A Case Cluster of Aseptic Meningitis Associated With a Newly Identified Recombinant Echovirus 6/Coxsackievirus B1 Enterovirus.

A day care teacher presented with complaints of headache, neck stiffness, and fever. Because of initial concerns about meningococcal meningitis, families of day care attendees were notified, and 10 children from the day care presented for evaluation. Cerebrospinal fluid from the teacher and nasal swabs from 4 children who were febrile were positive for enterovirus on reverse transcription polymerase chain reaction. A novel recombinant enterovirus was cultured from the teacher's cerebrospinal fluid and from 2 of the nasal swabs. The amino-terminal portion of the recombinant virus was derived from echovirus 6, with the carboxy-terminal portion originating from coxsackievirus B1; recombinant segments were most closely related to similar segments from strains isolated in France. Recombination occurred within the C2 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 that may affect virulence.