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Abstract：
BACKGROUND: We report a rare case of Toscana virus infection imported into Switzerland in a 23-year old man who travelled to Imperia (Italy) 10 days before onset of symptoms. Symptoms included both meningitis and as well epididymitis. This is only the fourth case of Toscana virus reported in Switzerland.
METHODS: The patient presented with lymphocytic meningitis and scrotal pain due to epididymitis. Meningitis was initially treated with ceftriaxone. Herpes simplex, tick-borne encephalitis, enterovirus, measles, mumps, rubella and Treponema pallidum were excluded with specific polymerase chain reaction (PCR) or serology. In support of routine diagnostic PCR and serology assays, unbiased viral metagenomic sequencing was performed of cerebrospinal fluid and serum. Toscana virus infection was identified in cerebrospinal fluid and the full coding sequence could be obtained. Specific PCR in cerebrospinal fluid and blood and serology with Immunoglobulin (Ig) M and IgG against Toscana virus confirmed our diagnosis. Neurological symptoms recovered spontaneously after 5 days.
CONCLUSIONS: This case of Toscana virus infection highlights the benefits of unbiased metagenomic sequencing to support routine diagnostics in rare or unexpected viral infections. With increasing travel histories of patients, physicians should be aware of imported Toscana virus as the agent for viral meningitis and meningoencephalitis.
METHODS: The patient presented with lymphocytic meningitis and scrotal pain due to epididymitis. Meningitis was initially treated with ceftriaxone. Herpes simplex, tick-borne encephalitis, enterovirus, measles, mumps, rubella and Treponema pallidum were excluded with specific polymerase chain reaction (PCR) or serology. In support of routine diagnostic PCR and serology assays, unbiased viral metagenomic sequencing was performed of cerebrospinal fluid and serum. Toscana virus infection was identified in cerebrospinal fluid and the full coding sequence could be obtained. Specific PCR in cerebrospinal fluid and blood and serology with Immunoglobulin (Ig) M and IgG against Toscana virus confirmed our diagnosis. Neurological symptoms recovered spontaneously after 5 days.
CONCLUSIONS: This case of Toscana virus infection highlights the benefits of unbiased metagenomic sequencing to support routine diagnostics in rare or unexpected viral infections. With increasing travel histories of patients, physicians should be aware of imported Toscana virus as the agent for viral meningitis and meningoencephalitis.
摘要：
背景：我们报告了一例罕见的托斯卡纳病毒感染病例，该病例输入瑞士，一名23岁男子在出现症状前10天前往意大利因佩里亚。症状包括脑膜炎和附睾炎。这只是瑞士报告的第四例托斯卡纳病毒病例。
方法：患者出现淋巴细胞性脑膜炎和附睾炎引起的阴囊疼痛。脑膜炎最初用头孢曲松治疗。单纯疱疹,蜱传脑炎,肠病毒,麻疹,腮腺炎,通过特异性聚合酶链反应（PCR）或血清学排除风疹和梅毒螺旋体。为了支持常规诊断PCR和血清学测定，对脑脊液和血清进行无偏病毒宏基因组测序。在脑脊液中鉴定出Toscana病毒感染，并可以获得完整的编码序列。脑脊液和血液中的特异性PCR以及针对Toscana病毒的免疫球蛋白（Ig）M和IgG的血清学证实了我们的诊断。5天后神经症状自发恢复。
结论：此例Toscana病毒感染病例强调了无偏宏基因组测序对支持罕见或意外病毒感染的常规诊断的益处。随着患者旅行史的增加，医生应了解进口的Toscana病毒可作为病毒性脑膜炎和脑膜脑炎的病原体。
方法：患者出现淋巴细胞性脑膜炎和附睾炎引起的阴囊疼痛。脑膜炎最初用头孢曲松治疗。单纯疱疹,蜱传脑炎,肠病毒,麻疹,腮腺炎,通过特异性聚合酶链反应（PCR）或血清学排除风疹和梅毒螺旋体。为了支持常规诊断PCR和血清学测定，对脑脊液和血清进行无偏病毒宏基因组测序。在脑脊液中鉴定出Toscana病毒感染，并可以获得完整的编码序列。脑脊液和血液中的特异性PCR以及针对Toscana病毒的免疫球蛋白（Ig）M和IgG的血清学证实了我们的诊断。5天后神经症状自发恢复。
结论：此例Toscana病毒感染病例强调了无偏宏基因组测序对支持罕见或意外病毒感染的常规诊断的益处。随着患者旅行史的增加，医生应了解进口的Toscana病毒可作为病毒性脑膜炎和脑膜脑炎的病原体。
