| Abstract | Neuroinvazivni arbovirusi kao što je virus krpeljnog encefalitisa (KMEV), virus Zapadnog Nila (VZN), Usutu virus (USUV) i Toscana virus (TOSV) značajni su uzročnici infekcija na području Europe. Cilj ovog rada bio je istražiti učestalost i epidemiološke značajke arbovirusnih infekcija u hospitaliziranih bolesnika s neuroinvazivnim oblikom bolesti na području Hrvatske. U istraživanje je uključeno 776 bolesnika u dobi od 6 do 90 godina u razdoblju od 2017. do 2023. godine. Dijagnoza je potvrđena prema kliničkim i laboratorijskim kriterijima Europskog centra za kontrolu i prevenciju bolesti (engl. European Centre for Disease Control and Prevention; ECDC) dokazom virusne RNA u krvi/ likvoru/urinu ili IgM protutijela u likvoru. Neuroinvazivna infekcija je potvrđena u 174 (22,4%) bolesnika. Najučestaliji dokazani arbovirus bio je KMEV (51,1%), potom VZN (44,9%) dok su sporadično dokazani i TOSV (2,3%) te USUV (1,7%). Analizom dobi oboljelih uočeno je da su najstariji bili bolesnici s VZN infekcijom (medijan 69; IQR=59-77 godina), potom USUV (medijan 60; IQR=42-71 godina), KMEV (medijan 49; IQR=25-59 godina) i TOSV (medijan 21; IQR=21-37 godina). Bolesnici s KMEV većinom su bili muškog spola (69,6%, omjer muškaraca i žena 1,7:1) za razliku od VZN od kojeg je oboljelo 57,6% muškaraca i 42,4% žena (omjer muškaraca i žena 1,3:1). Uočena je sezonska pojavnost arbovirusnih infekcija u razdoblju od travnja do studenog. KMEV je imao dva vrška, veći od travnja do kolovoza te manji u listopadu i studenom. Najveći broj VZN infekcija dokazan je u kolovozu i rujnu. KMEV, VZN i USUV dokazani su na području kontinentalnih županija, a TOSV samo na području priobalja (Splitsko-dalmatinska županija). Rezultati ovog rada potvrdili su značaj arbovirusa u etiologiji neuroinvazivnih infekcija na području Hrvatske, posebice u kontinentalnim županijama (22,4% bolesnika imalo je dokazanu arbovirusnu infekciju). Stoga arboviruse treba uključiti u rutinske dijagnostičke algoritme u bolesnika koji razviju simptome neuroinvazivne bolesti za vrijeme sezone prijenosa. |
| Abstract (english) | Neuroinvasive arboviruses such as tick-borne encephalitis virus (TBE), West Nile virus (WNV), Usutu virus (USUV) and Toscana virus (TOSV) are significant causes of infections in Europe. The aim of this study was to investigate the frequency and epidemiological characteristics of arbovirus infections in hospitalized patients with neuroinvasive disease in Croatia. The study included 776 patients aged between 6 and 90 years in the period from 2017 to 2023. The diagnosis was confirmed according to the clinical and laboratory criteria of the European Centre for Disease Control and Prevention (ECDC) by the evidence viral RNA in blood/ cerebrospinal fluid/urine or IgM antibodies in cerebrospinal fluid. Neuroinvasive infection was confirmed in 174 (22.4%) patients. The most common proven arbovirus was TBE (51.1%), followed by WZN (44.9%), while TOSV (2.3%) and USUV (1.7%) were also sporadically detected. By analyzing the age of patients, it was observed that the oldest were patients with WNV infection (median 69; IQR = 59-77 years), then USUV (median 60; IQR=42-71 years), TBE (median 49; IQR=25-59 years) and TOSV (median 21; IQR = 21-37 years). Patients with TBE were mostly male (69.6%, male-female ratio 1.7:1) in contrast to WNV, which affected 57.6% of men and 42.4% of women (male-female ratio 1.3:1). Seasonal occurrence of arbovirus infections has been observed in the period from April to November. The TBE had two peaks, the larger one from April to August and the smaller one in October and November. The highest number of WZN infections was proven in August and September. TBE, WNV and USUV have been proven in the area of continental counties, and TOSV only in the coastal area (Split-Dalmatia County). The results of this study confirmed the importance of arboviruses in the etiology of neuroinvasive infections in Croatia, especially in continental counties (22.4% of patients had a proven arbovirus infection). Therefore, arboviruses should be included in routine diagnostic algorithms in patients who develop symptoms of neuroinvasive disease during the transmission season. |
