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. 2016 May;22(5):846-53.
doi: 10.3201/eid2205.151807.

Astrovirus MLB2, a New Gastroenteric Virus Associated with Meningitis and Disseminated Infection

Samuel Cordey, Diem-Lan Vu, Manuel Schibler, Arnaud G L'Huillier, Francisco Brito, Mylène Docquier, Klara M Posfay-Barbe, Thomas J Petty, Lara Turin, Evgeny M Zdobnov, Laurent Kaiser

Astrovirus MLB2, a New Gastroenteric Virus Associated with Meningitis and Disseminated Infection

Samuel Cordey et al. Emerg Infect Dis. 2016 May.

Abstract

Next-generation sequencing has identified novel astroviruses for which a pathogenic role is not clearly defined. We identified astrovirus MLB2 infection in an immunocompetent case-patient and an immunocompromised patient who experienced diverse clinical manifestations, notably, meningitis and disseminated infection. The initial case-patient was identified by next-generation sequencing, which revealed astrovirus MLB2 RNA in cerebrospinal fluid, plasma, urine, and anal swab specimens. We then used specific real-time reverse transcription PCR to screen 943 fecal and 424 cerebrospinal fluid samples from hospitalized patients and identified a second case of meningitis, with positive results for the agent in the patient's feces and plasma. This screening revealed 5 additional positive fecal samples: 1 from an infant with acute diarrhea and 4 from children who had received transplants. Our findings demonstrate that astrovirus MLB2, which is highly prevalent in feces, can disseminate outside the digestive tract and is an unrecognized cause of central nervous system infection.

Keywords: astrovirus; astrovirus MLB2; enteric infections; high-throughput nucleotide sequencing; immunocompromised host; mamastrovirus; viral meningitis; viremia; viruses.

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Figures

Figure 1
Figure 1
Flowchart of study using NGS to determine potential viral etiologic agents of meningoencephalitic and respiratory syndromes, Geneva, Switzerland, 2014. *The diarrheic immunocompetent infant is not represented in Figure 2. CSF, cerebrospinal fluid; NGS, next-generation sequencing; RT-PCR, reverse transcription PCR.
Figure 2
Figure 2
Details of the cases of astrovirus MLB2 infection, Geneva, Switzerland, 2014. A) Next-generation sequencing results for the case-patient. Read coverage histogram is shown for each specimen analyzed. Percentage of genome coverage is also indicated. B–C) Real-time RT-PCR analysis results for the case-patient (B) and the HSCT recipient (C); D–G) real-time RT-PCR analysis results for the solid organ transplant pediatric recipients: liver transplant (D–F) and kidney transplant (G). Panel A) Red dashed lines represent the limit of PCR positivity (cycle threshold 40). CSF, cerebrospinal fluid; NPS, nasopharyngeal swab; BAL, bronchoalveolar lavage.
Figure 3
Figure 3
Phylogenetic tree constructed on the basis of full-length sequences of astroviruses and mamastroviruses. The sequence from the case-patient in this study is astrovirus MLB2 Geneva 2014. Brackets indicate the 4 Mamastrovirus species (MAstV 1, 6, 8, 9) from humans. Virus names and corresponding GenBank accession numbers are listed in Technical Appendix 2 Table. Scale bar indicates nucleotide substitutions per site.
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