Gert van der Hoek
In Memoriam - Editor, Senior Moderator
5 Oct 2018
We have strong evidence for the 1st human case of West Nile fever acquired in Germany -- a male veterinarian from Bavaria (Germany) has been diagnosed after contact with a West Nile virus (WNV)-infected bird.
The 31-year-old veterinarian, who works at a birds' clinic, had performed necropsy of a just-deceased owl (great grey owl, _Strix nebulosa_) found in a wildlife park near Poing, Ebersberg, Bavaria. WNV was detected by PCR in tissue samples recovered during the necropsy. The owl case was posted on 14 Sep 2018 on ProMED-mail [West Nile virus (35): Europe (Germany, Croatia) wild bird, OIE 20180914.6029586]. Then 3 days after the necropsy, the veterinarian developed flu-like symptoms persisting for 4 to 5 days and a maculopapular skin rash, followed by a 2nd episode of fever one week later. Serological examination of a serum sample collected one month after the necropsy revealed the presence of specific IgM antibodies against WNV with a titre of 1:80 by immunofluorescence assay. No IgM antibodies against dengue virus, tick-borne encephalitis (TBE) virus, yellow fever virus and Japanese encephalitis virus were present. IgG antibodies against WNV and the other flaviviruses tested were positive with titres of 1:640 each. The patient had a history of past vaccinations against TBE (during childhood) and yellow fever virus (in 2012). The diagnostic tests were performed at the Bundeswehr Institute of Microbiology (Federal Armed Forces).
A monospecific IgM response against WNV and a cross-reactive IgG response against WNV, as well as a broad spectrum of other flaviviruses after a history of flavivirus vaccinations in the past, is the expected antibody profile during a fresh or recent WNV infection and provides strong evidence for the diagnosis. Further tests of follow-up samples from the patient to confirm the diagnosis are pending.
Contact of the conjunctiva with contaminated body secretions of infected birds and occupational accidents involving injury with sharps have been described as potential transmission routes of WNV and may also have been the route of infection in the present case, although the patient was not aware of any such event.
Contributed by:
Sabine Zange and Lothar Zoeller
Bundeswehr Institute of Microbiology
Munich, Germany
We have strong evidence for the 1st human case of West Nile fever acquired in Germany -- a male veterinarian from Bavaria (Germany) has been diagnosed after contact with a West Nile virus (WNV)-infected bird.
The 31-year-old veterinarian, who works at a birds' clinic, had performed necropsy of a just-deceased owl (great grey owl, _Strix nebulosa_) found in a wildlife park near Poing, Ebersberg, Bavaria. WNV was detected by PCR in tissue samples recovered during the necropsy. The owl case was posted on 14 Sep 2018 on ProMED-mail [West Nile virus (35): Europe (Germany, Croatia) wild bird, OIE 20180914.6029586]. Then 3 days after the necropsy, the veterinarian developed flu-like symptoms persisting for 4 to 5 days and a maculopapular skin rash, followed by a 2nd episode of fever one week later. Serological examination of a serum sample collected one month after the necropsy revealed the presence of specific IgM antibodies against WNV with a titre of 1:80 by immunofluorescence assay. No IgM antibodies against dengue virus, tick-borne encephalitis (TBE) virus, yellow fever virus and Japanese encephalitis virus were present. IgG antibodies against WNV and the other flaviviruses tested were positive with titres of 1:640 each. The patient had a history of past vaccinations against TBE (during childhood) and yellow fever virus (in 2012). The diagnostic tests were performed at the Bundeswehr Institute of Microbiology (Federal Armed Forces).
A monospecific IgM response against WNV and a cross-reactive IgG response against WNV, as well as a broad spectrum of other flaviviruses after a history of flavivirus vaccinations in the past, is the expected antibody profile during a fresh or recent WNV infection and provides strong evidence for the diagnosis. Further tests of follow-up samples from the patient to confirm the diagnosis are pending.
Contact of the conjunctiva with contaminated body secretions of infected birds and occupational accidents involving injury with sharps have been described as potential transmission routes of WNV and may also have been the route of infection in the present case, although the patient was not aware of any such event.
Contributed by:
Sabine Zange and Lothar Zoeller
Bundeswehr Institute of Microbiology
Munich, Germany