A case-cluster of aseptic meningitis associated with a newly identified recombinant echovirus6/CoxsackievirusB1 enterovirus

Abstract A daycare teacher presented with complaints of headache, neck stiffness, and fever. Because of initial concerns about meningococcal meningitis, families of daycare attendees were notified and 10 children from the daycare presented for evaluation. CSF from the teacher and nasal swabs from four febrile children were RT-PCR positive for enterovirus. A novel recombinant enterovirus was cultured from the teacher’s CSF and from two of the nasal swabs. The amino-terminal portion of the recombinant virus was derived from an Echovirus E6 with the carboxy-terminal portion originating from a Coxsackievirus B1; recombinant segments were most closely related to similar segments from strains isolated in France. Recombination occurred within the C-2 gene associated with virus replication and virion morphogenesis. Structural modeling predicted that the recombinant protein was capable of forming hexameric and heptameric assemblies. Our data highlight the potential for recombination among enteroviruses, leading to modifications within viral proteins which may impact virulence.