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By Carol A. Kemper, MD

Spanish Sandfly Fever

Source: Mendoza-Montero J, et al. Clin Infect Dis 1998;27:434-436.

Toscana virus is a well-recog- nized cause of acute aseptic meningitis and encephalitis in central Italy, where it causes up to 80% of the viral CNS infections in children during the summer months (Infect Dis Alert 1998;17[15]:120). Cases have been recognized throughout the Mediterranean, but viral isolation has been accomplished only in Italy and Portugal. In contrast to Toscana virus, other causes of human sandfly fever, such as Sicilian virus and Naples virus, are not known to be neurotropic. Tocsana virus is believed to be transmitted by a sandfly, Phlebotomus perniciosus (also the vector for leishmaniasis), which is distributed throughout the Mediterranean, and is typically small enough to sneak through most window screens.

The authors identified 15 strains of Toscana virus isolated from the cerebrospinal fluid of 15 of 184 patients presenting with acute aseptic meningitis in Granada, Spain, between 1988 and 1998. Most of the patients were adults (median age, 27 years) and presented with abrupt onset of headache, vomiting, fever, and, less commonly, nuchal rigidity. All of the infections were self-limited.

Seroepidemiological studies, using indirect immunoflourescence, were performed in a total of 1268 serum specimens from nine different regions of Spain. Remarkably, 26.2% of specimens were positive for Toscana virus. Antibody titers first appeared in the second decade of life, and peaked in patients aged 60 or older. The highest rate of infection occurred in Palma de Mallorca (61%), a popular tourist destination on the Mediterranean Coast. These data suggest that Toscana virus is endemic throughout Spain, especially along the Mediterranean Coast.

Vampirism: Just Another Zoonosis?

Source: Gomez-Alonso J. Neurology 1998;51:856-859.

Gomez-alonso provides a tantalizing story for the possible association of rabies and the vampire legend. The earliest reports of vampirism date to the Balkans in the late 17th century, but vampires progressively vanished, except from the literary world, by the second half of the 18th century. Vampires were usually male, from poor or rural areas, and were described as pale or waxen in appearance, with prominent teeth, tongues, necks, and genitalia, with bloody fluid flowing out of the mouth. They were restless, wandered the earth, especially at night, and were feared for their ruthless attacks on people or animals, as well as their sexual proclivities. A person became a vampire through a bite from another vampire, or by eating the flesh of an animal killed by a vampire.

Any of this sound familiar? Rabies is seven times more common in males, prevails in rural areas, and commonly causes an encephalitic form of the disease with a predilection for the limbic system, resulting in restlessness, a wandering tendency, insomnia, and aggression toward others. "The rabid patient rushes at those who approach him, biting and tearing them as if he was a wild beast." Rabies can also cause persistent penile erections and hypersexuality, including reports of violent rapes. Laryngeal and facial spasms commonly result in an appearance of clenched teeth and retracted lips, which progresses to an inability to swallow secretions and frothing at the mouth.

It might also be mentioned that, in contrast to "furious rabies," paralytic rabies, which results in a progressive flacid paralysis, occurs in about 20% of those afflicted. Balkan legend holds that the "lying vampire" was "undead," whereas the "wandering vampire" was to be feared. And, as we all know, the vampire legend is tightly interwoven with bats, common carriers of rabies, as well as wolves and dogs (e.g., werewolves), which were both commonly affected during the rabies epidemics in 18th century central Europe. Now all we need is a skin snip from the nape of a vampire’s neck to prove the theory correct.

Life in an Urban Wilderness

Source: California Disease Brief, October 1998;CDBRIEF@CAHWNET.GOV.

Having just spent considerable effort dissuading a family of raccoons from making a home in my attic, my attention was drawn to a recent California Communicable Disease Control Brief reporting a case of meningoencephalitis due to Baylisascaris procyonis in a one-year-old child in Monterey county. B. procyonis is an intestinal roundworm of raccoons in the United States, which rarely causes visceral larva migrans (VLM) and eosinophilic meningoencephalitis in humans. Although infection is apparently common in raccoons, only about 10 cases have been described in humans—most of whom were infants or small children (presumably as a result of their propensity to eat dirt).

Because their larvae are larger and have a greater tendency to migrate to the central nervous system than do feline or canine roundworms, infection with B. procyonis is often fatal or results in severe neurological sequelae. VLM should be considered in any small child with eosinophilic meningitis/encephalitis residing in an "urban wilderness." Because of the increasing migration of families to wooded areas on the fringe of large urban centers, we may start seeing more of these unusual zoonosis.