The aetiology of acute meningoencephalitis in Sri Lankan children and adults is 
poorly understood. This study was carried out to determine pathogens responsible 
for meningoencephalitis in Sri Lanka. A hospital-based cross-sectional study was 
performed using cerebrospinal fluid samples (22 adult and 17 pediatric) 
collected from August to December 2009 from patients clinically diagnosed with 
acute meningoencephalitis at two tertiary care hospitals in Sri Lanka. Routine 
microbiology for bacterial pathogens together with in-house RT-PCR and PCR 
assays for the detection of dengue viruses, Japanese encephalitis virus, West 
Nile virus, chikungunya virus, enteroviruses, mumps virus, measles virus, herpes 
simplex viruses types 1 and 2, and varicella zoster virus were performed. 
Bacterial pathogens were not isolated from any patient specimens. However, from 
nine of the paediatric patients aged 1 month to 10 years (mean age 5.2 years) 
echovirus 9 (E-9; family Picornaviridae, genus Enterovirus,species Enterovirus B 
) was detected by RT-PCR. All nine patients presented with fever, six had 
headache, and seven had vomiting. Neck stiffness indicating meningitis was 
present in six of the patients. Phylogenetic analysis of partial VP1 and VP4-VP2 
genes showed these E-9 strains to be most closely related to E-9 strains 
detected in CSF from Korea and France in 2005 and 2006. The remaining patients 
were negative for all other viruses tested. E-9 was the most common cause of 
acute meningoencephalitis in the tested paediatric population from Sri Lanka in 
2009, which likely reflects circulation of this E-9 strain between Europe and 
Asia over several years.