding the VP1 capsid protein of the three isolates was determined and was compared with that of four control viruses. The virus isolates recovered from the patient shared >99% nucleotide sequence similarity with one another. In a phylogenetic tree, they were directly related to a control virus obtained from a patient hospitalized in 2000 during an outbreak of enterovirus meningitis. The epidemiological origin of a chronic echovirus infection in a patient with immune deficiency suggests that the echovirus had been continuously circulating in the general population after the outbreak that had revealed its emergence.

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Figures

FIG. 1.
FIG. 1.
Multiple-sequence alignment of the VP1 capsid proteins of the echovirus 13 Del Carmen prototype strain (E-13), the CF1393-00 control isolate, and the three sequential echovirus 13 isolates (isolates S1, S2, S3) recovered from the CSF specimens of the patient. Dots indicate amino acid similarity with the VP1 sequence of the prototype strain.
FIG. 2.
FIG. 2.
Phylogenetic tree based on the VP1-encoding sequence illustrating the relationships of echovirus 13 clinical isolates. The reliability of internal branches was estimated by the resampling method (bootstrap test, 1,000 replicates) and is indicated as a percentage. Values <90% are not given. The sequences of four echovirus 13 isolates, 42/99 (GenBank accession number AF295467), 19/Fukushima/01 (GenBank accession number AB086858), ON02-2R (GenBank accession number AB092984), and CR02-10F (GenBank accession number AB092985), were retrieved from international databases and were included in the analysis to increase the reliability of the results of the phylogenetic inference. Strain ON02-2R was isolated from the CSF of a child with aseptic meningitis, and strains CR02-10F and the 19/Fukushima/01 were isolated from stools of children with exanthema and aseptic meningitis, respectively. No isolation source was given for strain 42/99. The nucleotide sequence of the echovirus 13 Del Carmen prototype strain (E-13) was determined in our laboratory (EMBL database accession number AJ241427). The sequence of enterovirus 69 (EV-69; GenBank accession number AF081349) was used as the outgroup to root the tree.
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