Hantavirus Pulmonary Syndrome in Traveler Returning from Nepal to Spain.

Most human hantavirus infections occur in Asia, but some cases have been described in Europe in travelers returning from Asia. We describe a case of hantavirus pulmonary syndrome in a previously healthy traveler occurring shortly after he returned to Spain from Nepal. Serologic tests suggested a Puumala virus-like infection.

Mutations in Coding and Non-Coding Regions in Varicella-Zoster Virus Causing Fatal Hemorrhagic Fever Without Rash in an Immunocompetent Patient: Case Report.

INTRODUCTION: We report the case of a fatal hemorrhagic varicella primary infection in an immunocompetent man and whole-genome characterization of the virus for the investigation of biomarkers of virulence. CASE: A 38-year-old patient born in Nigeria presented to the emergency department with abdominal pain and subsequently developed fatal hemorrhagic disease without skin rash. Extensive laboratory tests including serology and PCR for arenaviruses, bunyaviruses and ebolaviruses were negative. Varicella-zoster virus (VZV) PCR of sera, liver and spleen tissue samples from autopsy revealed the presence of VZV DNA. Primary infection by varicella-zoster virus with hemorrhagic manifestations was diagnosed after virological testing. The VZV genome was sequenced using a mWGS approach. Bioinformatic analysis showed 53 mutations across the genome, 33 of them producing non-synonymous variants affecting up to 14 genes. Some of them, such as ORF11 and ORF 62, encoded for essential functions related to skin or neurotropism. To our knowledge, the mutations reported here have never been described in a VZV causing such a devastating outcome. DISCUSSION: In immunocompetent patients, viral factors should be considered in patients with uncommon symptoms or severe diseases. Some relevant mutations revealed by using whole genome sequencing (WGS) directly from clinical samples may be involved in this case and deserves further investigation. CONCLUSION: Differential diagnosis of varicella-zoster virus in immunocompetent adults should be considered among patients with suspected VHF, even if the expected vesicular rash is not present at admission and does not arise thereafter. Whole genome sequencing of strains causing uncommon symptoms and/or mortality is needed for epidemiological surveillance and further characterization of putative markers of virulence. Additionally, this report highlights the recommendation for a VZV vaccination policy in non-immunized migrants from developing countries.

Phlebovirus-associated diseases transmitted by phlebotominae in Spain: Are we at risk?

The genera Phlebovirus transmitted by Diptera belonging to the Psychodidae family are a cause of self-limited febrile syndrome in the Mediterranean basin in summer and autumn. Toscana virus can also cause meningitis and meningoencephalitis. In Spain, Toscana, Granada, Naples, Sicily, Arbia and Arrabida-like viruses have been detected. The almost widespread distribution of Phlebotomus genus vectors, and especially Phlebotomus perniciosus, in which several of these viruses have been detected, makes it very likely that there will be regular human infections in our country, with this risk considered moderate for Toscana virus and low for the other ones, in areas with the highest vector activity. Most of the infections would be undiagnosed, while only Toscana virus would have a greater impact due to the potential severity of the illness.

Rapid detection of important human pathogenic Phleboviruses.

BACKGROUND: Rapid diagnostics are not available for several human pathogens in the genus Phlebovirus of the Bunyaviridae. OBJECTIVES: To develop RT-PCR assays for Sandfly Fever Sicilian virus (SFSV), Sandfly Fever Naples virus (SFNV), Toscana virus (TOSV) and Rift Valley Fever virus (RVFV). STUDY DESIGN: RNA standards were generated and used to test the performance of the assays. RESULTS: A detection limit of 10-100 RNA molecules was determined for the SFSV, TOSV and RVFV assays. The sensitivity of the SFNV assay was not determined. The TOSV and the RVFV assays detected recent isolates from Spain and Africa, respectively. CONCLUSION: The assays should help to improve surveillance of pathogenic Phleboviruses.

[Meningitis by Toscana virus in Spain: description of 17 cases]. / Meningitis por el virus Toscana en España: descripción de 17 casos.

BACKGROUND AND OBJECTIVE: We aimed to analyze the clinical and epidemiological data from the first series of patients with meningitis by Toscana virus in Spain. PATIENTS AND METHOD: We analyzed a total of 724 cerebrospinal fluid (CSF) samples from patients with suspicion of aseptic meningitis for virus isolation in cell culture. The clinical records of patients in whom Toscana virus was isolated were analyzed. RESULTS: Toscana virus was isolated in CSF in 17 patients (7% of all viral isolates). The first case was diagnosed in June 1988 and the last one in August 2002. The mean age was 27 years (range: 10-64 years). Most patients were based in rural area (n = 11, 64.7%). Most common symptoms were headache (holocranial or focal) present in all patients and moderate fever observed in 76.5% of them with a mean duration of 48 h (range: 18 h-5 days). Nuchal rigidity was present in 9 patients (53%). All cases were seen between June and October, and predominantly in August (53%). The outcome was favorable in all cases, and the mean time of duration of the disease was 7 days (range: 3-10 days). CONCLUSIONS: Toscana virus must be taken into account among those agents responsible of lymphocytic meningitis in Spain.