Multicentre evaluation of central nervous system infections due to Flavi and Phleboviruses in Turkey.
OBJECTIVE
Flavi- and Phleboviruses associated with central nervous system (CNS) infections including West Nile Virus (WNV), Tick-borne Encephalitis Virus (TBEV) and Toscana Virus (TOSV) cause significant morbidity and mortality in humans. In this study, the impact of these agents have been investigated in CNS infections at referral hospitals in two provinces in Turkey, where circulation of these viruses have previously been recognized.


METHODS
In the study, 258 samples from 126 individuals from Ankara and 113 samples from 108 individuals from Izmir provinces collected in 2010 were included. Viral RNAs were investigated by multiple genus and strain specific primers. Commercial serological assays were employed in screening and reactive results were evaluated with additional assays and by plaque reduction neutralization assay.


RESULTS
Two cases of WNV CNS infections, 14 cases of TOSV infections and one TBEV-exposed individual were identified via serological testing. WNV infections in 61 and 56-year old individuals from Ankara presented with fever and encephalitis without skin rash and residual neurologic damage. TOSV-associated cases from both provinces mainly displayed signs of meningitis. TOSV exposure was documented for the first time from Izmir.


CONCLUSIONS
WNV, TBEV and TOSV infections must be considered in cases of meningoencephalitis of unknown etiology in Turkey.
Hacettepe University, Faculty of Medicine, Department of Medical Microbiology, 06100 Ankara, Turkey. ekoray@hacettepe.edu.tr
Koray
K
Ergunay
A Arzu
AA
Sayiner
Nadine
N
Litzba
Sabine
S
Lederer
Remi
R
Charrel
Petra
P
Kreher
Durdal
D
Us
Matthias
M
Niedrig
Aykut
A
Ozkul
Gulsen
G
Hascelik
D000328:Adult; D000368:Aged; D002044:Bunyaviridae Infections / Q000453:epidemiology* / Q000821:virology; D004669:Encephalitis Viruses, Tick-Borne / Q000302:isolation & purification*; D004675:Encephalitis, Tick-Borne / Q000453:epidemiology* / Q000821:virology; D005260:Female; D006761:Hospitals; D006801:Humans; D007118:Immunoassay; D008297:Male; D008590:Meningoencephalitis / Q000453:epidemiology* / Q000821:virology; D008875:Middle Aged; D009500:Neutralization Tests; D016133:Polymerase Chain Reaction; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D029301:Sandfly fever Naples virus / Q000302:isolation & purification*; D014421:Turkey / Q000453:epidemiology; D014901:West Nile Fever / Q000453:epidemiology* / Q000821:virology; D014902:West Nile virus / Q000302:isolation & purification*; D055815:Young Adult
D012367:RNA, Viral