title: Emergence and co-infections of West Nile virus and Toscana virus in Eastern Thrace, Turkey.
abstract: 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.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Gulhane Military Medical Academy, Haydarpasa Training and Research Hospital, Istanbul, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Erdem
authors.forename: K
authors.initials: K
authors.lastname: Ergunay
authors.forename: A
authors.initials: A
authors.lastname: Yilmaz
authors.forename: H
authors.initials: H
authors.lastname: Naz
authors.forename: F
authors.initials: F
authors.lastname: Akata
authors.forename: A S
authors.initials: AS
authors.lastname: Inan
authors.forename: A
authors.initials: A
authors.lastname: Ulcay
authors.forename: F
authors.initials: F
authors.lastname: Gunay
authors.forename: A
authors.initials: A
authors.lastname: Ozkul
authors.forename: B
authors.initials: B
authors.lastname: Alten
authors.forename: V
authors.initials: V
authors.lastname: Turhan
authors.forename: O
authors.initials: O
authors.lastname: Oncul
authors.forename: L
authors.initials: L
authors.lastname: Gorenek
mesh_terms: D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D002044:Bunyaviridae Infections / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D060085:Coinfection / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D005260:Female; D006801:Humans; D008297:Male; D008969:Molecular Sequence Data; D012367:RNA, Viral / Q000235:genetics; D029301:Sandfly fever Naples virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D017422:Sequence Analysis, DNA; D014421:Turkey / Q000453:epidemiology; D014901:West Nile Fever / Q000150:complications* / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D014902:West Nile virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral
keywords: TOSV; Thrace; Toscana virus; Turkey; WNV; West Nile virus