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Background <p>Toscana virus (TOSV), a sandfly-borne phlebovirus, is a leading cause of viral meningitis in the Mediterranean region and central Italy. Despite its prominence in endemic areas, TOSV infection is frequently underdiagnosed, particularly among international travellers.</p> Case presentation <p>A 24-year-old Hungarian male patient developed acute serous meningitis two weeks after returning from Naples, Italy. Symptoms began with a severe headache, accompanied by two episodes of vomiting. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis, elevated protein, and normal glucose levels. TOSV RNA was detected in CSF by RT-PCR, and a 350-nucleotide S-segment sequence showed 99% nucleotide identity to a TOSV lineage A strain previously identified in Italy. Seropositivity in the convalescent serum sample also confirmed the acute infection. Interestingly, blood panel tests showed markedly elevated total IgE levels (437 kU/L).</p> Conclusion <p>To our knowledge, this represents the first molecularly confirmed case of TOSV neuroinvasive disease acquired in the Campania region since 2005. This report emphasizes TOSV as an emerging travel-associated neurotropic pathogen beyond its traditional central Italian focus, and supports the inclusion of TOSV in diagnostic panels for travellers with acute neurological symptoms following exposure in Mediterranean regions.</p>

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Toscana virus infection acquired in Campania, Italy, in a Hungarian traveller: case report with mini-review

  • 期刊论文

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  • 发表日期：

    2026年5月20日

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  • Mohamed Mahdi,
  • Imre Bakos,
  • Anita Koroknai,
  • Márk Kozák,
  • Nikolett Csonka,
  • Anna Nagy,
  • István Zsolt Várkonyi

摘要

Background

Toscana virus (TOSV), a sandfly-borne phlebovirus, is a leading cause of viral meningitis in the Mediterranean region and central Italy. Despite its prominence in endemic areas, TOSV infection is frequently underdiagnosed, particularly among international travellers.

Case presentation

A 24-year-old Hungarian male patient developed acute serous meningitis two weeks after returning from Naples, Italy. Symptoms began with a severe headache, accompanied by two episodes of vomiting. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis, elevated protein, and normal glucose levels. TOSV RNA was detected in CSF by RT-PCR, and a 350-nucleotide S-segment sequence showed 99% nucleotide identity to a TOSV lineage A strain previously identified in Italy. Seropositivity in the convalescent serum sample also confirmed the acute infection. Interestingly, blood panel tests showed markedly elevated total IgE levels (437 kU/L).

Conclusion

To our knowledge, this represents the first molecularly confirmed case of TOSV neuroinvasive disease acquired in the Campania region since 2005. This report emphasizes TOSV as an emerging travel-associated neurotropic pathogen beyond its traditional central Italian focus, and supports the inclusion of TOSV in diagnostic panels for travellers with acute neurological symptoms following exposure in Mediterranean regions.