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Volume 43, Number 5, October 2010

Application of a Molecular Method for the Classification of Human Enteroviruses and its Correlation with Clinical Manifestations


Chiao-Wei Lo, Keh-Gong Wu, Mong-Cheng Lin, Chun-Jen Chen, Donald Min-The Ho, Ren-Bing Tang, Yu-Jiun Chan


Received: June 22, 2009    Revised: July 5, 2009    Accepted: August 18, 2009   

 

Corresponding author:

Yu-Jiun Chan, Division of Virology, Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, 201 Section 2, Shih-Pai Road, Taipei 112, Taiwan. E-mail: yjchan@vghtpe.gov.tw

Chiao-Wei Lo and Keh-Gong Wu contributed equally to this work.



 

Background and purpose: 

A new molecular classification scheme has recently been adopted that groups all enteroviruses into four species, designated human enterovirus A (HEV-A) through D. In this study, we tried to demonstrate the correlation between this molecular classification scheme and clinical manifestations in patients.



 

Methods:

We retrospectively reclassified the clinical isolates of enteroviruses from the preceding 4.5 years in our virology laboratory using reverse transcription-polymerase chain reaction, and reviewed the clinical manifestations of 138 pediatric patients.



 

Results:

We reclassified 23 isolates of the five serotypes into the HEV-A group, 110 isolates of 16 serotypes
into the HEV-B group, five isolates into the HEV-C group, and no isolate of the HEV-D group.
HEV-A species caused significantly more hand-foot-and-mouth disease (p < 0.001), herpangina (p = 0.029),
and myoclonic jerks (p < 0.001) compared with HEV-B species. However, HEV-B species caused significantly more pharyngitis (p = 0.043), respiratory tract infections (p = 0.046), nausea and vomiting (p = 0.007), and aseptic meningitis (p = 0.001). The only death in our report was caused by coxsackievirus A16, which belonged to the HEV-A group



 

Conclusion:

The association between the molecular classification of enteroviruses and related disease patterns is an important finding. We suggest that this molecular classification could be applied in a clinical laboratory as an alternative method under certain circumstances, such as limited availability of antisera or questionable serotyping results, to identify the untypeable isolates.



 

Key words:

aseptic meningitis, clinical manifestations, enteroviruses, molecular classification, RT-PCR