Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy, Haydarpasa Training and Research Hospital, Istanbul, Turkey.
Clin Microbiol Infect. 2014 Apr;20(4):319-25. doi: 10.1111/1469-0691.12310. Epub 2013 Aug 1.
The objective of this study was to identify the impact of West Nile virus (WNV) and Toscana virus (TOSV) in febrile diseases of unknown aetiology in Eastern Thrace, Turkey; this study was conducted during August-October 2012, and included 18 clinical cases and 296 blood donors for local serosurveillance. Antibodies were determined via commercial assays and further tested for specificity via neutralization assays (NA). Viral RNAs were sought via specific and/or generic primers. WNV infections were diagnosed in seven patients (38.8%), detected via RNA+IgM in four, RNA in one and IgM and low avidity IgG in two cases. The most common symptom was fever (>38°C), followed by headache, malaise/fatigue, myalgia/arthralgia, muscle stiffness/lower back pain, anorexia, nausea/vomiting, diarrhoea, supraorbital/retrobulbar pain and abdominal pain. Neurological symptoms were noted in one individual. WNV strains in RNA-detectable patients were characterized as lineage 1. TOSV RNA or IgM were identified in two individuals with confirmed WNV infections and in one patient without evidence of WNV exposure. The clinical and laboratory findings in individuals with WNV/TOSV co-infection were comparable to those in WNV-induced disease. The TOSV strain in the patient with detectable viral RNA was characterized as genotype A. In local blood donors, seroreactivity for specific WNV and TOSV immunoglobulins was observed in 1.7% (5/296) and 14.4% (26/180), respectively. These findings indicate the emergence of WNV and TOSV-associated diseases in Eastern Thrace. WNV/TOSV co-infections were documented for the first time.
本研究旨在确定西尼罗河病毒（WNV）和托斯卡纳病毒（TOSV）对土耳其东色雷斯地区不明病因发热性疾病的影响。该研究于 2012 年 8 月至 10 月进行，包括 18 例临床病例和 296 名用于当地血清学监测的献血者。采用商业检测方法检测抗体，并通过中和检测（NA）进一步检测其特异性。通过特异性和/或通用引物检测病毒 RNA。通过 RNA+IgM 在 4 例、RNA 在 1 例和 IgM 和低亲和力 IgG 在 2 例中诊断出 7 例患者（38.8%）的 WNV 感染。最常见的症状是发热（>38°C），其次是头痛、不适/疲劳、肌痛/关节痛、肌肉僵硬/下腰痛、食欲不振、恶心/呕吐、腹泻、眶上/球后痛和腹痛。1 例患者出现神经系统症状。RNA 可检测到的患者中的 WNV 株被表征为谱系 1。在 2 例确诊的 WNV 感染患者和 1 例无 WNV 暴露证据的患者中，鉴定出 TOSV RNA 或 IgM。WNV/TOSV 合并感染患者的临床和实验室发现与 WNV 引起的疾病相似。可检测到病毒 RNA 的患者中的 TOSV 株被表征为基因型 A。在当地献血者中，特异性 WNV 和 TOSV 免疫球蛋白的血清反应性分别为 1.7%（5/296）和 14.4%（26/180）。这些发现表明 WNV 和 TOSV 相关疾病在东色雷斯的出现。首次记录到 WNV/TOSV 合并感染。
