Medical Microbiology and Immunology

, Volume 205, Issue 5, pp 471–483 | Cite as

Analysis of an echovirus 18 outbreak in Thuringia, Germany: insights into the molecular epidemiology and evolution of several enterovirus species B members

  • Andi KrumbholzEmail author
  • Renate Egerer
  • Heike Braun
  • Michaela Schmidtke
  • Dagmar Rimek
  • Claudia Kroh
  • Bert Hennig
  • Marco Groth
  • Andreas Sauerbrei
  • Roland Zell
Original Investigation


In October and November 2010, six children and one woman were presented with symptoms of aseptic meningitis in Jena, Thuringia, Germany. Enterovirus RNA was detected in the cerebrospinal fluid of all patients by RT-PCR, and preliminary molecular typing revealed echovirus 18 (E-18) as causative agent. Virus isolates were obtained from stool samples of three patients and several contact persons. Again, most isolates were typed as E-18. In addition, coxsackievirus B5 (CV-B5) and echovirus 25 (E-25) were found to co-circulate. As only few complete E-18 sequences are available in GenBank, the entire genomes of these isolates were determined using direct RNA-sequencing technology. We did not find evidence for recombination between E-18, E-25 or CV-B5 during the outbreak. Viral protein 1 gene sequences and the cognate 3D polymerase gene sequences of each isolate and GenBank sequences were analysed in order to define type-specific recombination groups (recogroups).


Enterovirus Meningitis RNA-sequencing Molecular epidemiology Lineages Recogroups Recombination Germany 



The author’s cordially acknowledge the kind support obtained by Professor Eberhard Straube (Institute of Medical Microbiology, Jena), Professor Peter Wutzler (Institute of Virology and Antiviral Therapy, Jena), Dr. Ina Werner, Beate von Frommannshausen, Dr. Rolf Bergmann (all TLV, Bad Langensalza) and Professor Helmut Fickenscher (Institute of Infection Medicine, Kiel) for this study. Typing of EV strains isolated at the TLV was performed by the German National Reference Laboratory for Poliomyelitis and Enteroviruses at the Robert Koch Institute. Thus, authors would like to thank Dr. Sabine Diedrich and colleagues for their kind support. The authors are also grateful to all patients and patient’s families as well as to their nurseries and primary schools for providing additional samples and access to epidemiological data.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

430_2016_464_MOESM1_ESM.pdf (100 kb)
Supplementary Figure 1: Detailed 3Dpol tree based on 318 sequences. Available sequence data of 63 Enterovirus B types were included. GenBank accession numbers, strain designations and year of sampling are presented. Colour code: green, E-18; blue, CV-B5; red, E-25. Coloured boxed indicate the recogroup numbers of the respective type. Boxed 3D sequence indicates E-25 strain with lacking cognate VP1 sequence; this indicates the existence of additional E-25 recogroup. Scale bar indicates substitutions per site (PDF 100 kb)
430_2016_464_MOESM2_ESM.pdf (115 kb)
Supplementary Figure 2: Detailed CV-B5 VP1 tree based on 381 sequences. Branch lengths indicate node ages. The sequences of the nine proposed recogroups are highlighted in blue, and the respective recogroup is indicated by a boxed number. GenBank accession numbers, strain designations and year of sampling are presented. Relevant amino acid exchanges are indicated at the branches. Scale bar indicates years (PDF 115 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Andi Krumbholz
    • 1
    • 2
    • 3
    • 8
    Email author
  • Renate Egerer
    • 2
    • 3
  • Heike Braun
    • 2
  • Michaela Schmidtke
    • 2
  • Dagmar Rimek
    • 4
  • Claudia Kroh
    • 5
  • Bert Hennig
    • 6
  • Marco Groth
    • 7
  • Andreas Sauerbrei
    • 2
  • Roland Zell
    • 2
  1. 1.Institute of Infection MedicineChristian-Albrecht University Kiel and University Medical Center Schleswig-HolsteinKielGermany
  2. 2.Institute of Virology and Antiviral TherapyJena University HospitalJenaGermany
  3. 3.Institute of Medical MicrobiologyJena University HospitalJenaGermany
  4. 4.Thuringian State Authority for Consumer Protection (TLV)Bad LangensalzaGermany
  5. 5.Public Health Authority, City Council of JenaJenaGermany
  6. 6.Department of PediatricsJena University HospitalJenaGermany
  7. 7.Leibniz Institute on Aging – Fritz Lipmann Institute (FLI)JenaGermany
  8. 8.Medical Laboratory Dr. Krause and colleagues MVZ GmbHKielGermany

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