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Prevalence of antibodies to West Nile fever, sandfly fever Sicilian, and sandfly fever Naples viruses in healthy adults in Israel.

BACKGROUND: The arbovirus infections West Nile fever (WNF) and sandfly fever (SFF) are both endemic in the Middle East. Despite the fact that the mosquito and sandfly vectors of these viruses are still found in Israel, SFF has not been reported since 1948, whereas outbreaks of WNF occur periodically. It is suspected that some of the cases of nonspecific febrile illnesses in Israel may in fact be either WNF or SFF. AIM: To determine the extent of past arbovirus infections in subgroups of Israeli soldiers. METHODS: Sera from random samples of three groups of healthy soldiers aged 18-20 (n=273), 21-30 (n=497), and 40-55 years (n=285) were examined for IgG and IgM antibodies to West Nile virus (WNV), sandfly fever Sicilian virus (SFSV), and sandfly fever Naples virus (SFNV), using an ELISA method. RESULTS: The prevalence of antibodies increased with age for all three viruses examined, and ranged from 7.0%, 0, and 2.8%, for WNV, SFSV, AND SFNV, respectively, in soldiers aged 18-20 years, to 41.9%, 23.7%, and 30.8%, in those aged 40-55 years. The percentage of seropositives for IgG who were also IgM positive were 1.0%, 5.9%, and 3.4%, for WNV, SFSV, AND SFNV, respectively. 17.5% of the seropositives for WNV were also positive for SFSV, as compared with 5.7% among the WNV-seronegatives. Among the seropositives for WNV, 23.99% were positive for SFNV, compared with 9.1% of WNV seronegatives. 48.2% of seropositives for SFSV were positive for SFNV, as compared with 8.4% for SFSV-seronegatives. In the age agroup 40-55 years, there were significantly higher prevalence rates in those born in Israel compared with those born abroad. CONCLUSIONS: There is still significant exposure to WNV, SFSV, and SFNV in Israel. Arborviruses are probably responsible for many cases of non-specific febrile illness in this region.

Adolescent↗

Recoverability of Rift Valley fever and sandfly fever Sicilian viruses from infected Phlebotomus papatasi (Diptera: Psychodidae) trapped in various oils.

We studied the effects of various oils used to trap sand flies on the recovery of virus from infected adult Phlebotomus papatasi. Both Rift Valley fever and sandfly fever Sicilian viruses were readily recovered from virus-inoculated specimens held at 26 degrees C on mineral, olive or castor oil-soaked sheets for up to 12 h. However, after 50 h on oil-soaked paper, significantly greater titers were recovered from sand flies trapped with mineral oil than from sand flies trapped with either of the other oils. This indicates that sand flies trapped on oil-soaked paper would be suitable for virus isolation attempts and that mineral oil had the least effect on virus recovery.

Animals↗

[Meningitis after travel in the Mediterranean region, caused by the sandfly fever virus].

Sandfly fever virus is the causative agent of sandfly fever (pappataci fever). The virus is endemic in the Mediterranean region and is transmitted by bites of Phlebotomus species. The three sandfly fever virus serotypes, Sicilian (SFS), Naples (SFN) and Toscana (TOS), are of travel-related significance. In addition to a flu-like illness, the sandfly fever virus may result in a serious neurological disease with meningitis and encephalitis. Due to the high number of travelers may occur in nonimmune persons. Since many clinicians are not aware of this disease, sandfly fever is still rarely diagnosed.

Adult↗

Sandfly fever viruses in Italy.

Two serologically distinct agents, the sandfly fever Sicilian and the sandfly fever Naples viruses, were isolated by Sabin from blood samples taken during an Italian epidemic of febrile illness. Since then, several different viruses have been isolated from sandflies and/or humans in both the Old and New World. Toscana virus, a new virus closely antigenically related to sandfly fever Naples virus, was isolated in 1971 from the sandfly Phlebotomus perniciosus in Italy. Extensive studies on the importance of Toscana virus as a human pathogen demonstrated its association with acute neurologic diseases. A serosurvey for the presence of antibodies to sandfly fever Sicilian, sandfly fever Naples and Toscana viruses indicated that, as in other Mediterranean areas, both sandfly fever Sicilian and sandfly fever Naples viral infections decreased or disappeared after the 1940s in countries performing insecticide-spraying malaria eradication campaigns. In contrast, clinical cases of aseptic meningitis or meningoencephalitis caused by Toscana virus are observed annually in Central Italy during the summer. Toscana virus may be present in other Mediterranean countries where sandflies of the genus Phlebotomus are present.

Animals↗

Aseptic meningitis caused by sandfly fever virus, serotype Toscana.

Sandfly fever virus, serotype Toscana (TOS), is endemic in some Mediterranean countries and causes sandfly fever (pappataci fever). In some patients, TOS may cause meningitis and meningoencephalitis. We report on two German adults returning from Italy with TOS-related meningitis, complicated in one case by abducens nerve palsy. TOS infection should be considered as a cause of acute central nervous system disorders in patients returning from areas of endemicity.

Animals↗

Epidemiological, clinical and laboratory aspects of sandfly fever.

PURPOSE OF REVIEW: Sandfly fever viruses are still a significant health problem in many regions of the world, such as Africa, the Mediterranean basin, the Middle East, and Central Asia. This review provides an update on the advances in knowledge about epidemiological, clinical, and laboratory aspects of infections caused by Toscana, Sicilian and Naples viruses. RECENT FINDINGS: Diagnosis of Toscana virus infection has been facilitated by new molecular methods and by immunoenzymatic tests based on the recombinant nucleoprotein. Gene analysis has allowed identification of circulating Toscana variants possibly involved in the protean pathomorphism and extreme variability of the clinical picture. New attention has been addressed to the antigenic properties of the viral proteins (the nucleoprotein N and the surface glycoproteins G1 and G2), in order to understand their immunogenetic role. High genetic divergence within the serocomplexes belonging to each of the Sicilian and the Naples viruses has suggested that infection with one genotype may not completely immunize against infection with all other genotypes in a given serocomplex. These findings could serve as a basis for vaccine development and may account for reports of multiple episodes of sandfly fever in the same host. Recently, the performance of analysis models based on weather data and reported vector surveys has allowed the prediction of the risk of acquiring sandfly infection in the endemic geographic areas. SUMMARY: Recent developments include a better knowledge of the epidemiological, clinical, and laboratory aspects of sandfly infection, while the search for effective drugs and vaccines is still in progress.

Animals↗

High prevalence rates of antibody to three sandfly fever viruses (Sicilian, Naples, and Toscana) among Cypriots.

Neutralizing antibodies to sandfly fever Naples, sandfly fever Sicilian and Toscana viruses were investigated among 479 sera collected from a normal human population in Cyprus. Antibody prevalence rates of 57%, 32% and 20% were found to Naples, Sicilian and Toscana viruses, respectively. The observed frequency of dual and triple infections was higher than would be expected with a random chance of infection. Antibody prevalence rates were similar for men and women for all three viruses tested, but one of two study sites had significantly higher antibody prevalence to Naples and Sicilian viruses than the other. Individuals with antibodies to both Naples and Toscana viruses had higher antibody levels to Naples virus than those with antibodies to Naples virus only. If the antibody prevalence rates found in this study reflect a history of clinical disease as described in the literature, sandfly fever poses a significant public health problem in Cyprus.

Adolescent↗

Sandfly fever among Swedish tourists.

All clinical and serologically confirmed cases of sandfly fever among Swedish tourists during 1986-1989 were investigated. A total of 37 cases of Sicilian virus sandfly fever and 1 case of Naples virus sandfly fever were recorded from Cyprus. One case of Toscana virus infection was documented from Spain. The clinical and laboratory findings did not differ from those in previous reports, except for elevated aminotransferase levels. A questionnaire, that offered a possibility to estimate the number of cases that had not been reported, was sent to 713 tourists who had visited different hotels in Cyprus and Mallorca in September 1987. Serum samples from 95 of these tourists were tested for sandfly fever virus antibodies. These tests indicated that only some 20% of the real number of sandfly fever infections had been diagnosed. Both clinical cases and cases found by the questionnaire showed a focal distribution with an overrepresentation of certain hotels in Cyprus. The results were reported to the local health officers and possibly due to the measures undertaken hereafter the number of sandfly fever cases diagnosed have decreased.

Adult↗

Experimental infection of nonhuman primates with sandfly fever virus.

Due to the lack of an animal model, previous studies of sandfly fever have relied upon human challenge trials. We examined the infectivity and potential pathogenicity of sandfly fever virus in cynomolgus monkeys (Macaca fascicularis). Three different preparations of sandfly fever virus. Sicilian strain, and a placebo were compared by different routes of administration. The most notable postchallenge clinical event was a decrease in lymphocytes in the intramuscularly challenged monkeys. Plaque-reduction neutralization responses peaked earlier in animals challenged intravenously as compared with those in animals challenged intramuscularly. There was no evidence for neurotropism or meningeal inflammation. Sandfly fever virus was infectious for cynomolgus monkeys, but produced no detectable clinical disease that might serve as a marker for animal modeling studies. On the other hand, the preclinical data provide supportive evidence for safe parenteral administration of a Sicilian strain of sandfly fever virus inoculum to humans as a challenge model for sandfly fever disease.

Animals↗

[Virological study of cases of sandfly fever in Afghanistan].

Three strains (Af-1008, Af-1038, and Af-130) of Neapolitan sandfly fever virus (NSFF) and 2 strains (Af-1028 and Af-83) of Sicilian sandfly fever virus (SSFF) were isolated from febrile patients among soldiers of the limited military contingent of Soviet troops in Afghanistan in May-August, 1986-1987. The viruses were isolated in neonate mice and identified by indirect immunofluorescence, complement-fixation tests and plaque reduction neutralization test in Vero E6 and SPEV cells. The new NSFF strains in serological tests differed slightly from the original Sabin strain and completely differed from Toskana virus. In the examinations of 104 paired sera from convalescents, 87 subjects showed a rise in antibody titres either to NSFF or to SSFF virus, and 16 patients had antibodies to both viruses but without any rises in titre. Among 60 subjects with a presumable diagnosis of sandfly fever 12 persons had an antibody No information on isolation of sandfly fever viruses in Afghanistan has been available hitherto.

Afghanistan↗

Sequences and coding strategies of the S RNAs of Toscana and Rift Valley fever viruses compared to those of Punta Toro, Sicilian Sandfly fever, and Uukuniemi viruses.

The sequences and coding strategies of the S RNAs of two viruses, Toscana (TOS) and the M12 derivative of Rift Valley fever ZH-548 (RVF, Phlebovirus genus, Bunyaviridae) have been determined from cDNA clones and compared to the previously published sequences of Punta Toro (PT), Sandfly fever Sicilian (SFS), and Uukuniemi (UUK) viruses. All five viruses exhibit an ambisense coding strategy for their small (S) RNA species, i.e., one gene product (the NSs protein) is encoded in the 5' half of the viral RNA, a second (the N protein) is encoded in the sequence complementary to the 3' half. The terminal nucleotides of the S RNAs of the five viruses are comparable through 13-14 residues. The 3' and 5' ends of these S RNAs have inverted complementary compositions. Three phleboviruses (TOS, SFS, and RVFV) exhibit comparable G-rich, centrally located intergenic sequences, albeit of different lengths. These sequences have a number of similar motifs at, or immediately following, the end of the coding regions, motifs that may be involved in their S mRNA transcription termination processes. The other two viruses (UUK, PT) have AT-rich intergenic sequences that have the potential to form secondary structure. They lack the G-rich sequences or particular sequence motifs recognized in the other three virus RNAs. The deduced sizes of the TOS and RVFV N proteins are 27,704 and 27,430 kDa (respectively). Their NSS proteins are 36,677 and 29,903 kDa (respectively). When aligned, the deduced sequences of the N proteins of the five viruses exhibit homologies ranging from 54 to 30%. The order of homology to RVFV N protein is PT greater than TOS greater than SFS greater than UUK; to TOS N protein it is PT greater than or equal to RVF greater than SFS greater than UUK. The sequences of the NSS proteins are less similar, with values ranging from 30 to less than 17%. The order of homology to RVFV NSS is SFS greater than PT greater than TOS greater than UUK. Due to these more distant relationships, the homologies to TOS NSS protein are less clear.

Amino Acid Sequence↗

[Pappataci fever].

Sandfly fever virus is known to cause pappataci fever. The sandfly fever virus belongs to the Genus Phlebovirus (family: Bunyaviridae) and is endemically found in areas of South Europe, Asia and Africa. In Germany, pappataci fever is only described in connection with travelling to endemic areas. We report on a 15 year-old girl suffering from sandfly fever virus infection after vacation in Turkey. The initial symptoms started with fever for about three days, frontal headache, nausea and arthralgia. After a short time of clinical improvement symptoms recurred and our patient entered hospital with signs of severe meningitis. Liquor analysis showed a lymphocytic meningitis. Due to multiple insect bites on her legs sandfly fever was suspected. Blood analysis confirmed an acute infection with sandfly virus Sicilian from which she completely recovered. ELISA and immunoblot analysis revealed an infection with sandfly virus serotype Sicilian, which was not encountered with meningitis so far. Our case report illustrates that due to increased tourism sandfly fever virus infection has to be considered as a cause of aseptic meningitis in travellers.

Adolescent↗

[Sandfly fever Naples virus (serotype Toscana) infection with meningeal involvement after a vacation in Italy].

HISTORY AND CLINICAL FINDINGS: A 69-year-old man was admitted to our hospital with severe headache, recurrent episodes of fever and deterioration of general health. He returned from a vacation in Tuscany (Italy) a few days before admission. Physical examination revealed slight nuchal rigidity and an elevated body temperature of 37.8 C but was otherwise unremarkable. INVESTIGATIONS: Differential blood count showed a lymphocytopenia. Other abnormal laboratory findings included an elevated blood sedimentation rate and a slightly increased C-reactive protein value. Abdominal sonography demonstrated a marginally enlarged spleen. DIAGNOSIS, TREATMENT AND CLINICAL COURSE: A lumbar puncture was performed. Cerebrospinal fluid analysis revealed a lymphocytic meningitis. Serological examination of a blood sample showed specific IgM-antibodies against sandfly fever Naples virus (SFNV), subtype Toscana virus (TOSV). After this diagnosis had been made initially instituted intravenous administration of antibiotics and antiviral medication were discontinued. The patient's symptoms improved rapidly under symptomatic treatment. Slight headaches without episodes of fever persisted for a few weeks without residual neurological symptoms. CONCLUSIONS: A history of travel should always be sought in patients with clinical signs for meningitis. Considering the increasing spread and incidence of SFNV and its subtype Toscana in mediterranean countries, such virus should be kept in mind when treating patients who present such symptoms after returning from those countries during the summer season.

Acyclovir↗

Infections due to sandfly fever virus serotype Toscana in Spain.

Of the sandfly fever viruses known to be human pathogens (serotypes Toscana [TOS], Sicilian [SFS], and Naples [SFN]), only TOS has demonstrated neurotropic activity. Infections by TOS have been reported in Mediterranean countries, but the virus was previously isolated only in Italy and Portugal. We isolated 15 strains of TOS between 1988 and 1996 from the cerebrospinal fluid of patients with acute aseptic meningitis in Granada, Spain. This finding led us to study the presence of antibodies to TOS, SFS, and SFN in 1,181 adults and 87 children from different regions of Spain. We found that the prevalence of antibodies to these viruses was 26.2%, 2.2, and 11.9%, respectively; these rates imply that TOS infections are common in Spain.

Adolescent↗

Antigenic relationships among phlebotomus fever group arboviruses and their implication for the epidemiology of sandfly fever.

The antigenic relationships of 21 known or presumed Phlebotomus fever group serotypes and of 2 ungrouped, solvent sensitive, sandfly-associated arboviruses (Pacui and Charleville) were studied by complement fixation, plaque neutralization, and hemagglutination-inhibition methods. Results of complement fixation and neutralization tests were specific, allowing clear separation of the various serotypes, while those of the hemagglutination-inhibition test showed broader crossing and lack of specificity. Pacui virus was shown to be a member of the Phlebotomus fever serogroup. Six new Phlebotomus fever group serotypes are also described, increasing the known members of the group to 22. The implications of these and other recent data about the epidemiology of sandfly fever are discussed.

Animals↗

Inhibition of sandfly fever Sicilian virus (Phlebovirus) replication in vitro by antiviral compounds.

Sandfly fever Sicilian virus (SFSV) was used in our laboratory to screen antiviral substances active toward viruses of the Bunyaviridae family. Antiviral activity was estimated by the reduction of the cytopathic effect of SFSV on infected Vero cells. Cytotoxicity was evaluated by determining the inhibition of Trypan blue exclusion. The specificity of action of each tested compound was estimated by the selectivity index (CD50/ED50). Selectivity indices of human recombinant interferon-alpha (IFN alpha) (Roferon and Introna), iota-, kappa- and lambda- carrageenans, fucoidan and 6-azauridine were much higher than that of ribavirin, the only antiviral substance which has been previously investigated for its inhibitory effects on Phlebovirus infections. Other compounds showed significant antiviral activity: glycyrrhizin, suramin sodium, dextran sulphate and pentosan polysulphate. All these compounds caused a concentration-dependent reduction in the virus yield. Ribavirin, 6-azauridine and IFN alpha have been shown to inhibit a late step of the virus replicative cycle, whereas glycyrrhizin and suramin sodium were active at an early step and the sulphated polysaccharides inhibited adsorption of SFSV on the cells. The antiviral compounds selected in this study as specific inhibitors of in vitro replication of SFSV are promising candidates for the chemotherapy of haemorrhagic fevers caused by viruses of the Bunyaviridae family. The combination of IFN alpha and ribavirin, which showed a synergistic antiviral effect, should be evaluated for the treatment of these infections.

Animals↗

[Neurological symptoms after an infection by the sandfly fever virus].

UNLABELLED: CASE 1: A few days after returning from a holiday in Italy a 50-year-old man developed acute gastrointestinal symptoms, followed by headache, fever and joint pains. After transitory remission he had a relapse with fever, headache and meningitis 2 weeks later. Cerebrospinal fluid contained gram-negative diplococci, but no bacteria grew on culture. Under the suspected diagnosis of meningitis he was treated with penicillin. Ten days later he suddenly developed deafness in his right ear. The various signs and symptoms gradually disappeared and the patient was discharged after 24 days in hospital. Retrospectively serological tests indicated sandfly fever (SF) virus infection with serotype Toscana. This is thought to be the first reported case of deafness associated with this disease. CASE 2: One week after returning from a holiday in Tunisia a 34-year-old man fell ill with fever, headache, rigor, nausea, joint pains and a maculopapular rash for which he was treated as an outpatient. The symptoms improved after 7 days, except for the headache which persisted another 5 days. Serology demonstrated an acute infection by SF virus, serotype Sicilian. CONCLUSION: Sandfly fever should be included in the differential diagnosis of headache, fever and signs of meningitis in persons who have recently been to mediterranean countries.

Adult↗