Clinical review of Toscana virus: a Mediterranean Neuroinvasive Phlebovirus

Toscana virus (TOSV) is a sandfly-transmitted phlebovirus of the family Phenuiviridae and a leading cause of summer meningitis and meningoencephalitis in the Mediterranean basin. It was first isolated in 1971 from Phlebotomus perniciosus in central Italy and circulates wherever its principal vectors are established. Seroprevalence surveys show that population exposure is common, whereas overt disease is comparatively infrequent. Among patients who become symptomatic, most present with neuroinvasive illness, which separates TOSV from related sandfly-borne phleboviruses that cause undifferentiated febrile disease. This review covers virology, pathogenesis, epidemiology, vector biology, clinical features, diagnosis, and management of TOSV infection, and it keeps a clear separation between established clinical knowledge and experimental research. The practical message has not changed in a decade: management is supportive, no licensed antiviral or vaccine exists, and the agents that attract research interest, including repurposed nucleoside analogues, venom-derived peptides, RNA-interference strategies, and candidate vaccines, remain preclinical. Given warmer Mediterranean summers and a documented rise in recognised cases, the most useful priorities are better clinician awareness, wider access to TOSV-specific molecular testing, and integrated human and entomological surveillance.