We report twenty autochthonous sporadic cases of acute infection with HEV. The zoonotic etiology of the virus as well as the foodborne transmission of the infection is discussed. We found that aging and pre-existing underlying diseases are risk factors for a severe course of the HEV infection.

To the Editor: West Nile virus (WNV) is a mosquitoborne flavivirus. Approximately 80% of human infections are asymptomatic, 10%–20% are characterized by an acute febrile illness, and <1% by involvement of the central nervous system (West Nile neuroinvasive disease). Sporadic human cases and small outbreaks of West Nile fever were reported in Europe until the mid-1990s, when the first large outbreak occurred in Romania in 1996.\ud \ud Since then, and especially in recent years, sporadic human cases and outbreaks have been reported in other countries in Europe and neighboring countries on the Balkan Peninsula. A large outbreak of WNV lineage 2 infection occurred in Greece in 2010. Outbreaks have also been reported in other countries in Europe, which showed spread of WNV lineage 2. Some probable cases of West Nile fever were reported to the Bulgarian Ministry of Health on the basic of serologic test results.\ud \ud We report a case of fatal West Nile neuroinvasive disease in a man in Bulgaria. This case was confirmed by detection of specific antibodies against WNV and sequencing of the full virus genome

Aim: The aim of this study was to describe the etiological distribution, clinical and laboratory characteristics of patients with Fever of unknown origin (FUO), admitted to one Bulgarian hospital. Material and Method: A retrospective study was done for a period of four years. The modified criteria of Petersdorf and Beeson were applied. Complete history, physical examination and basic laboratory investigations were done. According to the potentially diagnostic clues, specific tests, immunological and imaging methods were performed. The invasive procedures were the last step. Results: Fifty-four patients met the inclusion criteria. The estimated causes were: infection 59.3%, neoplasm 3.7%, non-infectious inflammatory disease 14.8%, miscellaneous 5.5% and undiagnosed cases 16.7%, respectively. The mean age was 44.3 years. The leading clinical features were fever, chills, sweats and fatigue. The association of clinical signs, physical exam and laboratory results were discussed. Discussion: The infectious diseases were the leading cause of FUO. The etiological distribution of causes was near to results reported from South-East Europe. Some geographic, climatic, zoonotic and social factors influenced the results.

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A case of a 66-year-old man with West Nile neuroinvassive disease manifested with fever, weakness, fatigue, consciousness disorders and underlying diabetes mellitus type 2 and cardiovascular diseases is presented. Laboratory data showed elevated erythrocyte sedimentation rate and fibrinogen. Serological tests revealed West Nile virus specific antibodies of class IgM and IgG in serum. West Nile virus RNA was detected in urine sample. Supportive therapy was applied.

Purpose:The extent of filovirus exposure and the primary sources of ebolavirus spillover to high-risk communities remains poorly characterized. In the Bwindi region of Uganda, a hotspot of mammalian biodiversity in Africa, human livelihoods are intimately connected with wildlife, creating potential for exposure to filoviruses. Our objectives were to investigate previous exposure to filoviruses in people in the Bwindi region and characterize risk factors for past exposure, including livelihoods and interactions with wildlife.Methods & Materials: Samples from 331 febrile patients presenting to healthcare facilities near the Bwindi Impenetrable Forest, Uganda, were tested using molecular (PCR) and serological assay detection techniques. Serum was tested by Western blot utilizing recombinant glycoprotein antigens for Ebola virus (EBOV), Sudan virus (SUDV), Bundibugyo virus (BDBV) and Marburg virus. Questionnaires were used to collect demographic information, travel and medical history, and data on interactions with domestic and wild animals.Results: All patients were negative for active filovirus replication by PCR. However, several patient serum samples were reactive to SUDV (4.7%), EBOV (5.3%) and BDBV (8.9%) indicating likely previous exposure to these ebolaviruses. Direct contact with duikers was a significant risk factor associated with EBOV seropositivity (OR = 5.6; P = 0.026), while hunting primates (OR = 37.5; P = < 0.001) and contact with/or consumption of cane rats (OR = 10.7; P = 0.006) were significant risk factors for SUDV seropositivity.Conclusion: People in Southwestern Uganda have suspected previous exposure to filoviruses, particularly those with a history of wildlife contact. Identification of antibodies to ebolaviruses in humans in Bwindi likely represents previous infection with SUDV, EBOV, or BDBV or infection with serologically cross-reactive low or non-pathogenic undiscovered filoviruses that also share wildlife hosts. Our findings indicate that spillover of ebolaviruses in humans, and circulation of ebolaviruses, could be more common than previously reported. The results of this study inform ongoing surveillance efforts needed to improve our understanding of the role of wildlife in spillover of ebolaviruses, not only adding to investigations of bats as likely reservoir hosts, but also indicating that secondary spillover host species remain important sources of human infection.Purpose: Fever of unknown origin (FUO) is a perplexing medical problem. The causes for FUO are more than 200 diseases. The aim