{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T01:03:11Z","timestamp":1767920591857,"version":"3.49.0"},"reference-count":26,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T00:00:00Z","timestamp":1648166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>West Nile Virus (WNV) infection is a world-wide zoonotic disease transmitted by mosquitoes. The infection is usually self-limiting; however, elderly patients or those with comorbidities are predisposed to developing severe, and sometimes fatal complications of the infection. Recently, the incidence of WNV infection in Europe had seen a sharp increase, as compared to previous years. We are currently reporting on the clinical presentation and laboratory findings in 23 cases of WNV infection, of which one resulted in a fatal outcome. The clinical picture was predominantly that of meningitis\/meningoencephalitis of varying severity. One patient suffered a fatal outcome, and a rare manifestation of chorioretinal lesions and iridocyclitis was also reported as a result of WNV infection. Cerebrospinal fluid analysis predominantly showed lymphocytic pleocytosis, and total protein levels were increased in all but three of the patients. Levels of total protein in CSF samples were found to show a positive correlation with age. Given the ever-increasing incidence of WNV infection in Europe, a high index of clinical suspicion should always accompany cases of meningitis, especially during the summer period, as a similar epidemic pattern is predicted to recur.<\/jats:p>","DOI":"10.3390\/diagnostics12040805","type":"journal-article","created":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T15:31:21Z","timestamp":1648222281000},"page":"805","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Clinical Spectrum and CSF Findings in Patients with West-Nile Virus Infection, a Retrospective Cohort Review"],"prefix":"10.3390","volume":"12","author":[{"given":"Imre","family":"Bakos","sequence":"first","affiliation":[{"name":"Infectology Clinic, University of Debrecen Clinical Center, 4031 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7959-5996","authenticated-orcid":false,"given":"Mohamed","family":"Mahdi","sequence":"additional","affiliation":[{"name":"Infectology Clinic, University of Debrecen Clinical Center, 4031 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4749-1057","authenticated-orcid":false,"given":"L\u00e1szl\u00f3","family":"Kardos","sequence":"additional","affiliation":[{"name":"Infectology Clinic, University of Debrecen Clinical Center, 4031 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4081-2308","authenticated-orcid":false,"given":"Anna","family":"Nagy","sequence":"additional","affiliation":[{"name":"National Reference Laboratory for Viral Zoonoses, National Public Health Center, 1097 Budapest, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Istv\u00e1n","family":"V\u00e1rkonyi","sequence":"additional","affiliation":[{"name":"Infectology Clinic, University of Debrecen Clinical Center, 4031 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"471","DOI":"10.4269\/ajtmh.1940.s1-20.471","article-title":"A Neurotropic Virus Isolated from the Blood of a Native of Uganda1","volume":"20","author":"Smithburn","year":"1940","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1111\/j.1749-6632.2001.tb02690.x","article-title":"West Nile in the Mediterranean basin: 1950\u20132000","volume":"951","author":"Murgue","year":"2001","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_3","first-page":"89","article-title":"West Nile fever; the clinical features of the disease and the isolation of West Nile virus from the blood of nine human cases","volume":"59","author":"Goldblum","year":"1954","journal-title":"Am. J. Hyg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1093\/infdis\/93.3.207","article-title":"Isolation of West Nile virus in Israel","volume":"93","author":"Bernkopf","year":"1953","journal-title":"J. Infect. Dis."},{"key":"ref_5","first-page":"259","article-title":"The natural history of West Nile Fever. I. Clinical observations during an epidemic in Israel","volume":"64","author":"Goldblum","year":"1956","journal-title":"Am. J. Hyg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"376230","DOI":"10.1155\/2015\/376230","article-title":"The global ecology and epidemiology of West Nile virus","volume":"2015","author":"Chancey","year":"2015","journal-title":"Biomed. Res. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1007\/s00705-004-0463-z","article-title":"West Nile virus in the vertebrate world","volume":"150","author":"Pensaert","year":"2005","journal-title":"Arch. Virol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1099\/0022-1317-23-1-91","article-title":"The flaviviruses (group B arboviruses): A cross-neutralization study","volume":"23","author":"Porterfield","year":"1974","journal-title":"J. Gen. Virol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1056\/NEJMoa030969","article-title":"Transmission of West Nile virus through blood transfusion in the United States in 2002","volume":"349","author":"Pealer","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_10","first-page":"1976","article-title":"Possible West Nile Virus transmission to an infant through breast-feeding\u2014Michigan, 2002\u2014(Reprinted from MMWR, vol 51, pg 877\u2013878, 2002)","volume":"288","author":"Ognjan","year":"2002","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5778","DOI":"10.1182\/blood-2011-02-335901","article-title":"West Nile virus infection transmitted by granulocyte transfusion","volume":"117","author":"Meny","year":"2011","journal-title":"Blood"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"173","DOI":"10.7326\/0003-4819-137-3-200208060-00009","article-title":"West Nile virus: A primer for the clinician","volume":"137","author":"Petersen","year":"2002","journal-title":"Ann. Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/S1473-3099(04)01128-4","article-title":"West Nile virus: Where are we now?","volume":"4","author":"Granwehr","year":"2004","journal-title":"Lancet Infect. Dis."},{"key":"ref_14","unstructured":"European Centre for Disease Prevention and Control (ECDC) (2018). Weekly Updates: 2018 West Nile Fever Transmission Season, ECDC."},{"key":"ref_15","unstructured":"K\u00d6ZPONT NN (2018, November 16). Heti t\u00e1j\u00e9koztat\u00f3 a hazai j\u00e1rv\u00e1ny\u00fcgyi helyzetr\u0151l. 43. H\u00e9t. Available online: https:\/\/www.google.com\/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjTwIPeoOD2AhUTsFYBHYraA0gQFnoECBAQAQ&url=https%3A%2F%2Fwww.antsz.hu%2Fdata%2Fcms88419%2F2018_34_honlapheti.pdf&usg=AOvVaw2OwSjXV9UVxDJpN_RrbaSj."},{"key":"#cr-split#-ref_16.1","unstructured":"European Union (2018). Commission Implementing Decision"},{"key":"#cr-split#-ref_16.2","unstructured":"(EU) 2018\/945 of 22 June 2018 on the Communicable Diseases and Related Special Health Issues to Be Covered by Epidemiological Surveillance as Well as Relevant Case Definitions. Off. J. Eur. Union, 61, 1-74."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1556\/amicr.58.2011.2.8","article-title":"Serologic evidence of West Nile virus infection in patients with exanthema in Hungary","volume":"58","author":"Szomor","year":"2011","journal-title":"Acta Microbiol. Immunol. Hung."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.jviromet.2007.05.021","article-title":"Detection of West Nile virus lineages 1 and 2 by real-time PCR","volume":"146","author":"Linke","year":"2007","journal-title":"J. Virol. Methods"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"19933","DOI":"10.2807\/ese.16.31.19933-en","article-title":"Evidence of enzootic circulation of West Nile virus (Nea Santa-Greece-2010, lineage 2), Greece, May to July 2011","volume":"16","author":"Chaskopoulou","year":"2011","journal-title":"Eurosurveillance"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jviromet.2013.08.039","article-title":"Development of a Usutu virus specific real-time reverse transcription PCR assay based on sequenced strains from Africa and Europe","volume":"197","author":"Nikolay","year":"2014","journal-title":"J. Virol. Methods"},{"key":"ref_21","unstructured":"European Centre for Disease Prevention and Control (ECDC) (2019, July 01). Transmission of West Nile Fever, May to November 2017\u2014Table of Cases. Available online: https:\/\/www.ecdc.europa.eu\/en\/publications-data\/table-transmission-west-nile-fever-may-november-2017-table-cases-2017."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1016\/S0161-6420(03)00720-6","article-title":"Chorioretinal lesions in nonfatal cases of West Nile virus infection","volume":"110","author":"Hershberger","year":"2003","journal-title":"Ophthalmology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1001\/archopht.121.2.205","article-title":"Vitritis and chorioretinitis in a patient with West Nile virus infection","volume":"121","author":"Bains","year":"2003","journal-title":"Arch. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.survophthal.2004.10.001","article-title":"Systemic and intraocular manifestations of West Nile virus infection","volume":"50","author":"Garg","year":"2005","journal-title":"Surv. Ophthalmol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1648","DOI":"10.1001\/archopht.121.11.1648","article-title":"Uveitis associated with West Nile virus infection","volume":"121","author":"Kuchtey","year":"2003","journal-title":"Arch. Ophthalmol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/4\/805\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:43:08Z","timestamp":1760136188000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/4\/805"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,25]]},"references-count":26,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["diagnostics12040805"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12040805","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,25]]}}}