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Toscana virus causing severe meningoencephalitis in an elderly traveller
  1. J Kuhn1,
  2. H Bewermeyer1,
  3. U Hartmann-Klosterkoetter1,
  4. P Emmerich2,
  5. S Schilling2,
  6. M Valassina3
  1. 1Department of Neurology, Kliniken der Stadt Köln, Krankenhaus Merheim, Cologne, Germany
  2. 2Bernhard Nocht Institute For Tropical Medicine, Department of Virology, Hamburg, Germany
  3. 3University of Siena, Department of Molecular Biology, Microbiology Section, Laboratory of Virology, Siena, Italy
  1. Correspondence to:
 Dr Jens Kuhn
 Department of Neurology, Kliniken der Stadt Köln, Krankenhaus Merheim, Ostmerheimerstrasse 200, 51109 Cologne, Germany;;

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Toscana virus (TOSV) is classified in the sandfly fever virus group of arboviruses (family Bunyaviridae, genus Phlebovirus) along with Sicilian (SFSV) and Neapolitan (SFNV) sandfly fever virus. SFSV and SFNV cause a transient febrile illness, whereas TOSV also causes mild acute aseptic meningitis. In endemic regions TOSV has been identified as an important cause of viral aseptic meningitis among the indigenous population. TOSV is transmitted by the sandfly species Phlebotomus perniciosus and Phlebotomus perfiliewi. Circulation of TOSV follows the distribution of its vectors—that is, the Mediterranean, Middle East, Western Asia, and North Africa—and the disease coincides with the seasonal life cycle of insect vectors.1,3 Laboratory confirmation of clinically suspected cases can be carried out by detection of anti-TOSV IgG or IgM antibodies in blood and cerebrospinal fluid (CSF) using different techniques. Direct detection of virus is possible by cell culture or reverse transcriptase polymerase chain reaction (RT-PCR) but will often fail because of the short term nature of the viraemia.

Throughout the last decades there have been increasing numbers of cases of TOSV infection imported into northern Europe from endemic areas. Among other causes, it therefore now has to be considered in the differential diagnosis of acute aseptic meningitis.1,2

Case report

Four days after having returned from Malaga, Spain, in July 2004 an 80 year …

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  • Competing interests: none declared