Iranian Journal of Microbiology 2018. 10(3):194-201.

Enteroviruses and Adenoviruses in stool specimens of paralytic children- can they be the cause of paralysis?
Maryam Yousefi, Ahmad Nejati, Seyed Mohsen Zahraei, Sussan Mahmoudi, Najmeh Parhizgari, Seyed Mohammad Jazayeri Farsani, Mahmood Mahmoodi, Rakhshandeh Nategh, Shohreh Shahmahmoodi


Background and Objectives: Acute flaccid paralysis (AFP) is a complicated clinical syndrome with a wide range of potential etiologies. Several infectious agents including different virus families have been isolated from AFP cases. In most surveys, Non-polio Enteroviruses (NPEVs) have been detected as main infectious agents in AFP cases; however, there are also some reports about Adenovirus isolation in these patients. In this study, NPEVs and Adenoviruses in stool specimens of AFP cases with or without Residual Paralysis (RP) with negative results for poliovirus are investigated.

Materials and Methods: Nucleic acid extractions from 55 AFP cases were examined by nested PCR or semi-nested PCR with specific primers to identify NPEVs or Adenoviruses, respectively. VP1 (for Enteroviruses) and hexon (for Adenoviruses) gene amplification products were sequenced and compared with available sequences in the GenBank.

Results: From 55 fecal (37 RP+ and 18 RP-) specimens, 7 NPEVs (12.7%) (2 cases in RP+) and 7 Adenoviruses (12.7%) (4 cases in RP+) were identified. Echovirus types 3, 17 and 30, Coxsackie virus A8, and Enterovirus 80 were among NPEVs and Adenoviruses type 2 and 41 were also identified.

Conclusion: Our finding shows that NPEVs and Adenoviruses may be isolated from the acute flaccid paralyses but there is no association between the residual paralyses and virus detection.


Acute flaccid paralysis; Residual paralysis; Non-polio Enterovirus; Adenovirus

Full Text:



World Health Organisation. Polio laboratory manual. 2004.

Israeli E, Agmon-Levin N, Blank M, Chapman J, Shoenfeld Y. Guillain–Barré syndrome—a classical autoimmune disease triggered by infection or vaccination. Clin Rev Allergy Immunol 2012;42:121-130.

Marx A, Glass JD, Sutter RW. Differential diagnosis of acute flaccid paralysis and its role in poliomyelitis surveillance. Epidemiol Rev 2000;22:298-316.

Shahmahmoodi S, Mehrabi Z, Eshraghian MR, Azad TM, Tabatabaie H, Yousefi M, et al. First detection of Enterovirus 71 from an acute flaccid paralysis case with residual paralysis in Iran. J Clin Virol 2008;42:409-411.

Abbasian F, Saberbaghi T, Moosapour A. Role of Non-polioviruses in acute flaccid paralysis (AFP). J Gastroenterol Hepatol Res 2012;1:44-48.

Centers for Disease Control and Prevention (CDC). Laboratory surveillance for wild and vaccine-derived polioviruses--worldwide, January 2006-June 2007. MMWR Morb Mortal Wkly Rep 2007;56:965-969.

Shoja ZO, Tabatabie H, Shahmahmoudi S, Nategh R. Comparison of cell culture with RT-PCR for Enterovirus detection in stool specimens from patients with acute flaccid paralysis. J Clin Lab Anal 2007;21:232-236.

Bolanaki E, Kottaridi C, Dedepsidis E, Kyriakopoulou Z, Pliaka V, Pratti A, et al. Direct extraction and molecular characterization of Enteroviruses genomes from human faecal samples. Mol Cell Probes 2008; 22: 156-161.

Knipe D, Howley P, Cohen J, Griffin D, Lamb R, Martin M, et al. Fields virology, vol I Lippincott Williams & Wilkins. Philadelphia, PA 2013.

Dhole TN, Ayyagari A, Chowdhary R, Shakya AK, Shrivastav N, Datta T, et al. Non-polio Enteroviruses in acute flaccid paralysis children of India: Vital assessment before polio eradication. J Paediatr Child Health 2009;45:409-413.

Ghebremedhin B. Human adenovirus: Viral pathogen with increasing importance. Eur J Microbiol Immunol (Bp) 2014;4:26-33.

Wold W, Ison M. (2013). Fields virology: Adenoviruses. 6th ed Philadelphia: Wolters Kluwer New-York.

Chuang Y, Chiu C-H, Wong K-S, Huang J-G, Huang Y-C, Chang L-Y, et al. Severe Adenovirus infection in children. J Microbiol Immunol Infect 2003;36:37-40.

Faulkner R, Van Rooyen C. Adenovirus types 3 and 5 isolated from the cerebrospinal fluid of children. Can Med Assoc J 1962;87:1123-1125.

Similä S, Jouppila R, Salmi A, Pohjonen R. Encephalomeningitis in children associated with an Adenovirus type 7 epidemic. Acta Paediatrica 1970;59:310-316.

Ohtsuki N, Kimura S, Nezu A. Three cases with acute encephalopathy related with Adenovirus type 7 infection. No To Hattatsu 2000;32:68-72.

Ooi MH, Wong SC, Clear D, Perera D, Krishnan S, Preston T, et al. Adenovirus type 21—associated acute flaccid paralysis during an outbreak of hand-foot-and-mouth disease in Sarawak, Malaysia. Clin Infect Dis 2003;36:550-559.

Oberste MS, Maher K, Kilpatrick DR, Flemister MR, Brown BA, Pallansch MA. Typing of human Enteroviruses by partial sequencing of VP1. J Clin Microbiol 1999;37:1288-1293.

Nejati A, Farahmand M, Tabatabaie H, Yousefi M, Mollaei-Kandelous Y , Shahmahmoodi S. Molecular typing of Non-polio Enteroviruses isolated from acute flaccid paralysis cases in Iran from 2010 to 2015. Virol Sin 2017;32:249-252.

Bingjun T, Yoshida H, Yan W, Lin L, Tsuji T, Shimizu H, et al. Molecular typing and epidemiology of non-polio Enteroviruses isolated from Yunnan province, the people's republic of China. J Med Virol 2008;80:670-679.

Patti A, Santi A, Fiore L, Vellucci L, De Stefano D, Bellelli E, et al. Enterovirus surveillance of Italian healthy children. Eur J Epidemiol 2000;16:1035-1038.

Kuramitsu M, Kuroiwa C, Yoshida H, Miyoshi M, Okumura J, Shimizu H, et al. Non-polio Enterovirus isolation among families in Ulaanbaatar and Tov province, Mongolia: prevalence, intrafamilial spread, and risk factors for infection. Epidemiol Infect 2005;133:1131-1142.

Gear J. Non-polio causes of polio-like paralytic syndromes. Rev Infect Dis 1984;6 Suppl 2:S379-384.

Hayward JC, Gillespie SM, Kaplan KM, Packer R, Pallansch M, Plotkin S, et al. Outbreak of poliomyelitis-like paralysis associated with Enterovirus 71. Pediatr Infect Dis J 1989;8:611-616.

Apostol LN, Suzuki A, Bautista A, Galang H, Paladin FJ, Fuji N, et al. Detection of non-polio Enteroviruses from 17 years of virological surveillance of acute flaccid paralysis in the Philippines. J Med Virol 2012;84:624-631.

Adewumi M, Japhet M, David O, Oluyege A, Adeniji J, Famurewa O. Non-polio Enteroviruses in faeces of children diagnosed with acute flaccid paralysis in Nigeria. Virol J 2017;14:175.

Tao Z, Wang H, Liu Y, Li Y, Jiang P, Liu G, et al. Non-polio Enteroviruses from acute flaccid paralysis surveillance in Shandong province, China, 1988-2013. Sci Rep 2014;4:6167.

Rahimi P, Tabatabaie H, Gouya MM, Mahmudi M, Musavi T, Rad KS, et al. Direct identification of non-polio Enteroviruses in residual paralysis cases by analysis of VP 1 sequences. J Clin Virol 2009;45:139-141.

Sriwanna P, Chieochansin T, Vuthitanachot C, Vuthitanachot V, Theamboonlers A, Poovorawan Y. Molecular characterization of human Adenovirus infection in Thailand, 2009-2012. Virol J 2013;10:193.

Cherry JD, Jahn CL. Herpangina: the etiologic spectrum. Pediatrics 1965;36:632-634.

Hart R, Miller D. Echovirus-17 infections in Britain 1969-71. Lancet 1973;2:661-664.

Au GG, Beagley LG, Haley ES, Barry RD, Shafren DR. Oncolysis of malignant human melanoma tumors by Coxsackieviruses A13, A15 and A18. Virol J 2011;8:22.

Laxmivandana R, Yergolkar P, Gopalkrishna V, Chitambar SD. Characterization of the non-polio Enterovirus infections associated with acute flaccid paralysis in South-Western India. PLoS One 2013;8:e61650.

Manzara S, Muscillo M, La Rosa G, Marianelli C, Cattani P, Fadda G. Molecular identification and typing of Enteroviruses isolated from clinical specimens. J Clin Microbiol 2002;40:4554-4560.

Ivanova OE, Yurashko OV, Eremeeva TP, Baikova OY, Morozova NS, Lukashev AN. Adenovirus isolation rates in acute flaccid paralysis patients. J Med Virol 2012;84:75-80.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 3.0

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.