The unusual manifestations of
TOSV infection reported here occurred in persons from rural areas within Granada Province, where seroprevalence rates have been shown to be higher than in urban areas (3).
Toscana virus (
TOSV) is an arthropodbome virus first isolated in 1971 in central Italy from the sandfly Phlebotomus perniciosus, then from Ph.
Data concerning the geographic distribution of SFSV, SFNV, and
TOSV have drastically increased during the past 2 decades, resulting in a more accurate cartography of their presence in the Mediterranean basin, the Middle East, and central Asia (12-16).
(10) found
TOSV in 16 of 102 patients with fever of unknown origin who were diagnosed with central nervous system infection.
Infections by
TOSV and Leishmania represent an important public health problem in the countries where these pathogens circulate.
Although first data on sandfly fever were acquired from the Balkan region, few studies were published specifically about the situation in Kosovo (4): in 1976, a total of 9.6% of human serum samples contained neutralizing antibodies against SFSV (5) (the exact region of Kosovo was not mentioned), and in 2011, <1% of human serum samples collected in the Peje region contained
TOSV neutralizing antibodies (6).
Forty-one days after symptom onset, a second serum sample was taken from the patient and tested in parallel with the first serum sample by indirect immunofluorescence to detect IgM and IgG antibodies against 4 phleboviruses:
TOSV, SFNV, sandfly fever Sicilian virus (SFSV), and Cyprus virus (Sandfly Fever Virus Mosaic 1; Euroimmun, Lubeck, Germany).
Of 249 pools processed, 8 strains of phleboviruses were isolated: 2
TOSV, 3 Punique virus, and 3 other phleboviruses currently being characterized.
Routine virologic investigation included reverse transcription PCR (RT-PCR) of cerebrospinal fluid (CSF) samples for detection of HEV (Xpert EV system, Cepheid, Sunnyvale, CA, USA),
TOSV (7), and mumps virus (8), and PCR of herpes simplex virus (HSV) and varicella-zoster virus (LC VHS 1/2 Qual and LC VZV systems, respectively; Roche Diagnostics, Mannheim, Germany).
Presence of immunoglobulin (Ig) G and IgM against
TOSV was investigated by using a commercial enzyme immunoassay kit (EIA Enzywell Toscana virus IgG and IgM; DIESSE Diagnostica Senese S.p.A., Siena, Italy) developed by using the recombinant nucleocapsid (N) protein of
TOSV.
We report
TOSV infection of an American male physician, 65 years of age, who traveled to Sicily for 3 weeks and returned to the United States in October 2009.
Results of immunoluorescent assays for
TOSV and SFNV were positive with IgM titers of 1,280 and 160, respectively (cut-off 20) and IgG titers of 5,120 and 640, respectively (cut-off 20).