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West Nile virus in Spain: Report of the first diagnosed case (in Spain) in a human with aseptic meningitis
Article (PDF Available)  in Infectious Diseases 39(1):70-1 · February 2007 DOI: 10.1080/00365540600740553 · Source: PubMed

Abstract
We report the first case of illness caused by West Nile virus (WNV) so far diagnosed in Spain. A 21-y-old male
presented with clinical and biological signs compatible with viral meningitis. Acute and convalescent serum samples
showed IgM and IgG positivity for WNV. These results were confirmed by microneutralization assays

Case report
The patient was a previously healthy 21-y-old male  who, 5 d before admission to our hospital on 2
September 2004, noticed headache and malaise,followed 1 d later by abrupt onset of fever of 398C,
chills, vomiting, visual hallucinations and abdominal pain. Due to the persistence of these symptoms, he
was hospitalized. From 1 to 25 August 2004, he had been on holiday in a village called Valverde de
Legane´s, in the province of Badajoz (south-west Spain). He did not remember any significant epide-
miological data, including mosquito bites, and he was alert at admission. Physical examination
disclosed the presence of discrete neck stiffness and small cervical and inguinal adenopathies. Routine
haematological and chemical blood components were normal with the exception of light neutrophilia
(8.98 x 10.9/l) and minimal elevation of the gamma-GT level (0.81 ukat/l). A cranial CT was normal.
A lumbar puncture performed on d 6 of illness revealed clear CSF with 170 white blood cells/ml
(of which 65% were lymphocytes and 35% neutro-phils), 81 mg/dl proteins and 61.2 mg/dl glucose.
CSF Gram stain and culture were negative, and CSF PCR testing for herpes simplex virus was also
negative. We did not dispose of CSF samples, for the purpose of additional molecular studies. Clinical
evolution was spontaneously satisfactory and he was discharged without symptoms 5 d later. More than
1 y later, he is symptom-free and working.
We obtained acute and convalescent serum samples (d 8 and 42 of illness), and another sample
taken 10 months later. The acute serum was tested by serological methods for detecting recent infection
due to Brucella melitensis, Treponema pallidum, Borrelia burgdorferi, Toxoplasma gondii and Ep-
stein-Barr virus and all were negative.

Tests for HIVantigen p24 and antibodies to HIV-1 and -2 were also negative. The 3 samples were analysed in
parallel to detect IgM (by capture ELISA) and IgG (by indirect ELISA) to WNV (using reagent from
Focus, USA) and Toscana virus (TOSV) (from Diesse, Italy). All the samples showed IgM and
IgG positivity for WNV, the convalescent sample showing a rise of the IgG level (Table I). These
results were then confirmed by microneutralization assays using 100 TCDI 50 of West Nile Eg-101
reference strain, and the presence of neutralizing antibodies was confirmed. A slight rise in the
neutralization titre in the convalescent serum was also found. Results for TOSV were negative