In a moment of serendipity when investigating a case of meningitis in a daycare worker, University of Florida Emerging Pathogens Institute members stumbled upon a new virus caused by the recombination of genes.
It was late into the night when children and family members — still rubbing the sleep from their eyes — were seen in the UF Health emergency department for comprehensive testing after alarm bells rang regarding possible exposure to meningococcal meningitis. Several hours prior, their daycare worker was admitted to a different hospital’s emergency room complaining of headache, neck stiffness and fever.
At the time, the results from the initial hospital’s spinal tap suggested a diagnosis of meningococcal meningitis, a potentially serious bacterial infection of the membranes surrounding the brain and spinal cord. Based on this initial diagnosis, the daycare worker and four of the children were started on powerful antibiotics. However, further tests at UF revealed that the issue was not meningococcal meningitis. Instead, it was an infection caused by a previously undiscovered virus that was resulting in meningitis-like symptoms in the daycare worker and the children. Once this diagnosis was made, it was possible to stop antibiotic therapy.
Further genomic testing led by EPI Interim Director Marco Salemi, Ph.D., identified this virus as a recombinant strain combining genes from echovirus6 and Coxsackievirusb1 — a new enterovirus variant. All those infected fully recovered, but without expanding testing to identify another potential culprit, the treatment process would have taken longer with a much greater risk of side effects.
“Sometimes it’s difficult to say whether it’s a virus or it’s a bacterial infection, and that’s why (genetic testing and) sequencing is so important, because first of all, it clarifies whether it’s a virus or a bacteria, and also it can show whether you’re dealing with a strain that is already known or something new that has evolved and is beginning to circulate in the population,” Salemi said.
Enteroviruses are a group of viruses that tend to originate in the gastrointestinal tract, with over 100 strains responsible for various human illnesses. Common examples of diseases caused by enteroviruses include upper respiratory tract infections, meningitis, encephalitis and hand, foot and mouth disease. Healthcare providers are not required to notify state health departments of enterovirus cases or outbreaks, but this finding may be the push needed to begin monitoring them.
Kartikeya Cherabuddi, M.D., a former EPI member who led this collaborative effort, hopes this case study connects the hospital clinic network with the public health network and encourages the medical community to invest more in testing for a broader range of pathogens.
“When winter hits, or when we notice that there are higher community events, knowing what type of virus is circulating helps us be prepared better … and that can potentially help prevent a much larger outbreak,” said Cherabuddi, who now serves as the Chief Epidemiology Officer at Tampa General Hospital.
Founding EPI Director Glenn Morris, M.D., emphasizes how this scenario underscores the need to continuously identify emerging pathogens to safeguard communities. This recombinant enterovirus may not be a current cause for alarm, but proactive attention to its discovery reflects a larger commitment to public health preparedness.
“What (this paper) does is say maybe we should be looking more closely at these (enterovirus) cases, because then it gets down to, how do you identify an emerging pathogen?” Morris said.
That diagnostic precision creates a domino effect in health care. Once testing confirmed a viral cause in the daycare children’s infections, it became clear the antibiotics were ineffective.
Though often lifesaving, antibiotics do not treat viral infections and, when used unnecessarily, can prolong recovery and fuel antibiotic resistance. Published in the Journal of Infectious Diseases, the case of the daycare infections highlights how academic medical centers and public health networks collaborate to identify new viruses, respond effectively and prevent treatment misuse.
Written by: Sydney Burge