Published Date: 2012-10-13 13:51:10
Subject: PRO/AH/EDR> West Nile virus - Eurasia (13): Austria ex Serbia
Archive Number: 20121013.1341049

WEST NILE VIRUS - EURASIA (13): AUSTRIA ex SERBIA
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Date: 13 Oct 2012
From: Stephan Aberle [edited]
<Stephan.Aberle@meduniwien.ac.at>


West Nile virus Lineage 2 infection in an Austrian traveller imported from Serbia
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An Austrian woman of 65 years travelled to Serbia to spend the summer with her relatives living close (28 km [17 mi]) to Beograd. Within the last 3 weeks before onset of disease she stayed only in this region, the surroundings of Beograd.

On 7 Sep 2012 she developed fever with general malaise and because of neurological symptoms -- that is, seizures and altered mental status, she was hospitalized on 14 Sep 2012 in Beograd, Serbia (Klinika za infektivne i tropske bolesti). Clinical and laboratory findings (CSF 290 cells/microliter, 99 per cent lymphocytes) indicated a viral meningoencephalitis and infection with West Nile virus (WNV) was suspected.

On 21 Sep 2012 the patient was transferred to the Kaiser Franz Josef Hospital in Vienna, Austria. A blood sample taken on 23 Sep 2012 (16 days after onset of symptoms) was highly WNV IgM and IgG antibody positive (InBios ELISA). The infection with WNV was confirmed by detection of WNV RNA in blood as well as in urine taken on 25 Sep 2012 (18 days after onset of symptoms) using both real time and nested PCR. The sequence analyses of a 408bp long PCR fragment from the structural protein region revealed an infection with WNV lineage 2, closely related to published strains from Greece in 2010 and Italy in 2011. The neurological condition of the patient improved significantly and she will be discharged from hospital within the next days.

This imported case of WNV lineage 2 was reported to the Austrian and European health authorities.

--
Dr Stephan W Aberle, Dr Karin Stiasny, Dr Franz X Heinz
Department of Virology, Medical University of Vienna, Austria
National Reference Center for Flaviviruses

Dr Hermann Laferl, Dr Marton Szoll, Dr Gertrude Seiberl, Dr Christoph Wenisch
Fourth Medical Department (Infectious Diseases and Tropical Medicine),
Kaiser Franz Josef Hospital, Vienna, Austria

Dr Stephan Aberle
Department of Virology, Medical University of Vienna, Austria
Kinderspitalgasse 15
A-1095 Vienna, Austria
<Stephan.Aberle@meduniwien.ac.at>

[West Nile virus (WNV) has been actively transmitted this summer in the Balkans, including Serbia, with several human cases reported (see ProMED-mail archives below). As of 20 Sep 2012, 35 individuals were hospitalized with 3 deaths due to WNV infection in Serbia.

There have been scattered human cases of West Nile virus neurological infections in southern and central Europe and adjoining countries this year (2012). As Mod.AS commented on the 23 Aug 2012 ProMED-mail post (archive no. 20120823.1258325), "...the European Centre for Disease Prevention and Control (ECDC), dated 16 Aug 2012, 58 human cases of West Nile fever have been reported in the EU during 2012, 57 of them in Greece and 1 in Italy. 97 additional cases have been reported from "neighbouring counties": 4 in Israel, 1 in the Palestinian territory, 91 in the Russian Federation, and 1 in Tunisia."

ProMED-mail thanks Dr Aberle and colleagues for this interesting, detailed report. It provides an excellent example of the need for health facilities and providers to be prepared to diagnose and treat patients for diseases that do not usually occur in their geographic area.

The HealthMap/ProMED-mail interactive map of Serbia can be seen at http://healthmap.org/r/3jGD. - Mod.TY]

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