title: Human West Nile virus infection in Bosnia and Herzegovina.
abstract: OBJECTIVE
  To describe the first two cases of West Nile virus (WNV) neuroinvasive infections in Bosnia and Herzegovina.
  
  
  METHODS
  At the Clinic for Infectious Diseases of the University Clinical Centre Tuzla, Bosnia and Herzegovina (BiH), specific screening for WNV infection was performed on patients with neuroinvasive diseases from 1 August to 31 October 2013. Serum samples were tested for the presence of WNV IgM and IgG antibodies using enzyme-linked immunosorbent assay (ELISA); positive serum samples were further analyzed by detection of WNV nucleic acid of two distinct lineages (lineage 1 and lineage 2) in sera by RT-PCR.
  
  
  RESULTS
  Three (out of nine) patients met clinical criteria, and two of them had high serum titre of WNV specific IgM antibodies (3.5 and 5.2). Serum RT-PCR testing was negative. Conformation by neutralization testing was not performed. Both cases represented with encephalitis. None of these cases had recent travel history in WNW endemic areas, or history of blood transfusion and organ transplantation, so they represented autochthonous cases.
  
  
  CONCLUSIONS
  Although there were no previous reports of flavivirus infections in BiH, described cases had high titre of WNV specific antibodies in serum, and negative flavivirus-vaccination history, they were defined as probable cases because recommended testing for case confirmation was not performed. The West Nile virus should be considered a possible causative pathogen in this area, probably in patients with mild influenza-like disease of unknown origin and those with neuroinvasive disease during late summer and early autumn.
authors: Clinic for Infectious Diseases, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina.
authors: Sead
authors: S
authors: Ahmetagić
authors: Clinic for Infectious Diseases, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina.
authors: Jovan
authors: J
authors: Petković
authors: International Burch University, Sarajevo, Bosnia and Herzegovina.
authors: Mirsada
authors: M
authors: Hukić
authors: Clinic for Infectious Diseases, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina.
authors: Arnela
authors: A
authors: Smriko-Nuhanović
authors: Clinic for Infectious Diseases, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina.
authors: Dilista
authors: D
authors: Piljić
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017522:Bosnia and Herzegovina; D042241:Early Diagnosis; D018792:Encephalitis, Viral / Q000175:diagnosis / Q000821:virology*; D005260:Female; D006801:Humans; D008297:Male; D014901:West Nile Fever / Q000175:diagnosis / Q000276:immunology / Q000821:virology*; D014902:West Nile virus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*