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J Infect Dis. 2014 Aug 15;210(4):576-84. doi: 10.1093/infdis/jiu178. Epub 2014 Mar 20.

Variations in cerebrospinal fluid viral loads among enterovirus genotypes in patients hospitalized with laboratory-confirmed meningitis due to enterovirus.

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  • 1Epidémiologie et pathogénie des infections à entérovirus, Université d'Auvergne, Clermont Université
  • 2Epidémiologie et pathogénie des infections à entérovirus, Université d'Auvergne, Clermont Université CNR Enterovirus/Parechovirus laboratoire associé, Service de Virologie.
  • 3Délégation Recherche Clinique Innovation, CHU Clermont-Ferrand, Clermont-Ferrand.
  • 4CH Versailles, Laboratoire de Microbiologie, Le Chesnay, France.
  • 5CNR Enterovirus/Parechovirus laboratoire associé, Service de Virologie.



Acute enterovirus (EV) meningitis is a major cause of hospitalization among adults and children. It is caused by multiple EV genotypes assigned to 4 species (EV-A, EV-B, EV-C, and EV-D).


We determined viral loads in the cerebrospinal fluid (CSF) of 156 patients of all ages with EV meningitis during a 5-year observational prospective study. The virus strains were genotyped, and their time origin was determined with Bayesian phylogenetic methods.


The CSF viral loads ranged between 3.4 and 7.5 log10 copies/mL (median, 4.9 log10 copies/mL). They were higher in neonates than in infants and children (P = .02) but were comparable in adults. Viral loads were associated with EV genotypes (P < .001). The EV strains were identified in 152 of 156 patients and assigned to 23 genotypes within the EV-A and EV-B species. The most frequent genotypes, echoviruses 6 and 30, were associated with different viral loads (P < .001). The highest viral loads were in meningitis cases caused by coxsackievirus A9, B4, and B5 genotypes. Most patients infected by a same genotype were infected by a major virus variant of recent emergence.


The variations in CSF viral loads in patients at the onset of EV meningitis are related to genotypic differences in the virus strains involved.

© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail:


CSF viral load; Enterovirus genotypes; Enterovirus meningitis; adults; children; infants; meningitis pathophysiology; neonates; pleocytosis

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