{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T00:02:36Z","timestamp":1789344156180,"version":"build-2803163510"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T00:00:00Z","timestamp":1638316800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T00:00:00Z","timestamp":1640131200000},"content-version":"vor","delay-in-days":21,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinikum Freiburg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Toscana virus (TOSV) is an arthropod-borne virus transmitted by phlebotomine sandflies (<jats:italic>Phlebotomus<\/jats:italic> sp.) widespread throughout the Mediterranean having the potential to cause meningoencephalitis in humans. In Germany, the vectors of TOSV are introduced recently and become endemic especially in Southwestern Germany. As TOSV is not investigated regularly in patients with meningoencephalitis, cases of TOSV-neuroinvasive disease may remain mostly undetected.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We conducted a retrospective cohort study on patients with meningoencephalitis without identification of a causal pathogen from 2006 to 2016. Serologic assessment for anti-TOSV-IgG and IgM was performed on serum and CSF. Demographic, clinical and CSF data from TOSV-positive patients were compared to a cohort of patients with meningoencephalitis due to enterovirus. Informed consent was obtained from all included patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We found 138 patients with meningoencephalitis without identified causal pathogen. From 98 of these patients CSF and serum was available for further testing. Additionally, we included 27 patients with meningoencephalitis due to enterovirus. We identified two patients with serological confirmed TOSV-neuroinvasive disease (TOSV-IgM and IgG positive, 2%) and two patients with possible TOSV-neuroinvasive disease (isolated TOSV-IgM positive, 2%). Overall, TOSV-neuroinvasive was detected in 4% of our cases with suspected viral meningoencephalitis. None of them had a history of recent travel to an endemic area.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We found cases of TOSV-neuroinvasive disease in our German cohort of patients with meningoencephalitis. As no recent history of travel to an endemic area was reported, it remains probable that these cases resemble autochthonous infections, albeit we cannot draw conclusions regarding the origin of the respective vectors. TOSV could be considered in patients with meningoencephalitis in Germany.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12883-021-02528-7","type":"journal-article","created":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T06:04:18Z","timestamp":1640153058000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Toscana virus encephalitis in Southwest Germany: a retrospective study"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7366-4401","authenticated-orcid":false,"given":"R.","family":"Dersch","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Sophocleous","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Cadar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Emmerich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Schmidt-Chanasit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Rauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,22]]},"reference":[{"issue":"3","key":"2528_CR1","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1016\/j.medmal.2017.02.003","volume":"47","author":"A Boucher","year":"2017","unstructured":"Boucher A, Herrmann JL, Morand P, Buzel\u00e9 R, Crabol Y, Stahl JP, et al. Epidemiology of infectious encephalitis causes in 2016. Med Mal Infect. 2017;47(3):221\u201335.","journal-title":"Med Mal Infect"},{"issue":"6","key":"2528_CR2","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1056\/NEJMra1708714","volume":"379","author":"KL Tyler","year":"2018","unstructured":"Tyler KL. Acute Viral Encephalitis. N Engl J Med. 2018;379(6):557\u201366.","journal-title":"N Engl J Med"},{"issue":"5","key":"2528_CR3","doi-asserted-by":"publisher","first-page":"135","DOI":"10.5501\/wjv.v1.i5.135","volume":"1","author":"RN Charrel","year":"2012","unstructured":"Charrel RN, Bichaud L, de Lamballerie X. Emergence of Toscana virus in the mediterranean area. World J Virol. 2012;1(5):135\u201341.","journal-title":"World J Virol"},{"issue":"6","key":"2528_CR4","first-page":"577","volume":"9","author":"M Valassina","year":"2003","unstructured":"Valassina M, Cusi MG, Valensin PE. A Mediterranean arbovirus: the Toscana virus. J Neuro-Oncol. 2003;9(6):577\u201383.","journal-title":"J Neuro-Oncol"},{"issue":"1","key":"2528_CR5","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1007\/s00415-011-6121-y","volume":"259","author":"S Bartels","year":"2012","unstructured":"Bartels S, de Boni L, Kretzschmar HA, Heckmann JG. Lethal encephalitis caused by the Toscana virus in an elderly patient. J Neurol. 2012 Jan;259(1):175\u20137.","journal-title":"J Neurol"},{"issue":"4","key":"2528_CR6","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1086\/381201","volume":"38","author":"F Baldelli","year":"2004","unstructured":"Baldelli F, Ciufolini MG, Francisci D, Marchi A, Venturi G, Fiorentini C, et al. Unusual presentation of life-threatening Toscana virus meningoencephalitis. Clin Infect Dis Off Publ Infect Dis Soc Am. 2004;38(4):515\u201320.","journal-title":"Clin Infect Dis Off Publ Infect Dis Soc Am"},{"issue":"11","key":"2528_CR7","first-page":"868","volume":"23","author":"A Pierro","year":"2017","unstructured":"Pierro A, Ficarelli S, Ayhan N, Morini S, Raumer L, Bartoletti M, et al. Characterization of antibody response in neuroinvasive infection caused by Toscana virus. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis. 2017;23(11):868\u201373.","journal-title":"Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis"},{"issue":"50","key":"2528_CR8","doi-asserted-by":"publisher","first-page":"2838","DOI":"10.1055\/s-2006-957210","volume":"131","author":"C Imirzalioglu","year":"2006","unstructured":"Imirzalioglu C, Schaller M, Bretzel RG. Sandfly fever Naples virus (serotype Toscana) infection with meningeal involvement after a vacation in Italy. Dtsch Med Wochenschr. 2006;131(50):2838\u201340.","journal-title":"Dtsch Med Wochenschr"},{"issue":"1","key":"2528_CR9","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1186\/s13071-020-04058-6","volume":"13","author":"S Oerther","year":"2020","unstructured":"Oerther S, J\u00f6st H, Heitmann A, L\u00fchken R, Kr\u00fcger A, Steinhausen I, et al. Phlebotomine sand flies in Southwest Germany: an update with records in new locations. Parasit Vectors. 2020;13(1):173.","journal-title":"Parasit Vectors"},{"issue":"2","key":"2528_CR10","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/j.jcv.2007.10.001","volume":"41","author":"M Weidmann","year":"2008","unstructured":"Weidmann M, Sanchez-Seco MP, Sall AA, Ly PO, Thiongane Y, L\u00f4 MM, et al. Rapid detection of important human pathogenic Phleboviruses. J Clin Virol. 2008;41(2):138\u201342.","journal-title":"J Clin Virol"},{"issue":"1","key":"2528_CR11","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/j.jcv.2009.10.002","volume":"47","author":"D Tappe","year":"2010","unstructured":"Tappe D, Schmidt-Chanasit J, G\u00fcnther S, Ries A, Ziegler U, M\u00fcller A, et al. Acute Toscana virus infection mimicked by Yersinia-induced reactive arthritis syndrome after journey to Spain. J Clin Virol. 2010;47(1):104\u20135.","journal-title":"J Clin Virol"},{"issue":"3","key":"2528_CR12","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/j.jcv.2012.07.007","volume":"55","author":"S Jaijakul","year":"2012","unstructured":"Jaijakul S, Arias CA, Hossain M, Arduino RC, Wootton SH, Hasbun R. Toscana meningoencephalitis: a comparison to other viral central nervous system infections. J Clin Virol Off Publ Pan Am Soc Clin Virol. 2012;55(3):204\u20138.","journal-title":"J Clin Virol Off Publ Pan Am Soc Clin Virol"},{"issue":"8","key":"2528_CR13","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1212\/WNL.0b013e3182661f1a","volume":"79","author":"J Oechtering","year":"2012","unstructured":"Oechtering J, Petzold GC. Acute hydrocephalus due to impaired CSF resorption in Toscana virus meningoencephalitis. Neurology. 2012;79(8):829\u201331.","journal-title":"Neurology"},{"issue":"15","key":"2528_CR14","doi-asserted-by":"publisher","first-page":"1444","DOI":"10.1212\/WNL.0b013e31828cf551","volume":"80","author":"RN Charrel","year":"2013","unstructured":"Charrel RN, Petzold GC, Oechtering J. Acute hydrocephalus due to impaired CSF resorption in Toscana virus meningoencephalitis. Neurology. 2013;80(15):1444.","journal-title":"Neurology"},{"issue":"9","key":"2528_CR15","doi-asserted-by":"publisher","first-page":"2765","DOI":"10.1007\/s00436-020-06775-4","volume":"119","author":"D Werner","year":"2020","unstructured":"Werner D, Kowalczyk S, Kampen H. Nine years of mosquito monitoring in Germany, 2011-2019, with an updated inventory of German culicid species. Parasitol Res. 2020;119(9):2765\u201374.","journal-title":"Parasitol Res"},{"issue":"1","key":"2528_CR16","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1186\/s12877-017-0593-2","volume":"17","author":"J Veater","year":"2017","unstructured":"Veater J, Mehedi F, Cheung CK, Nabarro L, Osborne J, Wong N, et al. Toscana virus meningo-encephalitis: an important differential diagnosis for elderly travellers returning from Mediterranean countries. BMC Geriatr. 2017;17(1):193.","journal-title":"BMC Geriatr"}],"container-title":["BMC Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-021-02528-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12883-021-02528-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12883-021-02528-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T06:04:25Z","timestamp":1640153065000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcneurol.biomedcentral.com\/articles\/10.1186\/s12883-021-02528-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":16,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2528"],"URL":"https:\/\/doi.org\/10.1186\/s12883-021-02528-7","relation":{},"ISSN":["1471-2377"],"issn-type":[{"value":"1471-2377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]},"assertion":[{"value":"26 October 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 December 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted according to Helsinki criteria and received approval by the local ethics committee of the Medical Center \u2013 University of Freiburg, Faculty of Medicine (EK FR 536\/19). Written informed consent was obtained from each patient.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"RD reports lecture fees from Roche and Alexion and travel grants by Biogen.AS declares no conflict of interest.DC declares no conflict of interest.PE declares no conflict of interest.JSC declares no conflict of interest.SR reports consulting and lecture fees, grant and research support from Bayer Vital GmbH, Biogen, Celgene, Merck Serono, Novartis, Sanofi- Aventis, Genzyme, Roche and Teva; founding executive board member of ravo Diagnostika GmbH Freiburg.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"495"}}