Abstract Background: Many studies have presented virus sequences which suggest the existence of a variety of putative new phleboviruses transmitted by sandflies in the Old World.
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This report reviews the clinical and laboratory findings of patients with sandfly virus infection of disease outbreaks in and A retrospective single-centre descriptive study was performed. Informed consent was taken from the patients before participation. The patients with known disease, medical procedure or treatments affected the antibodies detection were excluded i. Determination of specific IgM was performed on samples received during and vector active season warm months, from May to Nov in Cyprus from selected patients with infectious pathologic features relating to Sandfly or West Nile fevers.
Based on similar selection criteria, 72 CSF samples from patients collected between and during vector active season were tested for circulating viral RNA. Samples were considered positive if in some cells, but not all, cytoplasmic finely granular structures and inclusion bodies fluoresced with the same pattern obtained as for the positive control serum.
For Flavivirus detection and quantification, the specific primers targeted the NS5 gene and were based on a previously published protocol The logistic regression model was generated from the GNU package R environment. The difference of mean age in anti-WNV seropositive group 33yr old compared to the seronegative patients group 37yr old was not statistically significant. Differences in frequencies observed between each age group, sex and district were also not statistically significant.
Difference of SFV IgM seroprevalence rates between each age group, sex and district were not statistically significant. The difference of WNV IgM seroprevalence rates between sexes, age groups or districts were not found statistically significant. Lower rates found here may reflect the different specificity and sensitivity of the assay used IIFT or plaque neutralization reduction assay PRNT 36 , sampling method skewed towards specific geographical areas Famagusta, Larnaca or Paphos districts , test subjects healthy donors or symptomatic patients , species tested humans or dogs or simply a lower exposition of the modern Cypriot population, possibly due to arthropods abatement programs to eradicate malaria in the island The anti-SFV IgG seroprevalence rate increasing with age is in agreement with the conclusions of previous studies 40 , 41 and demonstrates that the Cypriot population is exposed to SFVs throughout life.
This supports the hypothesis of random chance to contract each viral infection. Distinction between antigenically related viruses amongst the sandfly fever Naples species i. However, there was a significantly higher rate of sera from symptomatic patients tested for anti-SFV IgM reacting only against viruses from the Naples serogroup than sera reacting only against viruses belonging to the Sicilian serogroup.
Because of similar rates observed for IgG between serogroups and that patients were selected based on relevant symptoms, it confirms that infections from viruses belonging to the Naples serogroup are more symptomatic, particularly TOSV Anti-SFV IgM specific to members of the Naples serogroup are at higher concentrations or last longer than the ones specific to Sicilian-like viruses Even though their vectors are present on the island 48 , it is unlikely that the anti-SFV antibodies seroprevalence rates depicted in this report are markedly influenced due to such cross-reactivity.
Markers of recent WNV infection IgM were also detected in patients displaying relevant symptoms, highlighting its circulation and morbidity in the Cypriot population.
Few seropositive patients had neurological symptoms such as meningitis or meningoencephalitis. Together with the first Cypriot symptomatic case of a 75yr-old man with confirmed WNV infection during summer 24 , these results demonstrate the circulation of WNV in Cyprus.
All the anti-WNV IgM seropositive cases were from , following the trend of marked decreased West Nile fever autochthonous cases reported in Europe during these yr The most likely causes for this shortcoming are probably low SFV and WNV viremia detectable only in a small period of time, usually before patients present to the healthcare personnel, the limited number of samples tested and the use of direct RT-qPCR.
For these reasons, the surveillance and study of arboviral infections in Cyprus should be strengthened as these pathogens are potential causes of incapacitating and severe neurological diseases. The authors are grateful to Astero Constantinou and Sylvie Pavlides for technical assistance and Dr Christiana Demetriou for statistical assistance.
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