Meningitis and epididymitis caused by Toscana virus infection imported to Switzerland diagnosed by metagenomic sequencing: a case report

Background We report a rare case of Toscana virus infection imported into Switzerland in a 23-year old man who travelled to Imperia (Italy) 10 days before onset of symptoms. Symptoms included both meningitis and as well epididymitis. This is only the fourth case of Toscana virus reported in Switzerl...

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Vydané v:	BMC infectious diseases Ročník 19; číslo 1; s. 591 - 4
Hlavní autori:	Tschumi, Fabian, Schmutz, Stefan, Kufner, Verena, Heider, Maike, Pigny, Fiona, Schreiner, Bettina, Capaul, Riccarda, Achermann, Yvonne, Huber, Michael
Médium:	Journal Article
Jazyk:	English
Vydavateľské údaje:	London BioMed Central 08.07.2019 BioMed Central Ltd BMC
Predmet:	Adult Antibodies, Viral - blood Arboviruses Bunyaviridae Infections - diagnosis Bunyaviridae Infections - immunology Bunyaviridae Infections - virology Care and treatment Case Report Clinical metagenomics Computational biology Encephalitis Epididymitis Epididymitis - diagnosis Epididymitis - immunology Epididymitis - virology Herpes simplex Herpesvirus infections Humans Immunoglobulin G Immunoglobulins Infection Infectious Diseases Internal Medicine Italy Male Medical Microbiology Medicine Medicine & Public Health Meningitis Meningitis, Viral - diagnosis Meningitis, Viral - immunology Meningitis, Viral - virology Meningoencephalitis Metagenomics - methods Molecular Diagnostic Techniques Mumps Neurologic manifestations Parasitology Physicians Polymerase chain reaction Retirement benefits Risk factors RNA, Viral - genetics Rubella Sandfly fever Naples virus - genetics Sandfly fever Naples virus - immunology Sequence Analysis, RNA Switzerland Tick-borne diseases Tick-borne encephalitis Toscana virus Travelers Tropical Medicine Viral diseases Viral meningitis Virus diseases Young Adult Italy Switzerland Toscana virus Meningitis Epididymitis Clinical metagenomics Switzerland
ISSN:	1471-2334, 1471-2334
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Shrnutí:	Background We report a rare case of Toscana virus infection imported into Switzerland in a 23-year old man who travelled to Imperia (Italy) 10 days before onset of symptoms. Symptoms included both meningitis and as well epididymitis. This is only the fourth case of Toscana virus reported in Switzerland. Case presentation The patient presented with lymphocytic meningitis and scrotal pain due to epididymitis. Meningitis was initially treated with ceftriaxone. Herpes simplex, tick-borne encephalitis, enterovirus, measles, mumps, rubella and Treponema pallidum were excluded with specific polymerase chain reaction (PCR) or serology. In support of routine diagnostic PCR and serology assays, unbiased viral metagenomic sequencing was performed of cerebrospinal fluid and serum. Toscana virus infection was identified in cerebrospinal fluid and the full coding sequence could be obtained. Specific PCR in cerebrospinal fluid and blood and serology with Immunoglobulin (Ig) M and IgG against Toscana virus confirmed our diagnosis. Neurological symptoms recovered spontaneously after 5 days. Conclusions This case of Toscana virus infection highlights the benefits of unbiased metagenomic sequencing to support routine diagnostics in rare or unexpected viral infections. With increasing travel histories of patients, physicians should be aware of imported Toscana virus as the agent for viral meningitis and meningoencephalitis.
Bibliografia:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1471-2334 1471-2334
DOI:	10.1186/s12879-019-4231-9