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Enterovirus infection in pediatric patients

Inês Serras1; Maria Luís Sacras1; Paula Palminha2; Gonçalo Cordeiro Ferreira1; Maria João Brito1

1- Unidade de Infecciologia, Área de Pediatria Médica, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central EPE, Lisboa
2- Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa

- 7th Europediatrics, Florença, 13-16 de Maio de 2015 (Poster)

Introduction Enteroviruses have a worldwide distribution and occure by outbreaks. They cause a wide spectrum of clinical diseases and children usually exhibit only mild symptoms.
Objectives: Characterize enterovirus infection in the pediatric population of a terciary hospital in Portugal.
Methods: Descriptive study in child admitted from January 1st 2010 to 31th December 2013. Enterovirus detection was made by PCR in cerebrospinal fluid and fecal samples. Serotype identification was performed by viral culture and neutralization test in stool samples. Demographic, epidemiologic, clinical and laboratorial data are analyzed.
Results: 84 children were identified, mean 2 years old (min: 16 days, max: 12 years). (87% < 5 years). There was a peak (48%) in 2010, with 33% of cases in June and October. Diagnosis were meningoencefalitis (30), gastroenteritis (27), febrile illness (12), arthritis (3), neonatal sepsis (2), hepatitis (1) and others (5). Blood leucocytes were >15000/μL in 24% cases (median - 18400/μL) and C-reactive protein (CRP) was positive (> 50 mg/L) in nine children (median 87,6 mg/L). Serotyping was done in all cases; most frequent serotypes were Echovirus 6 (19%), Echovirus 11 (12%) and Echovirus 30 (12%) with outbreaks of Echovirus 6 in spring and Echovirus 11 in winter. Infections by Echovirus 6 and Echovirus 30 caused meningoencefalitis (50%) and cursed with leukocytosis (45%), but this result did not imply a more severe disease or longer hospitalization time. On the other hand Echovirus 11 was associated with longer hospitalization time (7,5 days vs 5 days), related with younger age (less than 2 years-old) (90%) and comorbidities (50%) - pneumonia (1), antiphospholipid syndrome (1), staphylococcus aureus toxic shock (1), febrile neutropenia (1) and coinfection with rotavirus and cytomegalovirus (1).
Conclusions: To our knowledge, there are no data regarding the most prevailing enterovirus types in Portugal. Echovirus 6 and Echovirus 30 were reported as responsible for outbreaks of viral meningitis in other countries. This might have corresponded to the same viral outbreak in Portugal. Echovirus 11 correlated with a more severe infection, affecting younger ages but the longer hospitalization times seem to be more related to comorbidities. 

Palavras Chave: enterovirus infection; PCR; Portugal.