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Report of Rift Valley Fever virus persistence in semen of immunosuppressed patient - Eurosurveilance

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  • Report of Rift Valley Fever virus persistence in semen of immunosuppressed patient - Eurosurveilance

    Eurosurveillance, Volume 21, Issue 18, 05 May 2016
    Rapid communication

    RIFT VALLEY FEVER IN KIDNEY TRANSPLANT RECIPIENT RETURNING FROM MALI WITH VIRAL RNA DETECTED IN SEMEN UP TO FOUR MONTHS FROM SYMPTOM ONSET, FRANCE, AUTUMN 2015





    Citation style for this article: Haneche F, Leparc-Goffart I, Simon F, Hentzien M, Martinez-Pourcher V, Caumes E, Maquart M. Rift Valley fever in kidney transplant recipient returning from Mali with viral RNA detected in semen up to four months from symptom onset, France, autumn 2015. Euro Surveill. 2016;21(18):pii=30222. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.18.30222

    Received:16 April 2016; Accepted:04 May 2016

    A 29-year-old kidney transplant recipient returning from Mali was diagnosed with Rift Valley fever (RVF) in France in autumn 2015. The patient was immunosuppressed due to his renal transplant. IgM and IgG specific to RVF virus (RVFV) were detected in cerebrospinal fluid and blood up to two months after symptom onset, whereas in urine, RVFV genomic RNA was detected by RT-PCR up to three months, and in semen up to four months post symptom onset.

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    Discussion and conclusion

    This case report highlights that RVF may be acquired in Mali and that the virus was detected in urine and semen after the onset of symptoms for up to three and four months, respectively, in an immunosuppressed patient.
    This is to the best of our knowledge the first documented human case of symptomatic RVF acquired in Mali. However, results from a study in 1999 among slaughterhouse personnel working with cattle and sheep in Saudi Arabia during the Hajj, showed a high seroprevalence for workers from Mali [7] and the village where the patient was infected is 30 km south the Mauritanian border, where an outbreak of RVF in sheep and goats was declared in October 2015 [8]. To our knowledge, there was no ongoing outbreak, unusual die-off or abortion reported in livestock in the village during the period of the patient?s stay but a silent circulation of the virus cannot be excluded [9]. The patient was frequently bitten by mosquitoes. He also reported raw milk consumption which is considered as a risk factor for human infection [10].
    Given the massive affection of the liver, the possibility of acute hepatitis B was ruled out by the low HBV viral load detected by RT-PCR at 20 IU/mL or 1.3 log, corresponding exactly to the threshold of this technique and with no clinical or biological significance, in a patient with a cured hepatitis B. Furthermore, a test for HBV viral load done one month later, was negative.
    This case demonstrates the difficulty in diagnosing a little known pathology. The initial clinical presentation was characteristic for acute hepatitis and four weeks later, the patient presented with a lymphocytic meningoencephalitis. The severity of the clinical picture may have been related to the necessary therapeutic immunosuppression in the kidney transplant recipient which might also have slowed down the clearance of the RVFV. We did not precisely identify the mode of infection, however, the time from raw milk consumption to symptom onset was approximately four days. Considering this, and the clinical course with hepatitis symptoms 12 days later, and meningoencephalitis 44 days after having visited the physician in Mali, this is in agreement with the incubation time in the literature [5,6].
    We report the first RVF viral RNA detection in urine and in human semen that did not have gross blood contamination. No information about infectivity could be determined as viral isolation failed. The RVFV was previously detected in cattle semen [10] but not in humans. Infectious Ebola virus can be present in semen more than three months after recovery and is transmitted to other persons by sexual route [11]. Similarly, Zika virus has been isolated from the semen of a patient 24 days post onset of symptoms [12]. Ebola virus RNA was detected more than nine months post-exposure [11]. Duration of virus persistence in semen may be linked to the immunosuppressive status of a patient or a viral characteristic as for Ebola and Zika virus. As a precaution, we recommend to abstain or engage only in protected intercourse when RVFV is detected in semen, until complete clearance of the virus.
    RVFV genomic RNA was detected in semen four months after the onset of symptoms in an immunocompromised patient. Testing semen could be a new method for diagnosing RVF retrospectively and presence of RVFV genomic RNA raises the possibility that RVF could be transmitted sexually.

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    ?Addressing chronic disease is an issue of human rights ? that must be our call to arms"
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