title: Sandfly virus seroconversion associated with neurologic presentation.
abstract: OBJECTIVE
  To describe the clinical presentation and unique neurologic manifestations of sandfly viruses (SFVs) in the Jerusalem area.
  
  
  METHODS
  We identified all patients with acute seroconversion to SFV at the Hadassah-Hebrew University Medical Centers during the years 2008-2013 and retrospectively collected and analyzed the clinical and imaging data.
  
  
  RESULTS
  Nine patients (ranging from 1.5 to 85 years old) were identified. Presentation included acute neurologic disease, mostly with fever, change in consciousness and behavior, seizures, headache, meningitis, limb paresis, or myelitis. Eight patients had clinical signs of meningitis, meningoencephalitis, or encephalitis alone. Four patients had myelitis. MRI identified pathologic symmetrical changes in the basal ganglia, thalami, and other deep structures in 5 patients, and additional myelitis of the spine was noted on imaging in 3 patients. Seven patients had long-term follow-up: 4 completely recovered and 3 had remaining neurologic sequelae, among them 1 with permanent severe brain damage.
  
  
  CONCLUSIONS
  Neurologic involvement associated with acute SFV infections is considered to be benign. However, in this series, all 9 patients presented with significant neurologic pathology associated with a unique finding of myelitis and symmetrical basal ganglia, thalami, or white matter involvement. Thus, acute SFV infection should be included in the differential diagnosis in febrile onset of neurologic manifestations and neuroradiologic changes.
authors.affiliation: Departments of Neurology (C.M., A.H., T.B.-H., R.E.), Pediatrics (H.Q., D.A.), Radiology (J.M.G.), Medicine (A.E.-R.B.), and Clinical Microbiology and Infectious Diseases (A.E.M., R.N.-P.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and Israel Central Virology Lab (H.B., Y.L.), Ministry of Health, Tel Hashomer, Israel.
authors.forename: Chen
authors.initials: C
authors.lastname: Makranz
authors.affiliation: Departments of Neurology (C.M., A.H., T.B.-H., R.E.), Pediatrics (H.Q., D.A.), Radiology (J.M.G.), Medicine (A.E.-R.B.), and Clinical Microbiology and Infectious Diseases (A.E.M., R.N.-P.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and Israel Central Virology Lab (H.B., Y.L.), Ministry of Health, Tel Hashomer, Israel.
authors.forename: Hiba
authors.initials: H
authors.lastname: Qutteineh
authors.affiliation: Departments of Neurology (C.M., A.H., T.B.-H., R.E.), Pediatrics (H.Q., D.A.), Radiology (J.M.G.), Medicine (A.E.-R.B.), and Clinical Microbiology and Infectious Diseases (A.E.M., R.N.-P.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and Israel Central Virology Lab (H.B., Y.L.), Ministry of Health, Tel Hashomer, Israel.
authors.forename: Hanna
authors.initials: H
authors.lastname: Bin
authors.affiliation: Departments of Neurology (C.M., A.H., T.B.-H., R.E.), Pediatrics (H.Q., D.A.), Radiology (J.M.G.), Medicine (A.E.-R.B.), and Clinical Microbiology and Infectious Diseases (A.E.M., R.N.-P.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and Israel Central Virology Lab (H.B., Y.L.), Ministry of Health, Tel Hashomer, Israel.
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Lustig
authors.affiliation: Departments of Neurology (C.M., A.H., T.B.-H., R.E.), Pediatrics (H.Q., D.A.), Radiology (J.M.G.), Medicine (A.E.-R.B.), and Clinical Microbiology and Infectious Diseases (A.E.M., R.N.-P.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and Israel Central Virology Lab (H.B., Y.L.), Ministry of Health, Tel Hashomer, Israel.
authors.forename: John Moshe
authors.initials: JM
authors.lastname: Gomori
authors.affiliation: Departments of Neurology (C.M., A.H., T.B.-H., R.E.), Pediatrics (H.Q., D.A.), Radiology (J.M.G.), Medicine (A.E.-R.B.), and Clinical Microbiology and Infectious Diseases (A.E.M., R.N.-P.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and Israel Central Virology Lab (H.B., Y.L.), Ministry of Health, Tel Hashomer, Israel.
authors.forename: Asaf
authors.initials: A
authors.lastname: Honig
authors.affiliation: Departments of Neurology (C.M., A.H., T.B.-H., R.E.), Pediatrics (H.Q., D.A.), Radiology (J.M.G.), Medicine (A.E.-R.B.), and Clinical Microbiology and Infectious Diseases (A.E.M., R.N.-P.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and Israel Central Virology Lab (H.B., Y.L.), Ministry of Health, Tel Hashomer, Israel.
authors.forename: Abed El-Raouf
authors.initials: Ael-R
authors.lastname: Bayya
authors.affiliation: Departments of Neurology (C.M., A.H., T.B.-H., R.E.), Pediatrics (H.Q., D.A.), Radiology (J.M.G.), Medicine (A.E.-R.B.), and Clinical Microbiology and Infectious Diseases (A.E.M., R.N.-P.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and Israel Central Virology Lab (H.B., Y.L.), Ministry of Health, Tel Hashomer, Israel.
authors.forename: Allon E
authors.initials: AE
authors.lastname: Moses
authors.affiliation: Departments of Neurology (C.M., A.H., T.B.-H., R.E.), Pediatrics (H.Q., D.A.), Radiology (J.M.G.), Medicine (A.E.-R.B.), and Clinical Microbiology and Infectious Diseases (A.E.M., R.N.-P.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and Israel Central Virology Lab (H.B., Y.L.), Ministry of Health, Tel Hashomer, Israel.
authors.forename: Tamir
authors.initials: T
authors.lastname: Ben-Hur
authors.affiliation: Departments of Neurology (C.M., A.H., T.B.-H., R.E.), Pediatrics (H.Q., D.A.), Radiology (J.M.G.), Medicine (A.E.-R.B.), and Clinical Microbiology and Infectious Diseases (A.E.M., R.N.-P.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and Israel Central Virology Lab (H.B., Y.L.), Ministry of Health, Tel Hashomer, Israel.
authors.forename: Diana
authors.initials: D
authors.lastname: Averbuch
authors.affiliation: Departments of Neurology (C.M., A.H., T.B.-H., R.E.), Pediatrics (H.Q., D.A.), Radiology (J.M.G.), Medicine (A.E.-R.B.), and Clinical Microbiology and Infectious Diseases (A.E.M., R.N.-P.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and Israel Central Virology Lab (H.B., Y.L.), Ministry of Health, Tel Hashomer, Israel.
authors.forename: Roni
authors.initials: R
authors.lastname: Eichel
authors.affiliation: Departments of Neurology (C.M., A.H., T.B.-H., R.E.), Pediatrics (H.Q., D.A.), Radiology (J.M.G.), Medicine (A.E.-R.B.), and Clinical Microbiology and Infectious Diseases (A.E.M., R.N.-P.), Hadassah-Hebrew University Medical Center, Jerusalem, Israel; and Israel Central Virology Lab (H.B., Y.L.), Ministry of Health, Tel Hashomer, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Nir-Paz