engleski

Neuroinvasive infection caused by Toscana virus - a neglected disease

Toscana virus (TOSV) is an arthropod-borne virus, transmitted to humans by sandflies. Although majority of human TOSV infections are asymptomatic or presented as a non-specific febrile disease, neuroinvasive disease may also occur. TOSV is endemic in the Mediterranean countries with the highest infection rates during summer months. In Croatia, there are very few data on clinical cases of TOSV infection. We present a case report of TOSV infection detected in Croatian patient presented with meningitis. In the summer 2018, a 21-year-old male patient from Middle Dalmatia was admitted to the Infectious Disease Department with a two-day history of fever (up to 38°C), headache, nausea, vomiting and fatigue. At admission, the patient was subfebrile (37.6°C) with normal vital signs. Routine blood laboratory parameters were within normal range. Cerebrospinal fluid (CSF) analysis revealed a white blood cell count of 175 cells/mm3 (76% lymphocytes), a protein level of 0.447 g/L (reference range 0.17-0.37) and a glucose level of 3.78 mmol/L (reference range 2.5- 3.3). Brain computed tomography was normal. Since the CSF findings were suggestive of aseptic meningitis, arboviral etiology was suspected. CSF and serum samples were collected and tested for the presence of neuroinvasive arboviruses: tick- borne encephalitis, West Nile, Usutu, TOSV, Tahyna and Bhanja virus. High titers of both IgM (1000) and IgG (32000) to TOSV in a serum sample indicated acute Toscana infection. TOSV RNA was not detected in the CSF or serum sample. In addition, antibodies to other phleboviruses (sandfly fever Sicilian, Naples and Cyprus virus) were negative. The patient was treated with symptomatic therapy and recovered fully within five days. The presented case highlights the need of increasing awareness of TOSV infection as a possible cause of aseptic meningitis/ meningoencephalitis during the arbovirus transmission season.

Toscana virus ; neuroinvasive infection

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