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Toscana virus encephalitis in Southwest Germany: a retrospective study
R Dersch1, A Sophocleous2, D Cadar3
1Clinic of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, 79106, Freiburg, Germany. Rick.Dersch@uniklinik-freiburg.de.
BMC Neurology
|December 23, 2021
Summary
Toscana virus (TOSV) can cause meningoencephalitis in Germany. This study identified TOSV infections in 4% of patients, suggesting local transmission and the need for broader diagnostic consideration.
Area of Science:
- Medical Entomology
- Virology
- Neurology
Background:
- Toscana virus (TOSV), an arbovirus transmitted by sandflies, is prevalent in the Mediterranean and can cause human meningoencephalitis.
- TOSV vectors are now endemic in Southwestern Germany, yet TOSV is not routinely tested in meningoencephalitis cases, leading to potential underdiagnosis.
Purpose of the Study:
- To investigate the prevalence of TOSV-neuroinvasive disease in patients with unexplained meningoencephalitis in Germany.
- To compare clinical and demographic data of TOSV-positive patients with those infected by enteroviruses.
Main Methods:
- A retrospective cohort study analyzed patients diagnosed with meningoencephalitis between 2006 and 2016 without an identified pathogen.
- Serological tests for TOSV-specific IgG and IgM antibodies were performed on serum and cerebrospinal fluid (CSF).
- Data from TOSV-positive patients were compared to a control group with enterovirus-confirmed meningoencephalitis.
Main Results:
- Out of 138 patients with idiopathic meningoencephalitis, 4% (4/98) showed serological evidence of TOSV infection (2% confirmed, 2% possible).
- None of the identified patients had a recent travel history to TOSV-endemic regions.
- Enterovirus meningoencephalitis served as a comparator cohort for 27 patients.
Conclusions:
- Toscana virus (TOSV) neuroinvasive disease cases were identified in a German patient cohort, indicating autochthonous infections.
- The findings suggest TOSV should be considered in the differential diagnosis of meningoencephalitis in Germany, even without a travel history.
- Further research is needed to determine the origin of endemic TOSV vectors in Germany.
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