Novel Phlebovirus in Febrile Child, Greece

et al. Evaluation of an immunoglobulin M–specifi c capture enzyme-linked immunosorbent assay for rapid diagnosis of dengue infection. To the Editor: Phleboviruses (family Bunyaviridae, genus Phlebovirus) are arthropod-borne, single-stranded, RNA viruses. Their genome consists of 3 segments—small, medium, and large—which encode the nucleoprotein and nonstructural proteins, the envelope glycoproteins, and the viral polymerase, respectively (1). The genus Phlebovirus consists at least 60 antigenically distinct serotypes, including the sandfl y fever viruses transmitted to humans by phlebotomine sandfl ies. In the Mediterranean region, 3 phleboviruses are known to circulate: Toscana virus, sandfl y fever Naples virus, and sandfl y fever Sicilian virus. Sandfl y fever Naples virus and sandfl y fever Sicilian virus cause a transient febrile illness, whereas Toscana virus is sometimes neurovirulent, leading to aseptic meningitis and meningoencephalitis (2,3). Phleboviruses have been detected in Greece in clinically ill persons and in sandfl ies; seroprevalance in humans is high, especially in the Ionian islands (3–7). In addition, in 2002, a Sicilian-like virus (Cyprus virus) was responsible for a major outbreak of febrile illness among Greek Army forces in Cyprus (8). We report genetic detection and sequencing of an Adria virus from a boy who was hospitalized because of simple febrile seizure; the identical sequence was initially detected in sandfl ies collected in a coastal area in Albania. after a single episode of simple febrile seizure. The patient was febrile (38.2°C) and had vomited 1 time while in nursery school. He had sudden onset of eye gaze, perioral cyanosis, masseter muscle spasm, generalized tonic convulsions of the body and extremities, and involuntary loss of urine. The episode lasted ≈3 minutes, after which the child became irritable and sleepy. At the time of hospital admission (30 minutes later), he was afebrile and conscious. The boy's history contained no previous neurologic or developmental disabilities and no family history of epilepsy or febrile seizures. Clinical examination, which included a thorough general and detailed neurologic evaluation, revealed no abnormalities except mild rhinitis. Laboratory tests showed leukocytosis (22,600 cells/μL) with 85.7% neutrophils. Blood levels of electrolytes, urea nitrogen, creatinine, glucose, albumin, bilirubin, alkaline phosphatase, and aminotransferases; prothrombin time; and urinalysis results were within reference limits. Electroencephalogram showed no brain abnormalities. Lumbar puncture and neuroimaging were not considered necessary. After 2 days of hospitalization, the child recovered, was free of signs and symptoms, and was discharged from the hospital with a diagnosis of simple febrile seizure and …