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Volume 19, Number 4—April 2013

Letter

West Nile Virus Infection in Belgian Traveler Returning from Greece

Lieselotte CnopsComments to Author , Anna Papa, Frideriki Lagra, Philippe Weyers, Kathleen Meersman, Nicolas Patsouros, and Marjan Van Esbroeck
Author affiliations: National Reference Center for WNV and Arboviruses–Institute of Tropical Medicine, Antwerp, Belgium (L. Cnops, K. Meersman, M. Van Esbroeck); National Reference Laboratory for Arboviruses–Aristotle University Medical School, Thessaloniki, Greece (A. Papa; Kavala General Hospital, Kavala, Greece (F. Lagra); Saint-Jean Hospital, Brussels, Belgium (P. Weyers, N. Patsouros)

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Table

Laboratory results confirming WNV infection of 73-year-old woman, Greece, 2012*†

Sample Date RT-PCR (Ct value) WNV ELISA IgM (ratio) WNV ELISA IgG (ratio) Flavi IFAT IgM Flavi IFAT IgG
Serum Aug 15 Positive (45.47) Positive (25) Negative ND ND
CSF Sep 3 ND Positive (5.16) Positive (2.21) ND ND
Serum Sep 6 Positive (42.87)‡ Positive (4.76) Positive (2.63) WNV positive WNV positive§

*WNV, West Nile virus; RT-PCR, reverse transcription PCR; Ct, cycle threshold; Flavi, flavivirus; IFAT, indirect fluorescent antibody technique; ND, not done; CSF, cerebrospinal fluid.
†The ELISA is positive if ratio >1.1 for IgM and >1.5 for IgG. The cutoff value for IFAT is 1/10 for both IgG and IgM.
‡Sequencing revealed a 116-bp sequence perfectly matched to the WNV amplicon and is highly suggestive for WNV lineage 2 on the basis of the presence of 2 specific nucleotides.
§Strongest signal for WNV, weak signal for other flaviviruses (Japanese encephalitis virus, dengue viruses 1–4, yellow fever virus).

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