engleski

Prevalence and molecular epidemiology of West Nile infections in Osijek-Baranja County, 2012-2018

In Osijek-Baranja County, first cases of West Nile virus (WNV) infections were confirmed at the end of August and early September 2012 in five patients with neuroinvasive disease. In 2017, there were two cases of neuroinvasive disease, while in 2018, the largest WNV epidemic has been recorded in Croatia as well as in Osijek-Baranja Country. Seventeen patients with neuroinvasive disease were hospitalized. Among 24 patients, there were 14 (58.3%) women and 10 (41.7%) men. The mean patient's age was 65.5 years (range 6-90 years). Eleven patients (45.8%) were from rural areas and 13 patients (54.2%) were from urban areas. Majority of patients were hospitalized in August (14/57.5%) and September (7/29.2%). Twenty- one patients (87.5%) reported an underlying disease, most commonly hypertension and diabetes. WNV neuroinvasive disease was presented as meningoencephalitis in 22 (91.6%) patients, acute cerebellitis in one female child (4.2%) and afebrile polyradiculoneuritis in one young woman (4.2%). The most common symptoms were fever (22/91.66%), headache (21/87.5%]), nausea (15/62.5%), changes in mental status (12/50.0%), neck stiffness (12/50.0%), vomiting (9/37.5%) and photophobia (5/20.8%). Cerebrospinal fluid (CSF) examination showed pleocytosis (leukocytes mean value 103.5x106/L ; 30% lymphocytes ; 49% neutrophils) and mild elevated protein level (mean value 0.756 g/L). Slow diffuse dysrhythmia in EEG was detected in 19 patients (79.2%). CT scans showed generalized brain atrophy in 6 patients (25.0%). WNV diagnosis was confirmed by detection of WNV IgM and low avidity IgG antibodies in serum and CSF and/or detection of WNV RNA in CSF and/or urine samples. Five sequenced strains showed circulation of WNV lineage 2. The patients were initially treated with acyclovir, ampicillin and ceftriaxone intravenously (until the completion of virology results) with a supportive (antiedematous) therapy. Two patients died (8.3%) and the other 22 patients (91.7%) recovered fully. The presented results indicate that Osijek- Baranja County is endemic area for WNV which was further supported by high WNV seropositivity rate in poultry and horses.

West Nile virus ; prevalence ; molecular epidemiology ; Osijek-Baranja County

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