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Abstract

Background

During 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.

Aims

We summarise the epidemiological and laboratory findings of the 2018 transmission season and expand experiences in flavivirus differential diagnostics.

Methods

Every 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.

Results

Until 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.

Conclusion

Careful 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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This work is licensed under a Creative Commons Attribution 4.0 International License.
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2019-07-11
2024-12-30
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Extraordinary increase in West Nile virus cases and first confirmed human Usutu virus infection in Hungary, 2018
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Anna+Nagy&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nagy Anna</a>, <a href="/search?value1=Eszter+Mezei&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mezei Eszter</a>, <a href="/search?value1=Orsolya+Nagy&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nagy Orsolya</a>, <a href="/search?value1=Tam%C3%A1s+Bakonyi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Bakonyi Tamás</a>, <a href="/search?value1=Nikolett+Csonka&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Csonka Nikolett</a>, <a href="/search?value1=Magdolna+Kaposi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kaposi Magdolna</a>, <a href="/search?value1=Anita+Koroknai&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Koroknai Anita</a>, <a href="/search?value1=Katalin+Szomor&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Szomor Katalin</a>, <a href="/search?value1=Zita+Rig%C3%B3&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rigó Zita</a>, <a href="/search?value1=Zsuzsanna+Moln%C3%A1r&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Molnár Zsuzsanna</a>, <a href="/search?value1=%C3%81gnes+D%C3%A1nielisz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Dánielisz Ágnes</a>, <a href="/search?value1=M%C3%A1ria+Tak%C3%A1cs&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Takács Mária</a></span>. Extraordinary increase in West Nile virus cases and first confirmed human Usutu virus infection in Hungary, 2018. <a href="/content/ecdc">Euro Surveill.</a> 2019;24(28):pii=1900038. <a href="https://doi.org/10.2807/1560-7917.ES.2019.24.28.1900038" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2019.24.28.1900038</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 07 Jan 2019;&nbsp;&nbsp; <span class="generated">Accepted</span>: 02 Apr 2019 </span> </p>
/content/10.2807/1560-7917.ES.2019.24.28.1900038
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