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Sabadi D, Bodulić K, Savić V, Vlahović Vlašić N, Bogdanić M, Perić L, Tabain I, Lišnjić D, Duvnjak M, Židovec-Lepej S, Grubišić B, Rubil I, Barbić L, Švitek L, Stevanović V, Smajić P, Berišić B, Zlosa M, Rončević I, Vilibić-Čavlek T. Clinical Characteristics, Laboratory Parameters, and Molecular Epidemiology of Neuroinvasive Flavivirus Infections in a Hotspot Region of Eastern Croatia. Pathogens 2025; 14:69. [PMID: 39861030 PMCID: PMC11768143 DOI: 10.3390/pathogens14010069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Revised: 01/08/2025] [Accepted: 01/12/2025] [Indexed: 01/27/2025] Open
Abstract
Neuroinvasive flaviviruses such as tick-borne encephalitis virus (TBEV) and West Nile virus (WNV) are widely distributed in continental Croatian regions. We analyzed clinical characteristics, laboratory parameters, and molecular epidemiology of neuroinvasive flavivirus infections in eastern Croatia. A total of 43 patients with confirmed flavivirus infection hospitalized from 2017 to 2023 were included in the study. Reverse-transcription polymerase chain reaction (RT-qPCR) was used to detect flavivirus RNA in clinical samples (cerebrospinal fluid; CSF, urine). ELISA was used for IgM and IgG antibody detection in serum and CSF with confirmation of cross-reactive samples by virus neutralization test. WNV was detected more frequently (74.4%) than TBEV (25.6%). A statistically significant age difference was found between WNV patients (median 65 years) and TBEV patients (median 36 years). Comorbidities were more frequently detected in WNV patients (hypertension 56.3 vs. 18.2%; diabetes 31.3 vs. 0%). Meningitis was the most common clinical presentation in both TBE and WNV neuroinvasive disease (WNND; 63.6 and 59.4%, respectively). In addition, some rare clinical presentations of WNND were also detected (cerebellitis, polyradiculoneuritis). No significant differences in the frequency of clinical symptoms were observed between WNV and TBEV-infected patients (fever 93.7 vs. 100%; malaise 78.1 vs. 100%; headache 75.0 vs. 100%; nausea 50.0 vs. 63.6%; vomiting 34.4 vs. 54.6%). Comparative analysis of total and differential leukocyte blood count showed similar results. However, CSF pleocytosis was higher in TBE patients, with a significant difference in the neutrophil and lymphocyte count (WNND median 48.5% and 51.5%; TBE median 10.0 and 90.0%, respectively). The length of hospital stay was 12 days for WNND and 9 days for TBE. Phylogenetic analysis of detected WNV strains revealed the presence of WNV lineage 2 in eastern Croatia.
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MESH Headings
- Humans
- Croatia/epidemiology
- Female
- Male
- Aged
- Middle Aged
- Adult
- West Nile virus/genetics
- West Nile Fever/epidemiology
- West Nile Fever/cerebrospinal fluid
- West Nile Fever/blood
- Flavivirus Infections/epidemiology
- Flavivirus Infections/blood
- Molecular Epidemiology
- Antibodies, Viral/blood
- Antibodies, Viral/cerebrospinal fluid
- Encephalitis Viruses, Tick-Borne/genetics
- Encephalitis Viruses, Tick-Borne/immunology
- Encephalitis Viruses, Tick-Borne/isolation & purification
- Encephalitis, Tick-Borne/epidemiology
- Encephalitis, Tick-Borne/cerebrospinal fluid
- Encephalitis, Tick-Borne/blood
- Encephalitis, Tick-Borne/virology
- Encephalitis, Tick-Borne/diagnosis
- Flavivirus/genetics
- Flavivirus/immunology
- Flavivirus/isolation & purification
- Aged, 80 and over
- RNA, Viral
- Young Adult
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Affiliation(s)
- Dario Sabadi
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia; (D.S.); (N.V.V.); (M.D.); (B.G.); (I.R.); (P.S.); (B.B.); (M.Z.)
- Department of Infectology and Dermatovenerology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (L.P.); (D.L.)
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Kristian Bodulić
- Research Department, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia;
| | - Vladimir Savić
- Poultry Center, Croatian Veterinary Institute, 10000 Zagreb, Croatia;
| | - Nika Vlahović Vlašić
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia; (D.S.); (N.V.V.); (M.D.); (B.G.); (I.R.); (P.S.); (B.B.); (M.Z.)
- Department of Infectology and Dermatovenerology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (L.P.); (D.L.)
| | - Maja Bogdanić
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (I.T.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ljiljana Perić
- Department of Infectology and Dermatovenerology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (L.P.); (D.L.)
| | - Irena Tabain
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (I.T.)
| | - Dubravka Lišnjić
- Department of Infectology and Dermatovenerology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (L.P.); (D.L.)
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Mario Duvnjak
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia; (D.S.); (N.V.V.); (M.D.); (B.G.); (I.R.); (P.S.); (B.B.); (M.Z.)
- Department of Infectology and Dermatovenerology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (L.P.); (D.L.)
| | - Snježana Židovec-Lepej
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10000 Zagreb, Croatia;
| | - Barbara Grubišić
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia; (D.S.); (N.V.V.); (M.D.); (B.G.); (I.R.); (P.S.); (B.B.); (M.Z.)
- Department of Infectology and Dermatovenerology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (L.P.); (D.L.)
| | - Ilija Rubil
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia; (D.S.); (N.V.V.); (M.D.); (B.G.); (I.R.); (P.S.); (B.B.); (M.Z.)
- Department of Infectology and Dermatovenerology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (L.P.); (D.L.)
| | - Ljubo Barbić
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (V.S.)
| | - Luka Švitek
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia; (D.S.); (N.V.V.); (M.D.); (B.G.); (I.R.); (P.S.); (B.B.); (M.Z.)
- Department of Infectology and Dermatovenerology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (L.P.); (D.L.)
| | - Vladimir Stevanović
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (V.S.)
| | - Petra Smajić
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia; (D.S.); (N.V.V.); (M.D.); (B.G.); (I.R.); (P.S.); (B.B.); (M.Z.)
- Department of Infectology and Dermatovenerology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (L.P.); (D.L.)
| | - Bernarda Berišić
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia; (D.S.); (N.V.V.); (M.D.); (B.G.); (I.R.); (P.S.); (B.B.); (M.Z.)
- Department of Infectology and Dermatovenerology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (L.P.); (D.L.)
| | - Mihaela Zlosa
- Clinic for Infectious Diseases, University Hospital Centre Osijek, 31000 Osijek, Croatia; (D.S.); (N.V.V.); (M.D.); (B.G.); (I.R.); (P.S.); (B.B.); (M.Z.)
- Department of Infectology and Dermatovenerology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia; (L.P.); (D.L.)
| | - Ivana Rončević
- Poultry Center, Croatian Veterinary Institute, 10000 Zagreb, Croatia;
| | - Tatjana Vilibić-Čavlek
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (I.T.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Vignjević G, Bušić N, Turić N, Varga Z, Zana B, Ábrahám Á, Kurucz K, Vrućina I, Merdić E. First Detection of West Nile Virus Lineage 2 in Culex pipiens Vectors in Croatia. Pathogens 2024; 13:1131. [PMID: 39770390 PMCID: PMC11676261 DOI: 10.3390/pathogens13121131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Revised: 12/16/2024] [Accepted: 12/18/2024] [Indexed: 01/11/2025] Open
Abstract
The West Nile virus (WNV) has recently become more widespread, posing a threat to both human and animal health. In Western Europe, most outbreaks have been caused by WNV lineage 1, while in Eastern Europe, WNV lineage 2 has led to human and bird mortality. The ability to appropriately manage this threat is dependent on integrated surveillance and early detection. This study aimed to quantify the prevalence of WNV infection in mosquitoes and to identify the circulating viral lineage in eastern Croatia. Mosquito traps were set up in rural and urban areas during the 2021-2023 seasons, and the collected specimens were identified morphologically. Mosquito species Culex pipiens and Aedes albopictus were tested for Flaviviruses using conventional PCR in a heminested system. The positive samples were then subjected to a specific real-time PCR designed to detect WNV. A total of 385 mosquito pools were tested, and positive pools were found in samples from Osijek-Baranja and Vukovar-Srijem, both of which contained Cx. pipiens mosquitoes. Sequencing of amplicons revealed WNV lineage 2 partial NS5 gene sequences. Phylogenetic analysis suggests the Hungarian origin of strain, which complements birds' migratory routes. These findings indicate the first detection of WNV in mosquitoes in Croatia. This suggests that human cases in this region are likely due to infections with lineage 2 transmitted by local Culex mosquitoes.
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Affiliation(s)
- Goran Vignjević
- Department of Biology, University Josip Juraj Strossmayer of Osijek, 31000 Osijek, Croatia; (G.V.); (I.V.); (E.M.)
| | - Nataša Bušić
- Department of Biology, University Josip Juraj Strossmayer of Osijek, 31000 Osijek, Croatia; (G.V.); (I.V.); (E.M.)
| | - Nataša Turić
- Department of Biology, University Josip Juraj Strossmayer of Osijek, 31000 Osijek, Croatia; (G.V.); (I.V.); (E.M.)
- Teaching Institute of Public Health of Osijek-Baranja County, 31000 Osijek, Croatia
| | - Zsaklin Varga
- National Laboratory of Virology, Szentagothai Research Centre, University of Pécs, 7600 Pécs, Hungary; (Z.V.); (B.Z.); (Á.Á.); (K.K.)
- Institute of Biology, Faculty of Sciences, University of Pécs, 7600 Pécs, Hungary
| | - Brigitta Zana
- National Laboratory of Virology, Szentagothai Research Centre, University of Pécs, 7600 Pécs, Hungary; (Z.V.); (B.Z.); (Á.Á.); (K.K.)
| | - Ágota Ábrahám
- National Laboratory of Virology, Szentagothai Research Centre, University of Pécs, 7600 Pécs, Hungary; (Z.V.); (B.Z.); (Á.Á.); (K.K.)
| | - Kornélia Kurucz
- National Laboratory of Virology, Szentagothai Research Centre, University of Pécs, 7600 Pécs, Hungary; (Z.V.); (B.Z.); (Á.Á.); (K.K.)
- Institute of Biology, Faculty of Sciences, University of Pécs, 7600 Pécs, Hungary
| | - Ivana Vrućina
- Department of Biology, University Josip Juraj Strossmayer of Osijek, 31000 Osijek, Croatia; (G.V.); (I.V.); (E.M.)
| | - Enrih Merdić
- Department of Biology, University Josip Juraj Strossmayer of Osijek, 31000 Osijek, Croatia; (G.V.); (I.V.); (E.M.)
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Bogdanic M, Savic V, Klobucar A, Barbic L, Sabadi D, Tomljenovic M, Madic J, Hruskar Z, Curman Posavec M, Santini M, Stevanovic V, Petrinic S, Antolasic L, Milasincic L, Al-Mufleh M, Roncevic D, Vilibic-Cavlek T. The Re-Emergence of Neuroinvasive Flaviviruses in Croatia During the 2022 Transmission Season. Microorganisms 2024; 12:2210. [PMID: 39597599 PMCID: PMC11596621 DOI: 10.3390/microorganisms12112210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 10/26/2024] [Accepted: 10/30/2024] [Indexed: 11/29/2024] Open
Abstract
(Re-)emerging arboviruses, such as tick-borne encephalitis virus (TBEV), West Nile virus (WNV), and Usutu virus (USUV), are continuously increasing in incidence. We analyzed the epidemiological characteristics of flavivirus infections in humans, sentinel animals, and mosquitoes detected in the 2022 transmission season in Croatia. From April to November 2022, 110 hospitalized patients with neuroinvasive diseases (NID) were tested for the presence of arboviruses. RT-qPCR was used to detect TBEV, WNV, and USUV RNA. An ELISA and virus neutralization tests were used for the detection of flavivirus antibodies. TBEV infection was confirmed in 22 patients with NID. WNV NID was detected in six patients. TBE showed male predominance (81.8%; male-to-female ratio of 4.5:1). All but one WNV patients were males. TBE occurred from April to August, with the majority of patients (83.3%) being detected during the May-June-July period. WNV infections were recorded in August and September. In addition to human cases, asymptomatic WNV infections (IgM positive) were reported in 10 horses. For the first time in Croatia, WNV NID was observed in one horse that presented with neurological symptoms. Furthermore, USUV was confirmed in one dead blackbird that presented with neurological symptoms. A total of 1984 mosquitoes were collected in the City of Zagreb. Two Ae. albopictus pools tested positive for flavivirus RNA: one collected in July (USUV) and the other collected in August (WNV). A phylogenetic analysis of detected human and avian strains confirmed WNV lineage 2 and the USUV Europe 2 lineage. The presented results confirm the endemic presence of neuroinvasive flaviviruses in continental Croatia. The continuous monitoring of virus circulation in humans, sentinel animals, and mosquitoes is needed to reduce the disease burden.
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Affiliation(s)
- Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (Z.H.); (L.A.); (L.M.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Vladimir Savic
- Poultry Center, Croatian Veterinary Institute, 10000 Zagreb, Croatia;
| | - Ana Klobucar
- Department of Epidemiology, Andrija Stampar Teaching Institute of Public Health, 10000 Zagreb, Croatia; (A.K.); (M.C.P.); (S.P.)
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (J.M.); (V.S.)
| | - Dario Sabadi
- Department of Infectious Diseases, Clinical Hospital Center Osijek, 31000 Osijek, Croatia;
- Medical Faculty, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Morana Tomljenovic
- Department of Epidemiology, Primorje-Gorski Kotar Teaching Institute of Public Health, 51000 Rijeka, Croatia; (M.T.); (D.R.)
- Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Josip Madic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (J.M.); (V.S.)
| | - Zeljka Hruskar
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (Z.H.); (L.A.); (L.M.)
| | - Marcela Curman Posavec
- Department of Epidemiology, Andrija Stampar Teaching Institute of Public Health, 10000 Zagreb, Croatia; (A.K.); (M.C.P.); (S.P.)
| | - Marija Santini
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- Department for Infections in Immunocompromised Patients, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (J.M.); (V.S.)
| | - Suncica Petrinic
- Department of Epidemiology, Andrija Stampar Teaching Institute of Public Health, 10000 Zagreb, Croatia; (A.K.); (M.C.P.); (S.P.)
| | - Ljiljana Antolasic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (Z.H.); (L.A.); (L.M.)
| | - Ljiljana Milasincic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (Z.H.); (L.A.); (L.M.)
| | - Mahmoud Al-Mufleh
- Department of Infectious Diseases, County Hospital Cakovec, 40000 Cakovec, Croatia;
| | - Dobrica Roncevic
- Department of Epidemiology, Primorje-Gorski Kotar Teaching Institute of Public Health, 51000 Rijeka, Croatia; (M.T.); (D.R.)
- Department of Public Health, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (Z.H.); (L.A.); (L.M.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
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Zidovec-Lepej S, Bodulić K, Bogdanic M, Gorenec L, Savic V, Grgic I, Sabadi D, Santini M, Radmanic Matotek L, Kucinar J, Barbic L, Zmak L, Ferenc T, Stevanovic V, Antolasic L, Milasincic L, Hruskar Z, Vujica Ferenc M, Vilibic-Cavlek T. Proinflammatory Chemokine Levels in Cerebrospinal Fluid of Patients with Neuroinvasive Flavivirus Infections. Microorganisms 2024; 12:657. [PMID: 38674602 PMCID: PMC11052399 DOI: 10.3390/microorganisms12040657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/17/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Tick-borne encephalitis virus (TBEV) and West Nile virus (WNV) are the most important neuroinvasive arboviruses detected in Europe. In this study, we analyzed cerebrospinal fluid (CSF) concentrations of 12 proinflammatory chemokines (CCL2, CCL3, CCL4, CCL11, CCL17, CCL20, CXCL1, CXCL5, CXCL8, CXCL9, CXCL10, and CXCL11) in 77 patients with neuroinvasive diseases (NIDs). Flavivirus infection was confirmed in 62 patients (TBEV and WNV in 31 patients each), while in 15 patients the etiology of NID was not determined (NDE). Similar patterns of high-level expression of chemokines regulating monocyte/macrophage responses (CCL2), neutrophil recruitment (CXCL1 and CXCL8), and interferon-inducible chemoattractants for leukocytes (CXCL10 and CXCL11) have been observed in WNV and TBEV groups. None of the tested chemokines significantly differed between patients with TBEV or WNV. Concentrations of CCL17, CCL20, CXCL5, CXCL10, and CXCL11 were significantly lower in both WNV and TBEV groups compared to NID NDE patients. The logistic regression model showed that CSF concentrations of CXCL11, CXCL5, and CXCL10 could potentially be used for the classification of patients into the WNV or TBEV group versus groups with other NIDs. This study identified, for the first time, similar patterns of CSF chemokine expression in WNV and TBEV infections, suggesting common immunopathogenic mechanisms in neuroinvasive flavivirus infections that should be further evaluated.
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Affiliation(s)
- Snjezana Zidovec-Lepej
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia; (S.Z.-L.); (L.G.); (I.G.); (L.R.M.)
| | - Kristian Bodulić
- Research Department, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia;
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (L.A.); (L.M.); (Z.H.)
| | - Lana Gorenec
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia; (S.Z.-L.); (L.G.); (I.G.); (L.R.M.)
| | - Vladimir Savic
- Poultry Center, Croatian Veterinary Institute, 10000 Zagreb, Croatia;
| | - Ivana Grgic
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia; (S.Z.-L.); (L.G.); (I.G.); (L.R.M.)
| | - Dario Sabadi
- Department of Infectious Diseases, Clinical Hospital Center Osijek, 31000 Osijek, Croatia;
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Marija Santini
- Department for Infections in Immunocompromised Patients, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Leona Radmanic Matotek
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic”, 10000 Zagreb, Croatia; (S.Z.-L.); (L.G.); (I.G.); (L.R.M.)
| | - Jasmina Kucinar
- Department of Serology and Immunology, Istria County Institute of Public Health, 52100 Pula, Croatia;
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (V.S.)
| | - Ljiljana Zmak
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
- Department of Microbiology, Croatian Institute of Public Health, 10000 Zagreb, Croatia
| | - Thomas Ferenc
- Department of Diagnostic and Interventional Radiology, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia; (L.B.); (V.S.)
| | - Ljiljana Antolasic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (L.A.); (L.M.); (Z.H.)
| | - Ljiljana Milasincic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (L.A.); (L.M.); (Z.H.)
| | - Zeljka Hruskar
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (L.A.); (L.M.); (Z.H.)
| | - Mateja Vujica Ferenc
- Department of Obstetrics and Gynecology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia;
| | - Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia; (M.B.); (L.A.); (L.M.); (Z.H.)
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
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Ben-Mostafa KK, Savini G, Di Gennaro A, Teodori L, Leone A, Monaco F, Alaoqib MMA, Rayes AA, Dayhum A, Eldaghayes I. Evidence of West Nile Virus Circulation in Horses and Dogs in Libya. Pathogens 2023; 13:41. [PMID: 38251348 PMCID: PMC10820222 DOI: 10.3390/pathogens13010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/30/2023] [Accepted: 12/30/2023] [Indexed: 01/23/2024] Open
Abstract
West Nile virus (WNV) is a globally significant mosquito-borne Flavivirus that causes West Nile disease (WND). In Libya, evidence of WNV circulation has been reported in humans but never in animals. The aim of this study was to determine the seroprevalence of WNV infection in horses and dogs in Libya. In total, 574 and 63 serum samples were collected from apparently healthy, unvaccinated horses and dogs, respectively, between 2016 and 2019. A commercially available competitive enzyme-linked immunosorbent assay (c-ELISA) kit was initially used to test the collected samples for the presence of WNV Ig-G antibodies. Positive and doubtful sera were also tested using a more specific virus neutralisation assay to confirm whether the ELISA-positive results were due to WNV or other Flavivirus antibodies. The seroprevalence of WNV IgG antibodies according to ELISA was 13.2% out of 574 of total horses' samples and 30.2% out of 63 of total dogs' samples. The virus neutralisation test (VNT) confirmed that 10.8% (62/574) and 27% (17/63) were positive for WNV-neutralising titres ranging from 1:10 to 1:640. Univariable analysis using chi-square tests was conducted to measure the statistical significance of the association between the hypothesized risk factors including city, sex, breed, and age group and were then analyzed using the subsequent multivariable logistic regression model for horse samples. Age group was found to be the only significant risk factor in this study. The results of the present study provide new evidence about WNV circulation in Libya.
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Affiliation(s)
- Kholoud Khalid Ben-Mostafa
- Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Tripoli, Tripoli P.O. Box 13662, Libya
- National Center for Animal Health, Tripoli P.O. Box 83252, Libya
| | - Giovanni Savini
- Department of Virology and Tissue Culture, Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise “G.Caporale”, 64100 Teramo, Italy
| | - Annapia Di Gennaro
- Department of Virology and Tissue Culture, Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise “G.Caporale”, 64100 Teramo, Italy
| | - Liana Teodori
- Department of Virology and Tissue Culture, Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise “G.Caporale”, 64100 Teramo, Italy
| | - Alessandra Leone
- Department of Virology and Tissue Culture, Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise “G.Caporale”, 64100 Teramo, Italy
| | - Federica Monaco
- Department of Virology and Tissue Culture, Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise “G.Caporale”, 64100 Teramo, Italy
| | - Mohammed Masoud A. Alaoqib
- Department of Internal and Infectious Diseases, Faculty of Veterinary Medicine, Omar Al-Mukhtar University, Albaida P.O. Box 919, Libya
| | - Abdunnabi A. Rayes
- Department of Internal Medicine, Faculty of Medicine, University of Tripoli, Tripoli P.O. Box 13932, Libya
| | - Abdunaser Dayhum
- Department of Preventive Medicine, Faculty of Veterinary Medicine, University of Tripoli, Tripoli P.O. Box 13662, Libya
| | - Ibrahim Eldaghayes
- Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Tripoli, Tripoli P.O. Box 13662, Libya
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Vilibic-Cavlek T, Janev-Holcer N, Bogdanic M, Ferenc T, Vujica Ferenc M, Krcmar S, Savic V, Stevanovic V, Ilic M, Barbic L. Current Status of Vector-Borne Diseases in Croatia: Challenges and Future Prospects. Life (Basel) 2023; 13:1856. [PMID: 37763260 PMCID: PMC10532474 DOI: 10.3390/life13091856] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Different vector-borne pathogens are present or have (re-)emerged in Croatia. Flaviviruses tick-borne encephalitis (TBEV), West Nile (WNV), and Usutu (USUV) are widely distributed in continental regions, while Toscana virus (TOSV) and sandfly fever viruses are detected at the Croatian littoral. Recently, sporadic clinical cases of Tahyna orthobunyavirus (TAHV) and Bhanja bandavirus infection and seropositive individuals have been reported in continental Croatia. Acute infections and serologic evidence of WNV, TBEV, USUV, and TAHV were also confirmed in sentinel animals and vectors. Autochthonous dengue was reported in 2010 at the Croatian littoral. Lyme borreliosis is the most widely distributed vector-borne bacterial infection. The incidence is very high in northwestern and eastern regions, which correlates with numerous records of Ixodes ricinus ticks. Acute human Anaplasma phagocytophilum infections are reported sporadically, but there are many records of serologic evidence of anaplasmosis in animals. Mediterranean spotted fever (Rickettsia conorii) and murine typhus (Rickettsia typhi) are the main rickettsial infections in Croatia. Human leishmaniasis is notified sporadically, while serologic evidence of leishmaniasis was found in 11.4% of the Croatian population. After the official eradication of malaria in 1964, only imported cases were reported in Croatia. Since vector-borne diseases show a growing trend, continuous monitoring of vectors is required to protect the population from these infections.
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Affiliation(s)
- Tatjana Vilibic-Cavlek
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Natasa Janev-Holcer
- Environmental Health Department, Croatian Institute of Public Health, 10000 Zagreb, Croatia
- Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia
| | - Thomas Ferenc
- Department of Diagnostic and Interventional Radiology, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Mateja Vujica Ferenc
- Department of Obstetrics and Gynecology, University Hospital Center Zagreb, 10000 Zagreb, Croatia
| | - Stjepan Krcmar
- Department of Biology, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Vladimir Savic
- Poultry Center, Croatian Veterinary Institute, 10000 Zagreb, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Maja Ilic
- Department of Communicable Disease Epidemiology, Croatian Institute of Public Health, 10000 Zagreb, Croatia
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
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Detection of Tahyna Orthobunyavirus-Neutralizing Antibodies in Patients with Neuroinvasive Disease in Croatia. Microorganisms 2022; 10:microorganisms10071443. [PMID: 35889162 PMCID: PMC9316594 DOI: 10.3390/microorganisms10071443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Tahyna orthobunyavirus (TAHV) is widely distributed in continental Europe. Very few studies have analyzed TAHV seroprevalence in Croatia. We analyzed the prevalence of TAHV RNA and antibodies in Croatian patients with neuroinvasive disease (NID). Methods: A total of 218 patients with unsolved NID detected during five consecutive arbovirus transmission seasons (April 2017–October 2021) were tested. Cerebrospinal fluid (CSF) and urine samples were tested for TAHV RNA using RT-PCR. In addition, CSF and serum samples were tested for TAHV antibodies using a virus neutralization test (VNT). Results: Clinical presentations in patients with NID were meningitis (141/64.7%), meningoencephalitis (56/25.7%), myelitis (8/3.7%), and ‘febrile headache’ (13/5.9%). TAHV RNA was not detected in any of the tested CSF or urine samples; however, TAHV-neutralizing (NT) antibodies were detected in 22/10.1% of patients. Detection of NT antibodies in the CSF of two patients presenting with meningitis suggested recent TAHV infection. TAHV seropositivity increased significantly with age, from 1.8% to 24.4%. There was no difference in seroprevalence between genders or areas of residence (urban, suburban/rural). The majority of seropositive patients (90.9%) resided in floodplains along the rivers in continental Croatia. Conclusions: The presented results confirm that TAHV is present in Croatia. The prevalence and clinical significance of TAHV infection in the Croatian population have yet to be determined.
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Severe West Nile Virus Neuroinvasive Disease: Clinical Characteristics, Short- and Long-Term Outcomes. Pathogens 2022; 11:pathogens11010052. [PMID: 35056000 PMCID: PMC8779330 DOI: 10.3390/pathogens11010052] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/17/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022] Open
Abstract
West Nile Virus Neuroinvasive Disease (WNV NID) requires prolonged intensive care treatment, resulting in high mortality and early disability. Long-term results are lacking. We have conducted an observational retrospective study with a prospective follow-up of WNV NID patients treated at the Intensive Care Unit (ICU), University Hospital for Infectious Diseases, Zagreb, Croatia, 2013–2018. Short-term outcomes were vital status, length of stay (LOS), modified Rankin Scale (mRS), and disposition at discharge. Long-term outcomes were vital status and mRS at follow-up. Twenty-three patients were identified, 78.3% males, median age 72 (range 33–84) years. Two patients (8.7%) died in the ICU, with no lethal outcomes after ICU discharge. The median ICU LOS was 19 days (range 5–73), and the median hospital LOS was 34 days (range 7–97). At discharge, 15 (65.2%) patients had moderate to severe/mRS 3–5, 6 (26.0%) had slight disability/mRS 2–1, no patients were symptom-free/mRS 0. Ten (47.6%) survivors were discharged to rehabilitation facilities. The median time to follow-up was nine months (range 6–69). At follow-up, seven patients died (30.5%), five (21.7%) had moderate to severe/mRS 3–5, one (4.3%) had slight disability/mRS 2–1, six (26.1%) had no symptoms/mRS 0, and four (17.4%) were lost to follow-up. Briefly, ten (43.5%) survivors improved their functional status, one (4.3%) was unaltered, and one (4.3%) aggravated. In patients with severe WNV NID, intensive treatment in the acute phase followed by inpatient rehabilitation resulted in significant recovery of functional status after several months.
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