ABSTRACT
Toscana virus (TOSV) is identified in sandflies, animals, and humans around the Mediterranean Sea. TOSV has not been reported in Australia. During investigations of cerebrospinal fluid samples from patients with encephalitis, TOSV genetic sequences were identified in a traveler returning to Australia from Europe. TOSV should be considered, especially during May to October, in travelers to Australia who embarked in countries in and around the Mediterranean Sea and who subsequently present for medical care because of neurological symptoms.
Subject(s)
Encephalitis, Viral/diagnosis , Phlebotomus Fever/diagnosis , Sandfly fever Naples virus/isolation & purification , Travel-Related Illness , Animals , Antibodies, Viral/blood , Encephalitis, Viral/cerebrospinal fluid , Encephalitis, Viral/virology , Europe , Humans , Insect Vectors/virology , Middle Aged , Phlebotomus Fever/cerebrospinal fluid , Phlebotomus Fever/virology , Psychodidae/virology , Retrospective Studies , Sandfly fever Naples virus/genetics , Sequence Analysis, DNAABSTRACT
Toscana virus was detected by reverse transcription-nested PCR in 5.6% of cerebrospinal fluid (CSF) samples from patients with meningitis and encephalitis during the summer in southern Italy. The central nervous system infections were associated with young adults and with a substantially benign clinical course. Presenting features and CSF findings are also discussed in the present report.
Subject(s)
Encephalitis, Viral/epidemiology , Meningitis, Viral/epidemiology , Phlebotomus Fever/epidemiology , Sandfly fever Naples virus/isolation & purification , Adolescent , Adult , Cerebrospinal Fluid/virology , Encephalitis, Viral/cerebrospinal fluid , Encephalitis, Viral/virology , Female , Humans , Italy/epidemiology , Male , Meningitis, Viral/cerebrospinal fluid , Meningitis, Viral/virology , Phlebotomus Fever/cerebrospinal fluid , Phlebotomus Fever/virology , Reverse Transcriptase Polymerase Chain Reaction , Sandfly fever Naples virus/classification , Sandfly fever Naples virus/geneticsABSTRACT
Acute lymphocytic meningitis, seen in France in summer, is often due to enteroviruses. Arboviruses as West Nile and tick-borne encephalitis do exist in Europe, but other viruses are rarely considered in patients unless they have had recent tropical travel. Toscana virus infection, which is endemic, especially in Italy,1-3 has been documented in some European travelers returning from Italy,4-6 but surprisingly was not documented in France until recently.7 We report a case of meningitis caused by Toscana virus imported to France.
Subject(s)
Meningitis, Viral/diagnosis , Phlebotomus Fever/diagnosis , Sandfly fever Naples virus/isolation & purification , Travel , Acute Disease , Diagnosis, Differential , Female , France , Humans , Italy , Meningitis, Viral/cerebrospinal fluid , Meningitis, Viral/virology , Middle Aged , Phlebotomus Fever/cerebrospinal fluid , Phlebotomus Fever/virologyABSTRACT
A 44-year-old woman suffered fever, headache and meningism during a summer stay in a region of central Italy where sand-fly fever is endemic. A few days after returning to the Netherlands, she appeared mentally and physically slow but had no fever. Because of the possibility of viral meningitis an examination of the cerebrospinal fluid (CSF) was carried out. This revealed a cell count of 1074/3 cells. Toscana virus antibodies of the IgG and IgM subclass were detected in two respective serum samples and in the CSF. This led to the diagnosis 'Toscana virus meningo-encephalitis'. Toscana virus is classified amongst the sandfly fever virus group. These viruses are transmitted by sand flies (Phlebotomus species) which reside in humid areas around the Mediterranean. Toscana virus is the main cause of viral meningoencephalitis in some areas of central Italy and possibly in southern Spain. The patient recovered within a few days without antiviral therapy. Toscana virus meningo-encephalitis should be included in the differential diagnosis of holidaymakers with neurological symptoms returning from the Mediterranean.
Subject(s)
Meningitis, Viral/diagnosis , Phlebotomus Fever/diagnosis , Sandfly fever Naples virus/isolation & purification , Adult , Antibodies, Viral/blood , Antibodies, Viral/cerebrospinal fluid , Diagnosis, Differential , Female , Humans , Immunoglobulin G/blood , Immunoglobulin G/cerebrospinal fluid , Immunoglobulin M/blood , Immunoglobulin M/cerebrospinal fluid , Italy , Meningitis, Viral/cerebrospinal fluid , Meningitis, Viral/virology , Phlebotomus Fever/cerebrospinal fluid , Phlebotomus Fever/virology , Sandfly fever Naples virus/immunology , TravelABSTRACT
A recombinant enzyme immunoassay (rEIA) to detect serum immunoglobulin M (IgM) and IgG to Toscana virus (TOSV) was developed with the aim of establishing a simple and easily available assay for diagnosing acute and/or previous infections. The rEIA, based on the recombinant nucleoprotein of TOSV expressed in Escherichia coli, was evaluated with 97 serum samples collected in an area where TOSV is endemic and compared to an analogous assay based on cell-derived TOSV. Discordant results were resolved by immunoblotting (IB). Twenty-two of these samples, obtained from subjects hospitalized during the summer season with meningitis of suspected TOSV etiology, were further characterized by indirect immunofluorescence and IB, and detection of specific TOSV RNA sequences in the cerebrospinal fluid of these patients was attempted by nested PCR. The results indicated that rEIA was able to diagnose acute TOSV infection by detection of specific serum IgM in all of the subjects with TOSV meningitis confirmed by nested PCR or serology. The overall sensitivity and specificity of rEIA were both 100% for IgM detection and 100 and 96.6%, respectively, for IgG detection. Thus, rEIA appears to be a simple and reliable laboratory test for the diagnosis of acute TOSV infection and for the assessment of immune status.
