July 2026

Summary:

• • • Geographic risk: Sandfly-borne phleboviruses (SFNV, SFSV, TOSV) circulate widely across the Mediterranean, including Italy, Spain, Croatia and Greece; the main transmission season runs from May to October.
    • Travel-associated: The vector species (Phlebotomus perniciosus, P. papatasi) have not yet spread north despite climate change, so infections in Central Europe remain travel-associated.
    • Clinical picture: After a short incubation of 3–6 days, sudden high fever, pronounced myalgia, retro-orbital headache and conjunctivitis are typical; Toscana virus can also cause aseptic meningitis and, rarely, encephalitis.
    • Course: Both sandfly fever and Toscana virus infection are usually self-limiting.
    • Diagnostics at IVI: Antibody testing (IgM/IgG) from serum or EDTA blood, plus an in-house PCR for direct Toscana virus detection from CSF (meningitis work-up) or serum/EDTA plasma (within ~5 days of symptom onset).

Pappataci Fever: Illness Caused by Sandfly Fever Virus / Toscana Virus

Summer is travel season, and with it comes the need to broaden the differential diagnostic spectrum of pathogens when taking a travel history. This includes viruses of the genus Phlebovirus, transmitted by sandflies that are widespread across the Mediterranean region — above all the sandfly fever viruses (SFNV and SFSV) and Toscana virus (TOSV). Sandflies are common throughout the Mediterranean, including in Italy, Spain, Croatia and Greece. While climate change has already driven a northward expansion of some sandfly subspecies, this has not yet included Phlebotomus perniciosus and Phlebotomus papatasi, the species that act as vectors for phleboviruses. As a result, these infections are currently seen almost exclusively as travel-associated. The main transmission season runs from May to October.

After a short incubation period of 3–6 days, Pappataci fever (also known as sandfly fever) typically presents with sudden-onset high fever, pronounced myalgia, headache — often with a retro-orbital character — and conjunctivitis. Toscana virus infection can additionally cause a neuroinvasive manifestation, presenting as aseptic meningitis, and very rarely a severe encephalitic course. In most cases, both sandfly fever virus infection and Toscana virus infection are self-limiting.

Our diagnostic portfolio at the Institute of Virology includes antibody testing from serum or EDTA blood. IgM antibodies are often detectable for months, IgG for years; cross-reactivity between different phleboviruses can occur. We also offer an in-house PCR for direct detection of Toscana virus — from CSF for the differential diagnostic work-up of suspected viral meningitis, or from serum/EDTA plasma for acute fever work-up, within approximately 5 days of symptom onset.

Links:

• https://www.ecdc.europa.eu/en/toscana-virus-infection
• https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2025.30.2.2400203
• https://www.sciencedirect.com/science/article/pii/S1201971225003832
• https://link.springer.com/article/10.1186/s40794-026-00306-2