Identification and characterization of an enterovirus isolate closely related to Echovirus E9 in cerebrospinal fluid samples from children with meningitis in Baghdad, Iraq

Aljuboori M. Nafea^1,2†, Yuer Wang^1†, Metha Abdel², Shan Xu^1*, Yigang Tong^1*

Show Less

¹ State Key Laboratory of Green Biomanufacturing, School of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China

² Department of Microbiology, College of Medicine, Ibn Sina University of Medical and Pharmaceutical Science, Baghdad, Iraq

†These authors contributed equally to this work.

MI, 026020007 https://doi.org/10.36922/MI026020007

Received: 7 January 2026 | Revised: 5 February 2026 | Accepted: 9 April 2026 | Published online: 5 June 2026

© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )

Download PDF

XML

Cite

Abstract

Viral infections are one of the most important causes of meningitis. Although common pathogen identification methods, such as polymerase chain reaction and antigen assay, have been widely used for pathogen detection in meningitis, traditional methods are time-consuming and not suitable for the identification of novel pathogens. Therefore, there is an urgent need for new detection methods to rapidly identify novel pathogens, which is important for timely clinical decision-making and patient management based on the type of pathogen. In recent years, sequencing technology has developed rapidly. Next-generation sequencing (NGS) technology can simultaneously sequence millions of DNA fragments and identify multiple pathogens at once in cerebrospinal fluid (CSF). In this study, we detected and identified an enterovirus isolate closely related to Echovirus E9 in the CSF samples of children with meningitis in Baghdad, Iraq, through NGS technology. This provides important insights into the epidemiology and disease evolution in these regions, contributing to more effective disease surveillance and response strategies on a global scale.

Keywords

Next-generation sequencing

Cerebrospinal fluid

Enterovirus

Meningitis

Detection

Funding

This research was supported by the Capital’s Funds for Health Improvement and Research (grant number: 2024- 1G-4421).

Conflict of interest

Yigang Tong serves as one of the Editors-in-Chief of this journal, but was not in any way involved in the editorial and peer-review process conducted for this paper, directly or indirectly. Separately, other authors declared that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.

References

Harvala H, Simmonds P. Viral meningitis: epidemiology and diagnosis. Lancet Infect Dis. 2016;16(11):1211-1212. doi: 10.1016/S1473-3099(16)30221-3

GBD 2019 Meningitis Antimicrobial Resistance Collaborators. Global, regional, and national burden of meningitis and its aetiologies, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 2023;22(8):685-711. doi: 10.1016/S1474-4422(23)00195-3

Kadambari S, Harvala H, Simmonds P, Pollard AJ, Sadarangani M. Strategies to improve detection and management of human parechovirus infection in young infants. Lancet Infect Dis. 2019;19(2):e51-e58. doi: 10.1016/S1473-3099(18)30288-3

Martin NG, Iro MA, Sadarangani M, Goldacre R, Pollard AJ, Goldacre MJ. Hospital admissions for viral meningitis in children in England over five decades: a population-based observational study. Lancet Infect Dis. 2016;16(11):1279- 1287. doi: 10.1016/S1473-3099(16)30201-8

Messacar K, Spence-Davizon E, Osborne C, et al. Clinical characteristics of enterovirus A71 neurological disease during an outbreak in children in Colorado, USA, in 2018: an observational cohort study. Lancet Infect Dis. 2020;20(2):230-239. doi: 10.1016/S1473-3099(19)30632-2

Tugume L, Ssebambulidde K, Kasibante J, et al. Cryptococcal meningitis. Nat Rev Dis Primers. 2023;9(1):62.

doi: 10.1038/s41572-023-00472-z

Ozair A, Wilding H, Bhanja D, et al. Leptomeningeal metastatic disease: new frontiers and future directions. Nat Rev Clin Oncol. 2025;22(2):134-154. doi: 10.1038/s41571-024-00970-3

Shyshov AS, Bazarova MV, Blank IA, et al. Enterovirus infections and meningitis in children. Zh Nevrol Psikhiatr Im S S Korsakova. 2016;116(2):9-15. doi: 10.17116/jnevro2016116219-15

Mukadi-Bamuleka D, Edidi-Atani F, Morales-Betoulle ME, et al. Fatal meningoencephalitis associated with Ebola virus persistence in two survivors of Ebola virus disease in the Democratic Republic of the Congo: a case report study. Lancet Microbe. 2024;5(10):100905. doi: 10.1016/S2666-5247(24)00137-X

Piantadosi A, Mukerji SS, Ye S, et al. Enhanced Virus Detection and Metagenomic Sequencing in Patients with Meningitis and Encephalitis. mBio. 2021;12(4):e0114321. doi: 10.1128/mBio.01143-21

Wilson MR, Sample HA, Zorn KC, et al. Clinical Metagenomic Sequencing for Diagnosis of Meningitis and Encephalitis. N Engl J Med. 2019;380(24):2327-2340. doi: 10.1056/NEJMoa1803396

Chen S, Zhou Y, Chen Y, Gu J. fastp: an ultra-fast all-in-one FASTQ preprocessor. Bioinformatics. 2018;34(17):i884-i890. doi: 10.1093/bioinformatics/bty560

Abedi GR, Watson JT, Nix WA, Oberste MS, Gerber SI. Enterovirus and Parechovirus Surveillance - United States, 2014-2016. MMWR Morb Mortal Wkly Rep. 2018;67(18):515-518. doi: 10.15585/mmwr.mm6718a2

Mardekian SK, Fortuna D, Nix A, et al. Severe human parechovirus type 3 myocarditis and encephalitis in an adolescent with hypogammaglobulinemia. Int J Infect Dis. 2015;36:6-8. doi: 10.1016/j.ijid.2015.05.008

Chang LY, Huang LM, Gau SS, et al. Neurodevelopment and cognition in children after enterovirus 71 infection. N Engl J Med. 2007;356(12):1226-1234. doi: 10.1056/NEJMoa065954

Previous article in this issue

Next article in this issue

Microbes & Immunity, Electronic ISSN: 3029-2883 Print ISSN: 3041-0886, Published by AccScience Publishing