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Clinical, Virological, and Immunological Findings in Patients with Toscana Neuroinvasive Disease in Croatia: Report of Three Cases

Toscana virus (TOSV) is an arthropod-borne virus, transmitted to humans by phlebotomine sandflies. Although the majority of infections are asymptomatic, neuroinvasive disease may occur. We report three cases of neuroinvasive TOSV infection detected in Croatia. Two patients aged 21 and 54 years prese...

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Autores principales: Vilibic-Cavlek, Tatjana, Zidovec-Lepej, Snjezana, Ledina, Dragan, Knezevic, Samira, Savic, Vladimir, Tabain, Irena, Ivic, Ivo, Slavuljica, Irena, Bogdanic, Maja, Grgic, Ivana, Gorenec, Lana, Stevanovic, Vladimir, Barbic, Ljubo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557803/
https://www.ncbi.nlm.nih.gov/pubmed/32937866
http://dx.doi.org/10.3390/tropicalmed5030144
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author Vilibic-Cavlek, Tatjana
Zidovec-Lepej, Snjezana
Ledina, Dragan
Knezevic, Samira
Savic, Vladimir
Tabain, Irena
Ivic, Ivo
Slavuljica, Irena
Bogdanic, Maja
Grgic, Ivana
Gorenec, Lana
Stevanovic, Vladimir
Barbic, Ljubo
author_facet Vilibic-Cavlek, Tatjana
Zidovec-Lepej, Snjezana
Ledina, Dragan
Knezevic, Samira
Savic, Vladimir
Tabain, Irena
Ivic, Ivo
Slavuljica, Irena
Bogdanic, Maja
Grgic, Ivana
Gorenec, Lana
Stevanovic, Vladimir
Barbic, Ljubo
author_sort Vilibic-Cavlek, Tatjana
collection PubMed
description Toscana virus (TOSV) is an arthropod-borne virus, transmitted to humans by phlebotomine sandflies. Although the majority of infections are asymptomatic, neuroinvasive disease may occur. We report three cases of neuroinvasive TOSV infection detected in Croatia. Two patients aged 21 and 54 years presented with meningitis, while a 22-year old patient presented with meningoencephalitis and right-sided brachial plexitis. Cerebrospinal fluid (CSF), serum, and urine samples were collected and tested for neuroinvasive arboviruses: tick-borne encephalitis, West Nile, Usutu, TOSV, Tahyna, and Bhanja virus. In addition, CSF and serum samples were tested for the anti-viral cytokine response. High titers of TOSV IgM (1000–3200) and IgG (3200−10,000) antibodies in serum samples confirmed TOSV infection. Antibodies to other phleboviruses (sandfly fever Sicilian/Naples/Cyprus virus) were negative. CSF samples showed high concentrations of interleukin 6 (IL-6; range 162.32−2683.90 pg/mL), interferon gamma (IFN-γ; range 110.12−1568.07 pg/mL), and IL-10 (range 28.08−858.91 pg/mL), while significantly lower cytokine production was observed in serum. Two patients recovered fully. The patient with a brachial plexitis improved significantly at discharge. The presented cases highlight the need of increasing awareness of a TOSV as a possible cause of aseptic meningitis/meningoencephalitis during summer months. Association of TOSV and brachial plexitis with long-term sequelae detected in one patient indicates the possibility of more severe disease, even in young patients.
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spelling pubmed-75578032020-10-22 Clinical, Virological, and Immunological Findings in Patients with Toscana Neuroinvasive Disease in Croatia: Report of Three Cases Vilibic-Cavlek, Tatjana Zidovec-Lepej, Snjezana Ledina, Dragan Knezevic, Samira Savic, Vladimir Tabain, Irena Ivic, Ivo Slavuljica, Irena Bogdanic, Maja Grgic, Ivana Gorenec, Lana Stevanovic, Vladimir Barbic, Ljubo Trop Med Infect Dis Case Report Toscana virus (TOSV) is an arthropod-borne virus, transmitted to humans by phlebotomine sandflies. Although the majority of infections are asymptomatic, neuroinvasive disease may occur. We report three cases of neuroinvasive TOSV infection detected in Croatia. Two patients aged 21 and 54 years presented with meningitis, while a 22-year old patient presented with meningoencephalitis and right-sided brachial plexitis. Cerebrospinal fluid (CSF), serum, and urine samples were collected and tested for neuroinvasive arboviruses: tick-borne encephalitis, West Nile, Usutu, TOSV, Tahyna, and Bhanja virus. In addition, CSF and serum samples were tested for the anti-viral cytokine response. High titers of TOSV IgM (1000–3200) and IgG (3200−10,000) antibodies in serum samples confirmed TOSV infection. Antibodies to other phleboviruses (sandfly fever Sicilian/Naples/Cyprus virus) were negative. CSF samples showed high concentrations of interleukin 6 (IL-6; range 162.32−2683.90 pg/mL), interferon gamma (IFN-γ; range 110.12−1568.07 pg/mL), and IL-10 (range 28.08−858.91 pg/mL), while significantly lower cytokine production was observed in serum. Two patients recovered fully. The patient with a brachial plexitis improved significantly at discharge. The presented cases highlight the need of increasing awareness of a TOSV as a possible cause of aseptic meningitis/meningoencephalitis during summer months. Association of TOSV and brachial plexitis with long-term sequelae detected in one patient indicates the possibility of more severe disease, even in young patients. MDPI 2020-09-14 /pmc/articles/PMC7557803/ /pubmed/32937866 http://dx.doi.org/10.3390/tropicalmed5030144 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Vilibic-Cavlek, Tatjana
Zidovec-Lepej, Snjezana
Ledina, Dragan
Knezevic, Samira
Savic, Vladimir
Tabain, Irena
Ivic, Ivo
Slavuljica, Irena
Bogdanic, Maja
Grgic, Ivana
Gorenec, Lana
Stevanovic, Vladimir
Barbic, Ljubo
Clinical, Virological, and Immunological Findings in Patients with Toscana Neuroinvasive Disease in Croatia: Report of Three Cases
title Clinical, Virological, and Immunological Findings in Patients with Toscana Neuroinvasive Disease in Croatia: Report of Three Cases
title_full Clinical, Virological, and Immunological Findings in Patients with Toscana Neuroinvasive Disease in Croatia: Report of Three Cases
title_fullStr Clinical, Virological, and Immunological Findings in Patients with Toscana Neuroinvasive Disease in Croatia: Report of Three Cases
title_full_unstemmed Clinical, Virological, and Immunological Findings in Patients with Toscana Neuroinvasive Disease in Croatia: Report of Three Cases
title_short Clinical, Virological, and Immunological Findings in Patients with Toscana Neuroinvasive Disease in Croatia: Report of Three Cases
title_sort clinical, virological, and immunological findings in patients with toscana neuroinvasive disease in croatia: report of three cases
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557803/
https://www.ncbi.nlm.nih.gov/pubmed/32937866
http://dx.doi.org/10.3390/tropicalmed5030144
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