ISOLATION AND GENETIC IDENTIFICATION OF HUMAN NON-POLIO ENTEROVIRUSES AT THE NATIONAL REFERENCE LABORATORY OF ENTEROVIRUSES, BULGARIA

Authors

  • Irina Georgieva National Center of Infectious and Parasitic Diseases image/svg+xml Author
  • Asya Stoyanova National Center of Infectious and Parasitic Diseases image/svg+xml Author
  • Virginia Petkova National Center of Infectious and Parasitic Diseases image/svg+xml Author
  • Simona Zlatanova Medical University Plovdiv image/svg+xml Author
  • Ana-Maria Donova Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases “Prof. Ivan Kirov”, Sofia Author
  • Ivan Ivanov Medical University of Sofia image/svg+xml Author
  • Oliana Boykinova Medical University Plovdiv image/svg+xml Author

DOI:

https://doi.org/10.58395/9xctnf19

Keywords:

Enteroviruses, isolation, real-time RT-PCR, genotyping

Abstract

Background: Human non-polio enteroviruses (NPEVs) are a diverse group of RNA viruses belonging to the genus Enterovirus within the subfamily Ensavirinae of the family Picornaviridae. They are responsible for a wide range of diseases, ranging from mild febrile illnesses to severe neurological conditions. Accurate isolation and genetic identification are critical for understanding their epidemiology, evolution, and pathogenic potential.

Aim: This study aimed to isolate NPEVs from clinical specimens, perform molecular identification through RT-PCR, and analyze viral sequences of parts the viral genome to elucidate their molecular genotyping.

Materials and methods: Clinical specimens from patients presenting with neurological, febrile illnesses, or HFMD were collected between 2021 and 2024 and were sent to NRL “Enteroviruses” for testing. All samples were tested using viral isolation and microneutralization. Direct molecular detection of enterovirus RNA was performed by real-time RT-PCR. Partial VP1 gene sequences were used for genotyping after Sanger sequencing of the target region.

Results: Successful serotyping via microneutralization was obtained for 9 isolates, which resulted in the identification of 4 echovirus 11 (E11), one echovirus 2 (E2), two coxsackievirus B (CVB), one echovirus 25 (E25), and one echovirus 6 (E6) strains. Molecular genotyping revealed multiple genotypes predominantly belonging to Enterovirus alphacoxsackie species, including CVA6, CVA16, CVA4, CVA2, and EV-A71. From Enterovirus betacoxsackie species E11, E9, E3, and E2 were detected.

Conclusion: Despite the incomplete enterovirus surveillance in Bulgaria and nonsystematic approach for NPEV detection, we managed to identify different virus strains in various clinical settings. Our study underscores the importance of combining virus isolation with molecular techniques for accurate identification of NPEVs, as well as the necessity of continuous monitoring of NPEVs.

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Author Biographies

  • Irina Georgieva, National Center of Infectious and Parasitic Diseases

    National Reference Laboratory "Enteroviruses”, Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria

  • Asya Stoyanova, National Center of Infectious and Parasitic Diseases

    National Reference Laboratory for Enteroviruses, Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria

  • Virginia Petkova, National Center of Infectious and Parasitic Diseases

    National Reference Laboratory for Enteroviruses, Department of Virology, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria

  • Simona Zlatanova, Medical University Plovdiv

    Infectious Diseases Clinic, Department of Infectious Diseases, Parasitology and Tropical medicine, Medical University, Plovdiv

  • Ana-Maria Donova, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases “Prof. Ivan Kirov”, Sofia

    Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases “Prof. Ivan Kirov”, Sofia

  • Ivan Ivanov, Medical University of Sofia

    Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases “Prof. Ivan Kirov”, Sofia;
    Department of Infectious Diseases, Parasitology and Tropical medicine, Medical University - Sofia

  • Oliana Boykinova, Medical University Plovdiv

    Infectious Diseases Clinic, Department of Infectious Diseases, Parasitology and Tropical medicine, Medical University, Plovdiv

References

1. Glaser C, Wilson MR. Enteroviruses: the elephants in the room. Lancet Infect Dis. 2020;20(2):153-155. https://doi.org/10.1016/S1473-3099(19)30679-6

2. Pons-Salort, M., Grassly, N. C., Ianiro, G. (2017). Epidemiology of non-polio enteroviruses: A systematic review. Clinical Infectious Diseases, 64(10), 1242–1248. https://doi.org/10.1093/cid/cix157

3. Jartti M, Flodström-Tullberg M, Hankaniemi MM. Enteroviruses: epidemic potential, challenges and opportunities with vaccines. J Biomed Sci. 2024;31(1):73. Published 2024 Jul 15. https://doi.org/10.1186/s12929-024-01058-x

4. Poliomyelitis (Polio). Available online: https://www.who.int/health-topics/poliomyelitis (accessed on 10 October 2025)

5. World Health Organization. Global polio surveillance action plan 2022-2024. World Health Organization, 2022.

6. Nix WA., Oberste MS, Pallansch MA. (2018). Sensitive, seminested PCR amplification of VP1 sequences for direct identification of all enterovirus serotypes from original clinical specimens. Journal of Clinical Microbiology, 40(3), 799–807. https://doi.org/10.1128/JCM.40.3.799-807.2002

7. Sanjuán R. From molecular genetics to phylodynamics: evolutionary relevance of mutation rates across viruses. PLoS pathogens 8.5 (2012): e1002685.

8. Harvala H, Benschop KSM, Berginc N, Midgley S, Wolthers K, Simmonds P, Feeney S, Bailly JL, Mirand A, Fischer TK, On Behalf Of The Enpen Hospital-Based Surveillance Network. European Non-Polio Enterovirus Network: Introduction of Hospital-Based Surveillance Network to Understand the True Disease Burden of Non-Polio Enterovirus and Parechovirus Infections in Europe. Microorganisms. 2021 Aug 27;9(9):1827. https://doi.org/10.3390/microorganisms9091827

9. Abreu E, de Almeida MFV, Oliveira CM. (2016). Molecular detection and genotyping of enteroviruses from clinical samples. Virology Journal, 13, 31. https://doi.org/10.1186/s12985-016-0512-2

10. Oberste MS, Maher K, Kilpatrick DR. (2004). Molecular identification of all enterovirus serotypes by RT-PCR amplified VP1 gene sequence. Journal of Clinical Microbiology, 42(8), 4097–4105. https://doi.org/10.1128/JCM.42.8.4097-4105.2004

11. Blomqvist S, Roivainen M. (2016). Isolation and Characterization of Enteroviruses from Clinical Samples. In: Martín, J. (eds) Poliovirus. Methods in Molecular Biology, vol 1387. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-3292-4_3

12. Dierssen U, Rehren F, Henke-Gendo C, Harste G, Heim A. Rapid routine detection of enterovirus RNA in cerebrospinal fluid by a one-step real-time RT-PCR assay. J Clin Virol. 2008 May;42(1):58-64. https://doi.org/10.1016/j.jcv.2007.11.016

13. Kroneman A,Vennema H, Deforche K, v d Avoort H, Peñaranda S, Oberste MS, Vinjé J, Koopmans M. An Automated Genotyping Tool for Enteroviruses and Noroviruses. J. Clin. Virol. Off. Publ. Pan Am. Soc. Clin. Virol. 2011, 51, 121–125, https://doi.org/10.1016/j.jcv.2011.03.006

14. Johannesen CK, Egeskov-Cavling AM, Jepsen MPG., Lange T, Krause TG, Nygaard U, Fisher TK. Changing rates but persisting seasons: patterns of enterovirus infections in hospitalizations and outpatient visits in Denmark 2015-2022. Front Virol. 2024;4 https://doi.org/10.3389/fviro.2024.1346352

15. de Schrijver S, VanhulleE, Ingenbleek A, Alexakis L, Johannesen CK, Broberg EK, Harvala H, Fischer TK, Benschop KSM, ENPEN Study Collaborators. Epidemiological and Clinical Insights into Enterovirus Circulation in Europe, 2018–2023: A Multicenter Retrospective Surveillance Study, The Journal of Infectious Diseases, Volume 232, Issue 1, 15 July 2025, Pages e104–e115, https://doi.org/10.1093/infdis/jiaf179

16. Georgieva I, Stoyanova A, Stoitsova S, Nikolaeva-Glomb L. Echovirus 30 in Bulgaria during the European Upsurge of the Virus, 2017-2018. Pathogens. 2024 Feb 5;13(2):143. https://doi.org/10.3390/pathogens13020143

17. Bubba L, Broberg EK, Jasir A, Simmonds P, Harvala H; Enterovirus study collaborators. Circulation of non-polio enteroviruses in 24 EU and EEA countries between 2015 and 2017: a retrospective surveillance study. Lancet Infect Dis. 2020 Mar;20(3):350-361. https://doi.org/10.1016/S1473-3099(19)30566-3

18. Hong J, Liu F, Qi H, Tu W, Ward MP, Ren M, Zhao Z, Su Q, Huang J, Chen X, Le J, Ren X, Hu Y, Cowling B, Li Z, Chang Z, Zhang Z. Changing epidemiology of hand, foot, and mouth disease in China, 2013-2019: a population-based study. Lancet Reg Health West Pac. 2022 Jan 2;20:100370. https://doi.org/10.1016/j.lanwpc.2021.100370

19. Bian L, Wang Y, Yao X, Mao Q, Xu M, Liang Z. Coxsackievirus A6: a new emerging pathogen causing hand, foot and mouth disease outbreaks worldwide. Expert Rev Anti Infect Ther. 2015;13(9):1061-71. https://doi.org/10.1586/14787210.2015.1058156

20. Xiao J, Huang K, Lu H, Song Y, Han Z, Zhang M, Li J, Zhou X, Chen J, Yu Q, Yang M, Yan D, Ji T, Yang Q, Zhu S, Xu W, Zhang Y. Genomic Epidemiology and Phylodynamic Analysis of Enterovirus A71 Reveal Its Transmission Dynamics in Asia. Microbiol Spectr. 2022 Oct 26;10(5):e0195822. https://doi.org/10.1128/spectrum.01958-22

21. Carmona RCC, Reis FC, Cilli A, Dias JMM, Machado BC, de Morais DR, Jorge AV, Dias AMN, de Sousa CA, Calou SB, et al. Beyond Poliomyelitis: A 21-Year Study of Non-Polio Enterovirus Genotyping and Its Relevance in Acute Flaccid Paralysis in São Paulo, Brazil. Viruses. 2024; 16(12):1875. https://doi.org/10.3390/v16121875

22. Suresh S, Forgie S, Robinson J. Non-polio Enterovirus detection with acute flaccid paralysis: A systematic review. J Med Virol. 2018 Jan;90(1):3-7. https://doi.org/10.1002/jmv.24933

23. Compagnoli Carmona RC, Caetano Machado B, Aparecida de Sousa C, Vieira HR, Moraes Alves MR, Farias de Souza KA, de Souza Gregório D, Costa Vilanova B, Sampaio Tavares Timenetsky MDC. Distribution of species enterovirus B in patients with central nervous system infections in São Paulo State, Brazil. J Med Virol. 2020 Dec;92(12):3849-3856. https://doi.org/10.1002/jmv.26131

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Published

2025-12-15

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How to Cite

(1)
Georgieva, I.; Stoyanova, A.; Petkova, V.; Zlatanova, S.; Donova, A.-M.; Ivanov, I.; Boykinova, O. ISOLATION AND GENETIC IDENTIFICATION OF HUMAN NON-POLIO ENTEROVIRUSES AT THE NATIONAL REFERENCE LABORATORY OF ENTEROVIRUSES, BULGARIA. Probl Infect Parasit Dis 2025, 53 (3), 17-22. https://doi.org/10.58395/9xctnf19.

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