Acute hydrocephalus due to impaired CSF resorption in Toscana virus meningoencephalitis

Department of Neurology, Charité–Universitätsmedizin Berlin, Berlin, Germany.
Neurology (Impact Factor: 8.29). 08/2012; 79(8):829-31. DOI: 10.1212/WNL.0b013e3182661f1a
Source: PubMed


Toscana virus, a neurotropic infectious agent endemic to Mediterranean countries, classified in the sandfly fever virus group (genus Phlebovirus, family Bunyaviridae), is a frequent cause of aseptic meningitis and encephalitis in Italy.(1) The disease usually has a favorable outcome, and reports of severe courses are rare.(1,2) We present an unusual case of acute hydrocephalus as the initial symptom of Toscana virus meningoencephalitis.

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    ABSTRACT: Toscana virus (TOSV), West Nile virus (WNV) and tickborne encephalitis virus (TBEV) are among major viral pathogens causing febrile disease and meningitis/encephalitis. The impact of these viruses was investigated at a referral centre in Ankara Province, Central Anatolia in 2012, where previous reports suggested virus circulation but with scarce information on clinical cases and vector activity. Serum and/or cerebrospinal fluid samples from 94 individuals were evaluated, in addition to field-collected arthropod specimens that included 767 sandflies and 239 mosquitoes. Viral nucleic acids in clinical samples and arthropods were sought via specific and generic nested/real-time PCRs, and antibody responses in clinical samples were investigated via commercial indirect immunofluorescence tests (IIFTs) and virus neutralization. A WNV antigen assay was also employed for mosquitoes. WNV neuroinvasive disease has been identified in a 63-year-old male via RNA detection, and the WNV strain was characterized as lineage 1. TOSV infections were diagnosed in six individuals (6.3%) via RNA or IgM detection. Partial sequences in a 23-year-old female, presented with fever and transient pancytopenia, were characterized as TOSV genotype A. Febrile disease with arthralgia and/or peripheral cranial nerve involvement was noted in cases with TOSV infections. Previous WNV and TOSV exposures have been observed in 5.3% and 2.1% of the subjects, respectively. No confirmed TBEV exposure could be identified. Morphological identification of the field-collected mosquitoes revealed Culex pipiens sensu lato (74.4%), Anopheles maculipennis (20.9%), An. claviger (2.1%) and others. Sandfly species were determined as Phlebotomus papatasi (36.2%), P. halepensis (27.3%), P. major s. l. (19.3%), P. sergenti (8.9%), P. perfiliewi (4.4%), P. simici (2.6%) and others. Viral infections in arthropods could not be demonstrated. TOSV genotype A and WNV lineage 1 activity have been demonstrated as well as serologically proven exposure in patients. Presence of sandfly and mosquito species capable of virus transmission has also been revealed.
    Zoonoses and Public Health 12/2013; 61(7). DOI:10.1111/zph.12096 · 2.37 Impact Factor