{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T14:33:26Z","timestamp":1783953206730,"version":"3.55.0"},"reference-count":30,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2020,9,14]],"date-time":"2020-09-14T00:00:00Z","timestamp":1600041600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004488","name":"Hrvatska Zaklada za Znanost","doi-asserted-by":"publisher","award":["IP 2016-06-7456"],"award-info":[{"award-number":["IP 2016-06-7456"]}],"id":[{"id":"10.13039\/501100004488","id-type":"DOI","asserted-by":"publisher"}]},{"name":"European Virus Archive Global project (European Union\u2019s Horizon 2020)","award":["871029"],"award-info":[{"award-number":["871029"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Toscana virus (TOSV) is an arthropod-borne virus, transmitted to humans by phlebotomine sandflies. Although the majority of infections are asymptomatic, neuroinvasive disease may occur. We report three cases of neuroinvasive TOSV infection detected in Croatia. Two patients aged 21 and 54 years presented with meningitis, while a 22-year old patient presented with meningoencephalitis and right-sided brachial plexitis. Cerebrospinal fluid (CSF), serum, and urine samples were collected and tested for neuroinvasive arboviruses: tick-borne encephalitis, West Nile, Usutu, TOSV, Tahyna, and Bhanja virus. In addition, CSF and serum samples were tested for the anti-viral cytokine response. High titers of TOSV IgM (1000\u20133200) and IgG (3200\u221210,000) antibodies in serum samples confirmed TOSV infection. Antibodies to other phleboviruses (sandfly fever Sicilian\/Naples\/Cyprus virus) were negative. CSF samples showed high concentrations of interleukin 6 (IL-6; range 162.32\u22122683.90 pg\/mL), interferon gamma (IFN-\u03b3; range 110.12\u22121568.07 pg\/mL), and IL-10 (range 28.08\u2212858.91 pg\/mL), while significantly lower cytokine production was observed in serum. Two patients recovered fully. The patient with a brachial plexitis improved significantly at discharge. The presented cases highlight the need of increasing awareness of a TOSV as a possible cause of aseptic meningitis\/meningoencephalitis during summer months. Association of TOSV and brachial plexitis with long-term sequelae detected in one patient indicates the possibility of more severe disease, even in young patients.<\/jats:p>","DOI":"10.3390\/tropicalmed5030144","type":"journal-article","created":{"date-parts":[[2020,9,14]],"date-time":"2020-09-14T09:04:53Z","timestamp":1600074293000},"page":"144","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Clinical, Virological, and Immunological Findings in Patients with Toscana Neuroinvasive Disease in Croatia: Report of Three Cases"],"prefix":"10.3390","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1877-5547","authenticated-orcid":false,"given":"Tatjana","family":"Vilibic-Cavlek","sequence":"first","affiliation":[{"name":"Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia"},{"name":"School of Medicine, University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Snjezana","family":"Zidovec-Lepej","sequence":"additional","affiliation":[{"name":"Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases \u201cDr Fran Mihaljevic\u201d, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dragan","family":"Ledina","sequence":"additional","affiliation":[{"name":"Clinic for Infectious Diseases, University Hospital Center Split, 21000 Split, Croatia"},{"name":"School of Medicine, University of Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira","family":"Knezevic","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinic, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0398-5346","authenticated-orcid":false,"given":"Vladimir","family":"Savic","sequence":"additional","affiliation":[{"name":"Laboratory for Virology and Serology, Croatian Veterinary Institute, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2518-522X","authenticated-orcid":false,"given":"Irena","family":"Tabain","sequence":"additional","affiliation":[{"name":"Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivo","family":"Ivic","sequence":"additional","affiliation":[{"name":"Clinic for Infectious Diseases, University Hospital Center Split, 21000 Split, Croatia"},{"name":"School of Medicine, University of Split, 21000 Split, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0187-0337","authenticated-orcid":false,"given":"Irena","family":"Slavuljica","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinic, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia"},{"name":"Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja","family":"Bogdanic","sequence":"additional","affiliation":[{"name":"Department of Virology, Croatian Institute of Public Health, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Grgic","sequence":"additional","affiliation":[{"name":"Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases \u201cDr Fran Mihaljevic\u201d, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lana","family":"Gorenec","sequence":"additional","affiliation":[{"name":"Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases \u201cDr Fran Mihaljevic\u201d, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9572-8760","authenticated-orcid":false,"given":"Vladimir","family":"Stevanovic","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ljubo","family":"Barbic","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine University of Zagreb, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ayhan, N., Prudhomme, J., Laroche, L., Ba\u00f1uls, A.L., and Charrel, R.N. 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