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Publication
Enterovírus não-polio e infeções do sistema nervoso central em crianças: avaliação laboratorial, 2023-2024
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Advisor(s)
Abstract(s)
Os enterovírus não-polio permanecem como os principais agentes patogénicos do sistema nervoso central (SNC) em todo o mundo, especialmente em crianças com idade inferior a 5 anos, causando desde doença ligeira a quadros graves que podem evoluir para desfechos fatais.
Entre 2023 e 2024 foram analisadas no INSA fezes de 327 crianças com suspeita de infeção por enterovírus. O diagnóstico laboratorial incluiu a deteção do RNA viral por RT-PCR em tempo real e o isolamento viral. A identificação viral foi realizada por sequenciação genómica.
Neste período foram identificados 109 (33,3%) casos de infeção a enterovírus, dos quais 26 casos (23,9%) corresponderam a infeções do SNC, maioritariamente em crianças com menos de 5 anos (88,5%), sem uma evidente distribuição temporal. Os enterovírus mais frequentes foram os echovírus (tipos 5, 6,7, 9, 18, 21, 25, 30, 31 e 32), detetados em 13 casos (52,0%), seguidos pelos Coxsackievírus A (tipos 4, 6, 9, 10 e 16), em 7 casos (28,0%), ambos associados a meningite e meningoencefalite. O Enterovírus 71 (EV71) foi detetado em dois casos, um de romboencefalite e um de paralisia flácida aguda (PFA), e um caso de meningite esteve associado ao EV-C99. Não se observou nenhum padrão de surto nestes dois anos.
Estes resultados reforçam a relevância da identificação rápida e dirigida para enterovírus como agentes etiológicos de infeções do SNC, fundamental para uma intervenção clínica direcionada, evitando o uso desnecessário de antibióticos e de múltiplos exames complementares de diagnóstico
Non-polio enteroviruses remain the major pathogens of the central nervous system (CNS) worldwide, especially in children under five years of age causing a range of diseases from mild to severe, which can lead to fatal outcomes. Between 2023 and 2024, stool samples from 327 children with suspected enterovirus infection were analysed at INSA. Laboratory diagnosis included detection of viral RNA by real-time RT-PCR and viral isolation. Serotype identification was performed through genomic sequencing. During this period, 109 (33.3%) cases of enterovirus infection were identified, of which 26 (23.9%) involved CNS infections, predominantly in children under 5 years of age (88.5%), without an evident temporal distribution. The most frequent enteroviruses were echoviruses (types 5,6, 7, 9, 18, 21, 25, 30, 31, and 32), detected in 13 cases (52.0%), followed by Coxsackievi ruses A (types 4, 6, 9, 10, and 16), in 7 cases (28.0%), both associated with meningitis and meningoencephalitis. Enterovirus 71 (EV71) was identified in two cases, one of rhombencephalitis and one of acute flaccid paralysis (AFP), while EV-C99 was associated with a case of meningi tis. No outbreak pattern was observed. These findings underscore the importance of rapid and targeted identification of enteroviruses as causative agents of CNS infections, which is crucial for guiding appropriate clinical management and preventing unnecessary use of antibiotics and multiple complementary diagnostic procedures.
Non-polio enteroviruses remain the major pathogens of the central nervous system (CNS) worldwide, especially in children under five years of age causing a range of diseases from mild to severe, which can lead to fatal outcomes. Between 2023 and 2024, stool samples from 327 children with suspected enterovirus infection were analysed at INSA. Laboratory diagnosis included detection of viral RNA by real-time RT-PCR and viral isolation. Serotype identification was performed through genomic sequencing. During this period, 109 (33.3%) cases of enterovirus infection were identified, of which 26 (23.9%) involved CNS infections, predominantly in children under 5 years of age (88.5%), without an evident temporal distribution. The most frequent enteroviruses were echoviruses (types 5,6, 7, 9, 18, 21, 25, 30, 31, and 32), detected in 13 cases (52.0%), followed by Coxsackievi ruses A (types 4, 6, 9, 10, and 16), in 7 cases (28.0%), both associated with meningitis and meningoencephalitis. Enterovirus 71 (EV71) was identified in two cases, one of rhombencephalitis and one of acute flaccid paralysis (AFP), while EV-C99 was associated with a case of meningi tis. No outbreak pattern was observed. These findings underscore the importance of rapid and targeted identification of enteroviruses as causative agents of CNS infections, which is crucial for guiding appropriate clinical management and preventing unnecessary use of antibiotics and multiple complementary diagnostic procedures.
Description
Keywords
Enterovírus Infeção por Enterovírus Enterovírus não-polio Vigilância Laboratorial Doenças Evitáveis por Vacinação Doenças Infecciosas
Pedagogical Context
Citation
Boletim Epidemiológico Observações. 2025 maio-agosto;14(38): 37-41
Publisher
Instituto Nacional de Saúde Doutor Ricardo Jorge, IP