title: First evidence of simultaneous occurrence of West Nile virus and Usutu virus neuroinvasive disease in humans in Croatia during the 2013 outbreak.
abstract: OBJECTIVE
  We report on first evidence of simultaneous occurrence of West Nile virus (WNV) and Usutu virus (USUV) neuroinvasive infection in humans in Croatia during the transmission season 2013.
  
  
  METHODS
  From June to December 2013, a total of 95 patients with clinically suspected WNV infection (WNV fever and neuroinvasive disease) were tested for WNV IgM/IgG antibodies using enzyme-linked immunosorbent assay. Twenty-six reactive samples were further tested by virus neutralization test for confirmation.
  
  
  RESULTS
  WNV neuroinvasive infection was confirmed in 20 patients, while in three patients USUV neutralizing antibodies were detected. Cases occurred during the 11-week interval (from 24 July to 07 October 2013). Both WNV and USUV cases were distributed in three north-western Croatian counties. In addition to human cases, recent asymptomatic WNV infection (detection of IgM antibodies) was recorded in 9/3,460 (0.3 %) tested sentinel horses. Infected animals were recorded in two eastern and one north-western county.
  
  
  CONCLUSIONS
  Our results indicate co-circulation of WNV and USUV in Croatia. WNV infection could be misdiagnosed with other emerging infectious diseases presenting with neurological symptoms such as USUV infection.
authors.affiliation: Department of Virology, Croatian National Institute of Public Health, School of Medicine University of Zagreb, Rockefellerova 12, 10000, Zagreb, Croatia, tatjana.vilibic-cavlek@hzjz.hr.
authors.forename: T
authors.initials: T
authors.lastname: Vilibic-Cavlek
authors.forename: B
authors.initials: B
authors.lastname: Kaic
authors.forename: L
authors.initials: L
authors.lastname: Barbic
authors.forename: I
authors.initials: I
authors.lastname: Pem-Novosel
authors.forename: V
authors.initials: V
authors.lastname: Slavic-Vrzic
authors.forename: V
authors.initials: V
authors.lastname: Lesnikar
authors.forename: S
authors.initials: S
authors.lastname: Kurecic-Filipovic
authors.forename: A
authors.initials: A
authors.lastname: Babic-Erceg
authors.forename: E
authors.initials: E
authors.lastname: Listes
authors.forename: V
authors.initials: V
authors.lastname: Stevanovic
authors.forename: I
authors.initials: I
authors.lastname: Gjenero-Margan
authors.forename: G
authors.initials: G
authors.lastname: Savini
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D057134:Antibodies, Neutralizing / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D017523:Croatia / Q000453:epidemiology; D004196:Disease Outbreaks; D018349:Encephalitis Viruses, Japanese / Q000302:isolation & purification; D004671:Encephalitis, Arbovirus / Q000453:epidemiology*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D009500:Neutralization Tests; D014901:West Nile Fever / Q000453:epidemiology*; D014902:West Nile virus / Q000302:isolation & purification
chemical_list: D057134:Antibodies, Neutralizing; D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M