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
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
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