Sandfly fever-a neglected disease

A45-year-old woman presented at the outpatient department of acenter for tropical diseases with fever, diarrhea, headache, myalgia, malaise, and an itchy papular rash. She had been on holiday with her family for 11days in amountain village in northern Cyprus. The place was infested with alot of small, stinging flies or mosquitoes. She and her family became sick after they returned home. The physical examination was normal apart from the rash on the inside of the extremities. Significantly elevated transaminases and aslightly increased C-reactive protein level were found in the blood examination. Considering the country of travel, the report of the stinging flies and the clinical presentation, sandfly fever was also taken into account as adifferential diagnosis for the hepatitis. Antibodies to the sandfly fever Sicilian virus (SFSV) were detected. They showed the typical dynamics during the course of the illness and thus pappataci fever was diagnosed. The case report and ashort review of up-to-date literature is meant encourage consideration of phlebovirus infection as apossible differential diagnosis in travelers or refugees suffering from severe febrile hepatitis and rash or aseptic viral meningitis after their stay in the Mediterranean area.