Echovirus type 9 is an important cause of viral encephalitis among infants and young children in Kuwait

Abstract

Background: The role of enteroviruses in encephalitis is not fully established.

Objective: This study determined the role of enteroviruses in encephalitis in neonates, infants and young children in Kuwait.

Study design: Cerebrospinal fluid (CSF) samples obtained from 147 patients presenting with 'severe encephalitis' (n=60), 'mild encephalitis' (n=43), and febrile seizures (n=44) over a 3.5-year period, were analyzed. Enteroviral RNA was detected by one-step reverse transcription-PCR (RT-PCR) assay and specific enteroviruses were identified by sequencing a variable region of the enteroviral genome.

Results: Enteroviral RNA was detected in 29 of 103 (28%) samples obtained from encephalitis patients but only in 8 of 44 (18%) samples from patients with febrile seizures. Echovirus type 9 (E9) was detected in 24 of 29 (83%) while E30 was found in 5 of 29 (17%) of enterovirus-positive encephalitis cases. Two of 8 (25%) cases of febrile seizures were infected with E9. The E9 viral load was higher in patients with 'severe encephalitis' than in patients with 'mild encephalitis' or in patients with febrile seizures. All but one enteroviral encephalitis case had a complete recovery.

Conclusions: Enteroviruses, especially E9 are an important cause of encephalitis among neonates, infants and young children in Kuwait.