Cross-Reactive Antibodies in Tick-Borne Encephalitis: Case Report and Literature Review

Scientific paper - Case study

• Author: Tatjana Vilibić-Čavlek
• Author: Thomas Ferenc
• Author: Mateja Vujica Ferenc
• Author: Maja Bogdanić
• Author: Tanja Potočnik-Hunjadi
• Author: Dario Sabadi
• Author: Vladimir Savić
• Author: Ljubo Barbić
• Author: Vladimir Stevanović
• Author: Federica Monaco
• Author: Eddy Listes
• Author: Giovanni Savini
• Author's institution: University of Zagreb; School of Medicine; (Department of Medical Microbiology and Parasitology)
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Medical Microbiology

Abstract (english)

Flaviviruses are a heterogeneous group of viruses that may induce broad antigenic cross-reactivity. We present a patient who was admitted to the infectious disease department with symptoms suggestive of aseptic meningitis. During the clinical workup, the patient reported a tick bite two weeks before the disease onset. High titers of IgM and IgG antibodies to tick-borne encephalitis virus (TBEV) were found in both serum and cerebrospinal fluid (CSF) samples, indicating acute TBEV infection. West Nile virus (WNV) and Usutu virus (USUV) IgM and/or IgG antibodies were also detected, and a virus neutralization test (VNT) was performed. A high titer of TBEV neutralizing (NT) antibodies (640) was detected, which confirmed acute TBE. However, NT antibodies to WNV and USUV were also detected (titer 80 for both viruses). After TBEV and WNV IgG avidity evaluation, previous flavivirus infection was highly suspected (avidity index 82% and 89%, respectively). Blood, CSF, and urine samples were negative for respective viruses’ RNA. The presented case highlights the challenges in flavivirus serodiagnosis. In the published literature, different degrees of cross-reactivity or cross-neutralization between TBEV and dengue, louping ill, Omsk hemorrhagic fever, Langat, and Powassan virus were also observed. Therefore, the serology results should be interpreted with caution, including the possibility of cross-reactivity. In areas where several flaviviruses co-circulate VNT is recommended for disease confirmation.

• Keywords (english): Usutu virus; West Nile virus; cross-reactive antibodies; flaviviruses; tick-borne encephalitis virus
• Language: english
• Publication type: Scientific paper - Case study
• Publication status: Published
• Peer review: Peer review
• Publication version: Published version
• Journal title: Antibodies
• Numbering: vol. 11, no. 4, 72
• e-ISSN: 2073-4468
• DOI: https://doi.org/10.3390/antib11040072
• URN:NBN: urn:nbn:hr:105:133200
• Publication: 2022-11-20
• Document URL: https://www.mdpi.com/2073-4468/11/4/72
• Type of resource: Text
• Access conditions: Open access
• Created on: 2023-06-19 09:45:39