Use of Testing for West Nile Virus and Other Arboviruses.

In the United States, the most commonly diagnosed arboviral disease is West Nile virus (WNV) infection. Diagnosis is made by detecting WNV IgG or viral genomic sequences in serum or cerebrospinal fluid. To determine frequency of this testing in WNV-endemic areas, we examined the proportion of tests ordered for patients with meningitis and encephalitis at 9 hospitals in Houston, Texas, USA. We identified 751 patients (567 adults, 184 children), among whom 390 (52%) experienced illness onset during WNV season (June-October). WNV testing was ordered for 281 (37%) of the 751; results indicated acute infection for 32 (11%). Characteristics associated with WNV testing were acute focal neurologic deficits; older age; magnetic resonance imaging; empirically prescribed antiviral therapy; worse clinical outcomes: and concomitant testing for mycobacterial, fungal, or other viral infections. Testing for WNV is underutilized, and testing of patients with more severe disease raises the possibility of diagnostic bias in epidemiologic studies.

Long-term outcomes of Murray Valley encephalitis cases in Western Australia: what have we learnt?

BACKGROUND: Murray Valley encephalitis virus (MVEV) is a mosquito-borne flavivirus that causes encephalitis in some cases of infection. It is endemic in Northern Australia and cases occasionally occur in South Eastern Australia. The long-term sequelae of MVEV infection have not previously been well described. AIM: To investigate the long-term sequelae of MVEV infection. METHODS: This was a descriptive case series of all clinical MVEV infections using data linkage and standard surveys. Hospital admissions, emergency department, psychiatric outpatients and mortality data were obtained. We attempted to follow-up all 53 cases of MVEV clinical infection that occurred in Western Australia from 1978 to 2011 inclusive. Two cases opted out of the study. RESULTS: We followed-up 39 surviving cases. Seven of the nine with paralysis or paresis were under 5 years and they fared worse than other patients, requiring lengthy hospitalisation (median duration 133 days). Two died due to complications of quadriplegia following a total of 691 days in hospital. Nine surviving patients, including two with non-encephalitic illness, required care for depression and other psychiatric conditions following MVEV infection. Two patients who were discharged with neurological sequelae had no further documented hospital occasions of service but reported ongoing challenges with cognitive dysfunction and inability to work. CONCLUSIONS: This is the first study of long-term outcomes of Murray Valley encephalitis that included cases with no obvious sequelae at discharge. In spite of the small numbers involved, the study demonstrated the significant medical and social burden due to MVEV in Australia.

Arboviral encephalitis and RNAi treatment.

Encephalitis refers to an acute, usually diffuse, inflammatory process affecting the brain. The clinical hallmark of acute encephalitis is the triad of fever, headache, and altered mental status. The most common and important cause of encephalitis is the infection by a virus although other organisms can cause the disease. This article is a general overview of the most common viral encephalitides, divided into two families, Flavivirus and Alphavirus, and provides details about virus and RNA interference. More detailed descriptions of each viral family are provided below.

[Flavivirus encephalitis].

The member of the genus Flavivirus family Flaviviridae are arthropod-transmitted viruses. This genus includes vector-borne neurotropic viruses such as the tick-borne encephalitis virus serocomplex and the Japanese encephalitis virus serocomplex. Flavivirus encephalitis is the generic term for encephalitis caused by viruses belonging to this genus. The Japanese encephalitis virus is still active in Japan, and the tick-borne encephalitis virus is prevalent in Hokkaido, the northern region of Japan. The West Nile fever/encephalitis epidemic has been active in North and South America since 1999.

Cognitive recovery from Encephalitis Lethargica.

The cognitive profile and outcome of Encephalitis Lethargica has not been systematically described in the literature. Treatment has typically focused upon medical management. The first case report of a patient with Encephalitis Lethargica who underwent a systematic programme of cognitive rehabilitation is presented. Initial neuropsychological assessment conducted during her acute presentation indicated generalized cognitive dysfunction, including memory and executive function impairments. An outpatient cognitive rehabilitation programme addressed the development of awareness and the remediation of memory and executive function impairments. Repeat assessment indicated significant improvement in cognitive function. The components of her rehabilitation programme are discussed. She has been able to successfully return to her pre-morbid level of work responsibility within 8 months of her admission.

Defending against viruses in biowarfare. How to respond to smallpox, encephalitides, hemorrhagic fevers.

The threat of bioterrorism with use of viruses is increasing. Smallpox, encephalitis, and hemorrhagic fevers are the most likely diseases to result from viral deployment. It is critical that all healthcare professionals become familiar with the clinical presentation, diagnosis, management, and prevention of these diseases. Awareness and preparedness are instrumental in reducing viral transmission and improving survival of the victims.

Sporadic encephalitis lethargica: a case treated successfully with ECT.

A patient who presented with seizures, opisthotonos, catatonia, and autonomic dysfunction developed features consistent with sporadic encephalitis lethargica. She received a course of ECT and had full recovery.

Encefalitis viral aguda / Acute viral encephalitis

La Encefalititis Viral Aguda es una enfermedad relativamente frecuente que representa una fuente importante de morbi-mortalidad, en todo el mundo incluyendo a nuestro país; por haber zonas endémicas algunas virosis adquieren mayor importancia. Las características clínicas pueden ser comunes para casi todas las encefalitis con variantes que dependen del agente infeccioso. En este trabajo se describe las encefalitis producidas por el sarampión, rubéola, parotiditis, encecefalitis equina venezolana, dengue, solo en su forma benigna (no se ha descrito casos autóctonos de dengue hemorrágico), fiebre amarilla y herpes virus. Se describe el cuadro clínico, el método de llegar al diagnóstico y nuevos aportes para su tratamiento.

Viral infections in the intensive care unit.

Serious viral infections requiring intensive care generally occur in immunocompromised patients and in those patients with underlying cardiopulmonary disease. However, occasional cases may occur in normal hosts. This article reviews the serious viral diseases that are commonly encountered in the adult ICU, including viral pneumonia, encephalitis, and hepatitis, and focuses on diagnostic techniques and management principles. A separate section is devoted to cytomegalovirus infection, given the prominent role that this virus plays in the immunocompromised host receiving intensive care.

Murray Valley encephalitis, 1974: clinical features.

Of the 58 patients who developed Murray Valley encephalitis (MVE) during 1974, 22 were admitted to Fairfield Hospital, Melbourne. The patients were of all ages, but the disease was most common in children. Calculations suggest that the incubation period of MVE is from one to four weeks. The severity of brain damage varies considerably; 11 patients recovered almost completely, seven had severe residual damage and four patients died. There are no special features which distinguish MVE from any other form of encephalitis. The survival of five of eight patients who required artificial respiration suggests that patients with suspected MVE should be transported at an early stage to a hospital where artificial respiration is available if necessary. There is no evidence that infection with the MVE virus can cause clinical manifestations of a disease other than acute encephalitis.