Antonello Roberta Maria, Formica Giuseppe, Attala Letizia, Mannini Dario, Zammarchi Lorenzo, Bartoloni Alessandro, Di Pietro Massimo Antonio
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Infectious Diseases Unit, Ospedale Santa Maria Annunziata, Bagno a Ripoli, Florence, Italy.
IDCases. 2024 Jul 21;37:e02034. doi: 10.1016/j.idcr.2024.e02034. eCollection 2024.
Toscana virus (TOSV) is an emerging cause of central nervous system (CNS) infections, especially in endemic countries during summer. Cerebrospinal fluid (CSF) is usually clear, with < 500 leukocytes/mm, normal glucose (> 60 % serum glucose) and normal (< 45 mg/dL) to slightly increased protein levels. Here we present two cases of TOSV meningitis with misleading CSF characteristics observed at Santa Maria Annunziata Hospital (Bagno a Ripoli, Florence, Italy). Case 1 presented with signs and symptoms of meningitis. CSF was opalescent on macroscopic examination, with 1192 cells/mm, hypoglycorrhachia (30 % serum glucose) and hyperproteinorachia (228.0 mg/dL). TOSV meningitis was confirmed with serology. Case 2 presented with headache, vomiting and mild neck stiffness. CSF was slightly turbid, with 1092 cells/mm, normal glucose (61 % serum glucose) and slightly increased protein (77.0 mg/dL) levels. TOSV meningitis was confirmed with serology and molecular test on CSF. We performed a literature review including cases of TOSV neuroinvasive infections in which CSF characteristics were reported. Pleocytosis > 500 cells/mm was reported in 12/62 (19.4 %) patients, hypoglycorrhachia in 3/62 (4.8 %) patients, mild hyperproteinorachia (45 - 75 mg/dL) in 7/62 (11.3 %) patients and severe hyperproteinorachia (> 75 mg/dL) in 40/62 (64.5 %) patients. TOSV should be considered in the differential diagnosis of CNS infections in endemic areas during the warm season even when CSF examination shows atypical results.
托斯卡纳病毒（TOSV）是中枢神经系统（CNS）感染的一个新兴病因，尤其是在夏季的流行国家。脑脊液（CSF）通常清澈，白细胞计数<500/mm，葡萄糖正常（>血清葡萄糖的60%），蛋白质水平正常（<45mg/dL）或略有升高。在此，我们报告在圣玛丽亚·安农齐亚塔医院（意大利佛罗伦萨巴尼奥阿里波利）观察到的两例具有误导性脑脊液特征的TOSV脑膜炎病例。病例1表现出脑膜炎的体征和症状。脑脊液宏观检查呈乳白色，细胞计数为1192/mm，脑脊液低糖（血清葡萄糖的30%）和高蛋白（228.0mg/dL）。血清学检查确诊为TOSV脑膜炎。病例2表现为头痛、呕吐和轻度颈部僵硬。脑脊液轻度浑浊，细胞计数为1092/mm，葡萄糖正常（血清葡萄糖的61%），蛋白质水平略有升高（77.0mg/dL）。脑脊液的血清学和分子检测确诊为TOSV脑膜炎。我们进行了一项文献综述，纳入了报告了脑脊液特征的TOSV神经侵袭性感染病例。62例患者中有12例（19.4%）报告有细胞增多>500/mm，3例（4.8%）有脑脊液低糖，7例（11.3%）有轻度高蛋白（45 - 75mg/dL），40例（64.5%）有重度高蛋白（>75mg/dL）。即使脑脊液检查显示非典型结果，在温暖季节的流行地区，中枢神经系统感染的鉴别诊断中也应考虑TOSV。
