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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:

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.



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.



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



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