Usutu virus

- Dr. Pruthvi Raj

EMERGING

REEMERGING

SUBMERGING

DELIBERATELY EMERGING
 Emerging infections
• Those whose incidence in humans has increased
within the past 2 decades or threatens to increase
in the near future.
• Evolution of an existing organism
• The spread of a new agent
• The recognition of an infection that has been
present
• Reemerging infections
– Those that result due to breakdown of public
health measures for previously controlled
infections; including the failure of antibiotics,
vaccines, or vector control programs
– Eg:WNV, Chagas, Leishmaniasis
• Submerging Infections
– Which came to surveillance radar due to their
probable threat as a result of apparent association
owing to the new pathogen identification
molecular techniques, but further studies failed to
show a causal association between the organism
and the disease implicated. Eg. GBV-C/HGV, XMRV,
TTV
Steps in emergence of a new pathogen

INTRODUCTION

ADAPTATION

DISSEMINATION
V CJD CHIKUNGUNYA CWD
DENV ST.LOUIS ENCEPHALITIS HHV8
BABESIA VIRUS HIV VARIANTS
LEISHMANIA PARVO B19
PLASMODIUM H5N1
T.CRUZI SIV
HAV
BORRELIA BURGDOFERI
Usutu virus history
Human case
reports
Pecorari et al. 2009.
Cavrini et al. 2009

Black bird
Possible mass mortality in birds Austria
2001

Isolation
USUV was isolated for the first time from
a patient with fever and skin rash. 1981

Usutu River
Mc Intosh survey of viruses. South
Africe 1959
Vector
Host
 Humans
• 2009- neuroinvasive infection with diffuse large B-cell
lymphoma who presented with fever and neurologic
symptoms was diagnosed with meningoencephalitis
• USUV-related illness was reported in Italy in a woman
who received an orthotropic liver transplant as a final
consequence of a thrombotic thrombocytopenic
purpura
 Headache

Fever

Nuchal rigidity

Hand tremor

Hyperreflexia
Studies
• Northern Italy- specific IgG against USUV in 1.1% (4/359) blood donors.
• Neutralizing antibodies against USUV in 6,000 sera collected in 2010–2011
from healthy blood donors in the northeastern part of the country found
14 (0.23%) samples positive.
• Germany- 2012-4,200 serum samples from healthy blood donors- one
USUV IgG- and IgM-positive sample.
• Croatia- 2013- 3 out of 95 patients(suspected WNV).
• 30 (patients suffering from acute meningoencephalitis) - NIL
Diagnosis
• Virus isolation in susceptible cell culture is the gold
standard for virus detection.
• Earlier-complement fixation and agar gel precipitation
technique
• Recent- viral neutralization tests and
immunofluorescence assays
• Specific flavirirus- hemagglutination inhibition, or,
preferably, plaque reduction neutralization test.
• ELISA to NS1
• RT-PCR targeting the NS5 gene- sensitivity of 50
genomic copies
Prevention
• Neither specific licensed drugs nor vaccines
• Avoiding mosquito bites
• Supportive care measures, such as intravenous
antipyretics, fluids, respiratory support
Usutu & Transfusion Medicine
• Italy- around 16% of the donors (53/359) had
antibodies against WNV and 4 of the donors had
antibodies against USUV.
• USUV antibodies in a blood donor in Germany
• Exclusion of donors- The extent to which general
exclusion criteria such as fever would reduce the risk
of a USUV transmission by blood or blood products is
unclear, since no signs of febrile illness exist in most
persons who tested serologically positive.
• Specific counselling on USUV infections and USUV
prophylaxis
• Donor Testing- antibody-positive donations as a rule
only point to a USUV infection.
• Plasma donations can be tested for viral RNA using
PCR
• Pan-flavivirus NAT systems
PRT
• Pooled plasma treated with the solvent/detergent methods
is safe, since flaviviruses and other enveloped viruses are
effectively inactivated.
• Methylene blue in combination with photoinactivation
inactivates flaviviruses.
• Amotosalen hydrochloride (Psoralen, S-59) and ultraviolet
(UV) light (intercept method) inactivate a number of
pathogens including flaviviruses
• Riboflavin in combination with UV light
Thank you
References
1. Aberle SW, Kolodziejek J, Jungbauer C, Stiasny K, Aberle JH, Zoufaly A, et al. Increase in
human West Nile and Usutu virus. 2018;(September):3–8.
2. Bassi MR, Sempere N, Meyn P, Polacek C. crossm Extinction of Zika Virus and Usutu
Virus by Lethal Mutagenesis Reveals Different Patterns of Sensitivity to Three Mutagenic Drugs.
2018;62(9):1–15.
3. Franco L. Usutu virus – potential risk of human disease in Europe. 2011;(May 2014).
4. Adaptation V. Usutu virus : current knowledge and future perspectives. 2017;27–40.
5. Medicine V. Usutu virus is back : Not only in blackbirds but also in humans. 2019;2017–
9.
6. Blut A, Bewertung U, Krankheitserreger B. Usutu Virus. 2014;73–82.
7. Calzolari M, Bellini R, Chiari M. The veterinary experience on West Nile and Usutu
viruses in vectors ( mosquitoes ) and reservoirs ( wild birds ) in northern Italy ( 2013-2014 ).
2014;(November).
8. Ursu K, Cso T, Lussy H, Chvala S, Bukovsky C, Meister T, et al. Emergence of Usutu Virus
in Hungary ᰔ. 2007;45(12):3870–4.