{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T04:03:34Z","timestamp":1773288214699,"version":"3.50.1"},"reference-count":22,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,1,29]],"date-time":"2021-01-29T00:00:00Z","timestamp":1611878400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007365","name":"Fondazione IRCCS Policlinico San Matteo","doi-asserted-by":"publisher","award":["80206"],"award-info":[{"award-number":["80206"]}],"id":[{"id":"10.13039\/100007365","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Phleboviruses transmitted by phlebotomine sandflies are endemic in the Mediterranean basin. Toscana phlebovirus (TOSV), Sicilian phlebovirus (SFSV), and Naples phlebovirus (SFNV) are responsible of summer fever, with well-known pathogenic potential for humans ranging from asymptomatic to mild fever, in addition to neuro-invasive infections during summer. Although TOSV, in particular, is a significant and well-known human pathogen, SFVs remain neglected, with many gaps in the relevant knowledge. Sero-epidemiological studies and case reports recently showed a geographical wider distribution than previously considered, although the real incidence of phleboviruses infections in the Mediterranean area is still unknown. Here we retrospectively evaluated the circulation of phleboviruses during summer seasons between 2007 and 2019 in 649 patients showing neurological symptoms using both molecular and serological approaches. We found that 42\/649 (6.5%) subjects experienced phlebovirus infection and only 10\/42 cases were detected by molecular assays, whereas the other 32\/42 were identified using serological approaches, including neutralization assays. During the 2013 summer, an outbreak in the Lombardy region is described because the prevalence of phlebovirus infection reached 37.2% (19\/51 subjects). Interestingly, only 5\/19 (26.5%) reported traveling in endemic areas. Of note, no cross-neutralization was observed between different strains tested, showing the possibility to be reinfected by newly discovered phlebovirus strains. In conclusion, phlebovirus infections are still inadequately considered by physicians and are generally underestimated. However, based on our results, sandfly fever viruses should be routinely included in diagnostic panels during summer period, including in Northern Italy.<\/jats:p>","DOI":"10.3390\/v13020209","type":"journal-article","created":{"date-parts":[[2021,1,30]],"date-time":"2021-01-30T06:22:20Z","timestamp":1611987740000},"page":"209","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Thirteen Years of Phleboviruses Circulation in Lombardy, a Northern Italy Region"],"prefix":"10.3390","volume":"13","author":[{"given":"Elena","family":"Percivalle","sequence":"first","affiliation":[{"name":"Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3385-2088","authenticated-orcid":false,"given":"Irene","family":"Cassaniti","sequence":"additional","affiliation":[{"name":"Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"},{"name":"Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7489-2556","authenticated-orcid":false,"given":"Mattia","family":"Calzolari","sequence":"additional","affiliation":[{"name":"Istituto Zooprofilattico Sperimentale della Lombardia e dell\u2019Emilia Romagna B. Ubertini, 25100 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5775-6058","authenticated-orcid":false,"given":"Davide","family":"Lelli","sequence":"additional","affiliation":[{"name":"Istituto Zooprofilattico Sperimentale della Lombardia e dell\u2019Emilia Romagna B. Ubertini, 25100 Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fausto","family":"Baldanti","sequence":"additional","affiliation":[{"name":"Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"},{"name":"Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3023","DOI":"10.1007\/s00705-020-04731-2","article-title":"2020 taxonomic update for phylum Negarnaviricota (Riboviria: Orthornavirae), including the large orders Bunyavirales and Mononegavirales","volume":"165","author":"Kuhn","year":"2020","journal-title":"Arch. Virol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.antiviral.2013.07.005","article-title":"Sandfly-borne phleboviruses of Eurasia and Africa: Epidemiology, genetic diversity, geographic range, control measures","volume":"100","author":"Alkan","year":"2013","journal-title":"Antivir. Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1186\/s13071-017-2334-y","article-title":"Direct evidence for an expanded circulation area of the recently identified Balkan virus (sandfly fever Naples virus species) in several countries of the Balkan archipelago","volume":"10","author":"Ayhan","year":"2017","journal-title":"Parasites Vectors"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"19507","DOI":"10.2807\/ese.15.10.19507-en","article-title":"Arthropod-borne viruses transmitted by Phlebotomine sandflies in Europe: A review","volume":"15","author":"Depaquit","year":"2010","journal-title":"Eurosurveillance"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.3201\/eid1111.050869","article-title":"Emergence of Toscana virus in Europe","volume":"11","author":"Charrel","year":"2005","journal-title":"Emerg. Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1097\/00001432-200310000-00003","article-title":"Epidemiological, clinical and laboratory aspects of Sandfly Fever","volume":"16","author":"Dionisio","year":"2003","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1002\/(SICI)1096-9071(200001)60:1<86::AID-JMV14>3.0.CO;2-N","article-title":"Detection of neurotropic viruses circulating in Tuscany: The incisive role of Toscana virus","volume":"60","author":"Valassina","year":"2000","journal-title":"J. Med. Virol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1080\/00365549850161539","article-title":"Phlebotomus-transmitted toscana virus infections of the central nervous system: A seven-year experience in Tuscany","volume":"30","author":"Braito","year":"1998","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_9","first-page":"41","article-title":"Sandfly fever virus in Italy","volume":"11","author":"Nicoletti","year":"1996","journal-title":"Arch. Virol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/S1386-6532(02)00041-0","article-title":"Acute meningitis due to Toscana virus infection among patients from both the Spain Mediterranean region and region of Madrid","volume":"26","author":"Echevarria","year":"2003","journal-title":"J. Clin. Virol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1086\/514684","article-title":"Infection due to sandflyfeverserotype Toscana in Spain","volume":"27","year":"1998","journal-title":"Clin. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2295","DOI":"10.1007\/s00705-018-3843-5","article-title":"Taxonomy of the family Arenaviridae and the order Bunyavirales: Update 2018","volume":"163","author":"Maes","year":"2018","journal-title":"Arch. Virol."},{"key":"ref_13","first-page":"397","article-title":"Ecological and epidemiologicalstudies of Toscana virus, an arbovirusisolated from Phlebotomus","volume":"18","author":"Verani","year":"1982","journal-title":"Ann. Ist. Super. Sanita"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Moriconi, M., Rugna, G., Calzolari, M., Bellini, R., Albieri, A., Angelini, P., Cagarelli, R., Landini, M.P., Charrel, R.N., and Varani, S. (2017). Phlebotominesandfly-bornepathogens in the MediterraneanBasin: Human leishmaniasis and phlebovirusinfections. PLoS Negl. Trop. Dis., 11.","DOI":"10.1371\/journal.pntd.0005660"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jcv.2007.05.003","article-title":"Reversetranscription, real-time PCR assay for detection of Toscana virus","volume":"39","author":"Collao","year":"2007","journal-title":"J. Clin. Virol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1002\/jmv.10465","article-title":"Detection and Identification of Toscana and other Phleboviruses by RT-Nested-PCR assays with degenerated primers","volume":"71","author":"Tenorio","year":"2003","journal-title":"J. Med. Virol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1186\/s13071-018-2668-0","article-title":"Isolation of three novel reassortant phleboviruses, Ponticelli I, II, III, and of Toscana virus from field-collected sandflies in Italy","volume":"11","author":"Calzolari","year":"2018","journal-title":"Parasites Vectors"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.ejim.2004.05.006","article-title":"Sandflyfever due to Toscanavirus: An emerging infection in southern France","volume":"15","author":"Parola","year":"2004","journal-title":"Eur. J. Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.meegid.2018.06.014","article-title":"Co-circulation of eight different phleboviruses in sand flies collected in the Northern Apennine Mountains (Italy)","volume":"64","author":"Calzolari","year":"2018","journal-title":"Infect. Genet. Evol."},{"key":"ref_20","first-page":"451","article-title":"Sendfly virus among Swedish tourists","volume":"23","author":"Eitrem","year":"1991","journal-title":"J. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1128\/CVI.00376-08","article-title":"Age-Dependent seroprevalence of Toscana virus in Central Italy and correlation with the clinical profile","volume":"16","author":"Terrosi","year":"2009","journal-title":"Clin. Vaccine Immunol."},{"key":"ref_22","first-page":"485","article-title":"Symptomatic infections by toscana virus in the Modena province in the triennium 1999\u20132001","volume":"25","author":"Portolani","year":"2002","journal-title":"New Microbiol."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/13\/2\/209\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:17:25Z","timestamp":1760159845000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/13\/2\/209"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,29]]},"references-count":22,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["v13020209"],"URL":"https:\/\/doi.org\/10.3390\/v13020209","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,29]]}}}