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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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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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