Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Institute of Medical Virology, University of Zurich, Winterthurerstrasse 190, 8057, Zurich, Switzerland.
BMC Infect Dis. 2019 Jul 8;19(1):591. doi: 10.1186/s12879-019-4231-9.
We report a rare case of Toscana virus infection imported into Switzerland in a 23-year old man who travelled to Imperia (Italy) 10 days before onset of symptoms. Symptoms included both meningitis and as well epididymitis. This is only the fourth case of Toscana virus reported in Switzerland.
The patient presented with lymphocytic meningitis and scrotal pain due to epididymitis. Meningitis was initially treated with ceftriaxone. Herpes simplex, tick-borne encephalitis, enterovirus, measles, mumps, rubella and Treponema pallidum were excluded with specific polymerase chain reaction (PCR) or serology. In support of routine diagnostic PCR and serology assays, unbiased viral metagenomic sequencing was performed of cerebrospinal fluid and serum. Toscana virus infection was identified in cerebrospinal fluid and the full coding sequence could be obtained. Specific PCR in cerebrospinal fluid and blood and serology with Immunoglobulin (Ig) M and IgG against Toscana virus confirmed our diagnosis. Neurological symptoms recovered spontaneously after 5 days.
This case of Toscana virus infection highlights the benefits of unbiased metagenomic sequencing to support routine diagnostics in rare or unexpected viral infections. With increasing travel histories of patients, physicians should be aware of imported Toscana virus as the agent for viral meningitis and meningoencephalitis.
我们报告了一例罕见的托斯卡纳病毒感染病例，该患者为 23 岁男性，在出现症状前 10 天前往意大利因佩里亚旅行。症状包括脑膜炎和附睾炎。这是瑞士报告的第四例托斯卡纳病毒感染病例。
患者表现为淋巴细胞性脑膜炎和附睾炎引起的阴囊疼痛。脑膜炎最初用头孢曲松治疗。通过特异性聚合酶链反应（PCR）或血清学排除了单纯疱疹病毒、蜱传脑炎病毒、肠道病毒、麻疹、腮腺炎、风疹和梅毒螺旋体感染。为支持常规诊断 PCR 和血清学检测，对脑脊液和血清进行了无偏倚的病毒宏基因组测序。在脑脊液中鉴定出了托斯卡纳病毒感染，并获得了完整的编码序列。脑脊液和血液中的特异性 PCR 以及针对托斯卡纳病毒的 IgM 和 IgG 血清学检测证实了我们的诊断。神经症状在 5 天后自发恢复。
本例托斯卡纳病毒感染突出了无偏倚宏基因组测序在支持罕见或意外病毒感染常规诊断中的作用。随着患者旅行史的增加，医生应意识到输入性托斯卡纳病毒可引起病毒性脑膜炎和脑膜脑炎。
