Family outbreak of an infection with a recombinant Coxsackie A virus in eastern Switzerland
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CASE REPORT
Family outbreak of an infection with a recombinant Coxsackie A virus in eastern Switzerland R. Butsch • C. Tapparel • P. Keller • K. Herzog • M. Krause • W. Wunderli L. Kaiser • W. Bossart
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Received: 15 March 2012 / Accepted: 12 September 2012 / Published online: 5 October 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract Purpose We report on an unusual familial outbreak of a coxsackie virus infection in Switzerland in which five family members were affected. Most of the patients presented with signs of meningitis, and four were hospitalized. Methods In three individuals, the virus was detected in the cerebrospinal fluid, pharynx, and stool, respectively. The genome was sequenced in specimens of two patients. Results The nucleotide sequences of both virus strains were identical. Blast search revealed that the first half of the sequence was 88 % homologous to Enterovirus 75 (EV-75), 87 % with Echovirus 11 (E-11), and 84 % homologous to Coxsackie virus A9 (CV-A9). The second half of the sequence was 77 % homologous to EV-75, 75 % to E-11, and 91 % to CV-A9.
Conclusion We propose that the isolated virus strain is a recombinant strain with a 50 untranslated region and with the start of the VP4 sequence originating from E-11/EV-75 and the rest of the genome originating from CV-A9. Interestingly, this novel virus strain showed an exceptional virulence and rapid spread. Two weeks after the initial outbreak in this family, a similar outbreak was observed in a second geographic area roughly 100 km distant to the primary identification site, and another 2 months later this virus strain was found to circulate in the western part of Switzerland some 250 km distant to the primary locus. These findings suggest that genetic recombination has resulted in a novel enterovirus with features of high virulence, contagiosity, and spreading.
R. Butsch (&) Division of Internal Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland e-mail: [email protected]
P. Keller Institute of Medical Microbiology, University Laboratories, Friedrich Schiller University of Jena, Erlanger Allee 101, 07747 Jena, Germany e-mail: [email protected]
R. Butsch M. Krause Department of Internal Medicine, Cantonal Hospital Mu¨nsterlingen, 8596 Mu¨nsterlingen, Switzerland M. Krause e-mail: [email protected] C. Tapparel L. Kaiser Laboratory of Virology, Division of Infectious Diseases and Division of Laboratory Medicine, University of Geneva Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland e-mail: [email protected]
K. Herzog Department of Microbiology, Cantonal Hospital Mu¨nsterlingen, P.O. Box, 8596 Mu¨nsterlingen, Switzerland e-mail: [email protected] W. Wunderli W. Bossart Institute of Medical Virology, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland e-mail: [email protected] W. Bossart e-mail: [email protected]
L. Kaiser e-mail: [email protected]
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Keywords Coxsackie virus
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