Extraordinary increase in West Nile virus cases and first confirmed human Usutu virus infection in Hungary, 2018

Anna Nagy, Eszter Mezei, Orsolya Nagy, T. Bakonyi, Nikolett Csonka, Magdolna Kaposi, Anita Koroknai, Katalin Szomor, Zita Rigó, Zsuzsanna Molnár, Ágnes Dánielisz, M. Takács

Research output: Article

7 Citations (Scopus)

Abstract

BackgroundDuring the 2018 WNV transmission season, similarly to other endemic areas in Europe, a large number of human West Nile virus (WNV) infections were reported in Hungary.AimsWe summarise the epidemiological and laboratory findings of the 2018 transmission season and expand experiences in flavivirus differential diagnostics.MethodsEvery patient with clinical suspicion of acute WNV infection was in parallel tested for WNV, tick-borne encephalitis virus and Usutu virus (USUV) by serological methods. Sera, whole blood and urine samples were also tested for the presence of viral nucleic acid.ResultsUntil the end of December 2018, 215 locally acquired and 10 imported human WNV infections were notified in Hungary. All reported cases were symptomatic; most of them exhibited neurological symptoms. In a large proportion of tested individuals, whole blood was the most appropriate sample type for viral nucleic acid detection, but because whole blood samples were not always available, testing of urine samples also extended diagnostic possibilities. In addition, the first human USUV infection was confirmed in 2018 in a patient with aseptic meningitis. Serological cross-reactions with WNV in different serological assays were experienced, but subsequent molecular biological testing and sequence analysis identified Europe lineage 2 USUV infection.ConclusionCareful interpretation and simultaneous application of different laboratory methods are necessary to avoid misdiagnosis of human USUV cases. Expansion of the laboratory-confirmed case definition criteria for detection of viral RNA in any clinical specimens to include urine samples could increase diagnostic sensitivity.

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West Nile virus
Hungary
Virus Diseases
Urine
Nucleic Acids
Tick-Borne Encephalitis Viruses
Viruses
Aseptic Meningitis
Flavivirus
Cross Reactions
Viral RNA
Diagnostic Errors
Sequence Analysis
Serum

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health
  • Virology

Cite this

Extraordinary increase in West Nile virus cases and first confirmed human Usutu virus infection in Hungary, 2018. / Nagy, Anna; Mezei, Eszter; Nagy, Orsolya; Bakonyi, T.; Csonka, Nikolett; Kaposi, Magdolna; Koroknai, Anita; Szomor, Katalin; Rigó, Zita; Molnár, Zsuzsanna; Dánielisz, Ágnes; Takács, M.

In: Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, Vol. 24, No. 28, 01.07.2019.

Research output: Article

Nagy, Anna ; Mezei, Eszter ; Nagy, Orsolya ; Bakonyi, T. ; Csonka, Nikolett ; Kaposi, Magdolna ; Koroknai, Anita ; Szomor, Katalin ; Rigó, Zita ; Molnár, Zsuzsanna ; Dánielisz, Ágnes ; Takács, M. / Extraordinary increase in West Nile virus cases and first confirmed human Usutu virus infection in Hungary, 2018. In: Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin. 2019 ; Vol. 24, No. 28.
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abstract = "BackgroundDuring the 2018 WNV transmission season, similarly to other endemic areas in Europe, a large number of human West Nile virus (WNV) infections were reported in Hungary.AimsWe summarise the epidemiological and laboratory findings of the 2018 transmission season and expand experiences in flavivirus differential diagnostics.MethodsEvery patient with clinical suspicion of acute WNV infection was in parallel tested for WNV, tick-borne encephalitis virus and Usutu virus (USUV) by serological methods. Sera, whole blood and urine samples were also tested for the presence of viral nucleic acid.ResultsUntil the end of December 2018, 215 locally acquired and 10 imported human WNV infections were notified in Hungary. All reported cases were symptomatic; most of them exhibited neurological symptoms. In a large proportion of tested individuals, whole blood was the most appropriate sample type for viral nucleic acid detection, but because whole blood samples were not always available, testing of urine samples also extended diagnostic possibilities. In addition, the first human USUV infection was confirmed in 2018 in a patient with aseptic meningitis. Serological cross-reactions with WNV in different serological assays were experienced, but subsequent molecular biological testing and sequence analysis identified Europe lineage 2 USUV infection.ConclusionCareful interpretation and simultaneous application of different laboratory methods are necessary to avoid misdiagnosis of human USUV cases. Expansion of the laboratory-confirmed case definition criteria for detection of viral RNA in any clinical specimens to include urine samples could increase diagnostic sensitivity.",
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T1 - Extraordinary increase in West Nile virus cases and first confirmed human Usutu virus infection in Hungary, 2018

AU - Nagy, Anna

AU - Mezei, Eszter

AU - Nagy, Orsolya

AU - Bakonyi, T.

AU - Csonka, Nikolett

AU - Kaposi, Magdolna

AU - Koroknai, Anita

AU - Szomor, Katalin

AU - Rigó, Zita

AU - Molnár, Zsuzsanna

AU - Dánielisz, Ágnes

AU - Takács, M.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - BackgroundDuring the 2018 WNV transmission season, similarly to other endemic areas in Europe, a large number of human West Nile virus (WNV) infections were reported in Hungary.AimsWe summarise the epidemiological and laboratory findings of the 2018 transmission season and expand experiences in flavivirus differential diagnostics.MethodsEvery patient with clinical suspicion of acute WNV infection was in parallel tested for WNV, tick-borne encephalitis virus and Usutu virus (USUV) by serological methods. Sera, whole blood and urine samples were also tested for the presence of viral nucleic acid.ResultsUntil the end of December 2018, 215 locally acquired and 10 imported human WNV infections were notified in Hungary. All reported cases were symptomatic; most of them exhibited neurological symptoms. In a large proportion of tested individuals, whole blood was the most appropriate sample type for viral nucleic acid detection, but because whole blood samples were not always available, testing of urine samples also extended diagnostic possibilities. In addition, the first human USUV infection was confirmed in 2018 in a patient with aseptic meningitis. Serological cross-reactions with WNV in different serological assays were experienced, but subsequent molecular biological testing and sequence analysis identified Europe lineage 2 USUV infection.ConclusionCareful interpretation and simultaneous application of different laboratory methods are necessary to avoid misdiagnosis of human USUV cases. Expansion of the laboratory-confirmed case definition criteria for detection of viral RNA in any clinical specimens to include urine samples could increase diagnostic sensitivity.

AB - BackgroundDuring the 2018 WNV transmission season, similarly to other endemic areas in Europe, a large number of human West Nile virus (WNV) infections were reported in Hungary.AimsWe summarise the epidemiological and laboratory findings of the 2018 transmission season and expand experiences in flavivirus differential diagnostics.MethodsEvery patient with clinical suspicion of acute WNV infection was in parallel tested for WNV, tick-borne encephalitis virus and Usutu virus (USUV) by serological methods. Sera, whole blood and urine samples were also tested for the presence of viral nucleic acid.ResultsUntil the end of December 2018, 215 locally acquired and 10 imported human WNV infections were notified in Hungary. All reported cases were symptomatic; most of them exhibited neurological symptoms. In a large proportion of tested individuals, whole blood was the most appropriate sample type for viral nucleic acid detection, but because whole blood samples were not always available, testing of urine samples also extended diagnostic possibilities. In addition, the first human USUV infection was confirmed in 2018 in a patient with aseptic meningitis. Serological cross-reactions with WNV in different serological assays were experienced, but subsequent molecular biological testing and sequence analysis identified Europe lineage 2 USUV infection.ConclusionCareful interpretation and simultaneous application of different laboratory methods are necessary to avoid misdiagnosis of human USUV cases. Expansion of the laboratory-confirmed case definition criteria for detection of viral RNA in any clinical specimens to include urine samples could increase diagnostic sensitivity.

KW - human infection

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KW - neuroinvasive disease

KW - Usutu virus

KW - West Nile virus

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