Acute disseminated encephalomyelitis following Saint Louis encephalitis virus infection.

Saint Louis encephalitis virus (SLEV) infection is an arbovirosis associated with a broad spectrum of neurological complications. We present a case of a 55-year-old man hailing from Manaus, a city situated in the heart of the Amazon Rainforest, who exhibited symptoms of vertigo, tremors, urinary and fecal retention, compromised gait, and encephalopathy 3 weeks following SLEV infection. Neuroaxis MRI revealed diffuse, asymmetric, and poorly defined margins hyperintense lesions with peripheral and ring enhancement in subcortical white matter, as well as severe spinal cord involvement. Serology for SLEV was positive both on serum and cerebrospinal fluid. To the best of our knowledge, the present report is the first to show brain lesions along with myelitis as a post-infectious complication of SLEV infection.

Post-infectious encephalomyelitis associated with St. Louis encephalitis virus infection.

Neurologic illness associated with acute St. Louis encephalitis, West Nile, and Japanese encephalitis virus infection includes acute aseptic meningitis, encephalomyelitis, and a poliomyelitis-like syndrome. Few post-infectious immune-mediated neurologic events associated with flaviviral infection have been reported. The authors report on a woman with apparent post-infectious encephalomyelitis associated with recent St. Louis encephalitis virus infection, suggesting that neurologic illness from flaviviruses may also be seen in the post-infectious period following mild clinical illness.

Effect of interferon-alpha2b therapy on St. Louis viral meningoencephalitis: clinical and laboratory results of a pilot study.

The safety and potential efficacy of interferon (IFN)-alpha2b were determined for 15 patients during an outbreak of meningoencephalitis due to St. Louis encephalitis (SLE) virus. Clinical and laboratory results were compared with those of 17 untreated patients who were admitted to the same hospital during this nonrandomized preliminary trial. Quadriplegia, quadriparesis, or respiratory insufficiency persisted after the first week of hospitalization, for 11 of 17 untreated patients and for only 2 of 15 treated patients. These complications existed after the second week of hospitalization for 5 of the 17 untreated patients and for 1 of the 15 treated patients. Transient neutropenia and/or mild hepatitis occurred in 11 treated patients. Early initiation of IFN-alpha2b therapy may reduce the severity and duration of complications due to previously untreatable flavivirus meningoencephalitis. A prospective randomized controlled trial is warranted.

The neurobehavioural consequences of St. Louis encephalitis infection.

BACKGROUND: St. Louis encephalitis (SLE) is a relatively common cause of neurological illness, yet little is known about its cognitive and psychosocial consequences. PURPOSE: To describe the cognitive, emotional, psychophysiological, and psychosocial consequences of SLE infection. METHOD: A comprehensive neuropsychological and psychophysiological evaluation of a high functioning woman 6 weeks and 1 year after acute SLE infection is presented. The focus and course of rehabilitation is also examined. RESULTS: The primary cognitive consequences of SLE infection involved attention, working memory, speed of processing, and cognitive efficiency. Depression was also observed. Psychometric testing suggested that these deficits largely resolved after 1 year. CONCLUSIONS: SLE produces neurocognitive deficits which are reflected in both psychometric and psychophysiologic measures and functional status. Psychometric and vocational improvement were observed over 1 year. However, the normal vocational return came at a significant psychosocial cost. This case emphasizes the importance of a comprehensive neuropsychological evaluation and illustrates the importance of an integrated rehabilitation programme.