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James E. Mcjunkin - One of the best experts on this subject based on the ideXlab platform.
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La Crosse Encephalitis: An Adult Case Series
The American journal of medicine, 2016Co-Authors: Amy Lynn A. Teleron, Brandon Rose, David M. Williams, Suzanne Kemper, James E. McjunkinAbstract:Abstract Background La Crosse viral Encephalitis is well described in children, but to date, there are only 2 adult cases described in the literature. Despite the fact that pediatric infection can be life threatening and typically presents as a febrile meningoEncephalitis often complicated by seizures and mental status changes, little is known about the presentation and course of adult infection. We report the Largest case series of adult La Crosse Encephalitis. Methods Inpatient data were reviewed between 2001 and 2012 to identify adults (≥18 years of age) with possible La Crosse Encephalitis. Subsequent review of serologic testing was followed by a comprehensive chart review. Results Ten cases were identified, with ages ranging from 20 to 80 years. Fever, headache, and hyponatremia were seen in the majority, while mental status changes occurred in 5 patients and seizures in 2 patients. The mean length of stay was 8.4 days (± 8.4); 3 patients required intensive care unit admission, 2 of them were intubated, and 4 patients required discharge to a rehabilitation facility. Conclusions La Crosse Virus produces a clinically significant Encephalitis in adults, and a high level of suspicion should be maintained, particuLarly in endemic areas. There were no deaths, but La Crosse Encephalitis in adults remained a morbid illness often associated with mental status changes, prolonged length of stay or intensive care unit admission, and frequent need for postdischarge rehabilitation.
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Safety and pharmacokinetics of ribavirin for the treatment of La Crosse Encephalitis.
The Pediatric infectious disease journal, 2011Co-Authors: James E. Mcjunkin, Raheel R. Khan, Emily De Los Reyes, Manuel J. Caceres, Linda L. Minnich, Milap C. Nahata, W. Garrett Hunt, Mouna G. Chebib, Sasidharan Taravath, Roxane R. CarrAbstract:Background:La Crosse viral Encephalitis (LaCVE) is associated with residual epilepsy and neurocognitive deficits in survivors. This report summarizes 3 phases of clinical studies of children treated with intravenous (IV) ribavirin (RBV), each one exploring a different phase (I, IIA, IIB) of clinical
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Periodic Lateralized epileptiform discharges in La Crosse Encephalitis, a worrisome subgroup: clinical presentation, electroencephalogram (EEG) patterns, and long-term neurologic outcome.
Journal of child neurology, 2007Co-Authors: Emily C. De Los Reyes, James E. Mcjunkin, Tracy A. Glauser, Mark Tomsho, James O'nealAbstract:La Crosse virus Encephalitis is the most common mosquito-borne virus in children in the United States. La Crosse virus Encephalitis has emerged as a significant health concern due to its potential for acute morbidity, including seizures, alterations in mental status, and, in rare cases, death, as well as the potential for chronic morbidity, including, epilepsy and cognitive and behavioral disorders. The aim of this study is to provide a clinical description of the Largest series of children reported with periodic Lateralizing epileptiform discharges (PLEDS) associated with La Cross virus Encephalitis with reference to their clinical course, seizure type, electroencephalogram (EEG) patterns, and 2- and 10-year long-term neurologic outcome. In addition, to evaluate whether this subset of children may indeed have more severe disease than children with La Crosse virus Encephalitis without PLEDS, comparisons are made between the 2 groups on specific variables. All patients presented with fever and disorientation; 6 of the 9 (66%) presented with seizures. PLEDS localized to the temporal lobe in 7 patients (77%). The children with PLEDS had longer intensive care unit stays (6.5 +/- 2.4 vs 3.2 +/- 1.9; P < .0001), a higher rate of intubation (88% vs 20%; P < .001), and a higher rate of cerebral herniation (1%; P < .05) than children with La Crosse virus Encephalitis without PLEDS. Follow-up data on the subset with PLEDS also suggest a reLatively high rate of epilepsy and behavioral difficulties with hyperactivity symptoms, memory deficits, and school difficulties. The implications for recognition, management, and follow-up of this worrisome subset of patients with La Crosse virus Encephalitis are discussed.
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La Crosse Encephalitis in children.
The New England journal of medicine, 2001Co-Authors: James E. Mcjunkin, Raheel R. Khan, Theodore F. Tsai, Emily De Los Reyes, Jose E. Irazuzta, Manuel J. Caceres, Linda L. Minnich, Gretchen D. Lovett, Ann ThompsonAbstract:Background La Crosse Encephalitis is a mosquito-borne disease that can be mistaken for herpes simplex Encephalitis. It has been reported in 28 states but may be underrecognized. Methods We investigated the manifestations and clinical course of La Crosse Encephalitis in 127 patients hospitalized from 1987 through 1996. The diagnosis was established by serologic testing for IgM and IgG antibodies to La Crosse virus. Data were collected by chart review. Results Most of the patients were school-aged children (mean [±SD] age, 7.8±3.5 years; range, 0.5 to 15.0). Symptoms included headache, fever, and vomiting (each in 70 percent or more of the patients), seizures (in 46 percent), and disorientation (in 42 percent). Thirteen percent had aseptic meningitis. Hyponatremia developed in 21 percent, and there were signs of increased intracranial pressure in 13 percent. Six patients, including three with cerebral herniation, underwent intracranial-pressure monitoring. The 13 patients (11 percent) whose condition deteri...
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california La Crosse Encephalitis
Infectious Disease Clinics of North America, 1998Co-Authors: James E. Mcjunkin, Raheel R. Khan, Theodore F. TsaiAbstract:La Crosse Encephalitis, a mosquito-borne viral disease that can be mistaken for herpes simplex Encephalitis, is under-recognized in the United States, despite case reports from 28 states and an incidence in endemic areas (20-30/100,000) exceeding that of bacterial meningitis. The disease recurs every summer in endemic foci in the midwestern and mid-AtLantic United States in areas forested with hardwood trees, which provide breeding sites for the treehole-dwelling mosquito vector, Aedes triseriatus. La Crosse Encephalitis should be considered in the child presenting with meningoEncephalitis in summer and early fall, particuLarly for children living in (or recent travel to) endemic areas in mid-AtLantic and midwestern states.
William Schaffner - One of the best experts on this subject based on the ideXlab platform.
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assistance with this investigation.
2016Co-Authors: We Thank S, Y Halford, William SchaffnerAbstract:2. Jones TF, Craig AS, Nasci RS, et al. Newly recognized focus of La Crosse Encephalitis in Tennessee. Clin Infect Dis 1999;28:93±7. 3. Centers for Disease Control and Prevention. Case de®nitions for infectious conditions under public health surveilLance. MMWR Morb Mortal Wkly Rep 1997;46:1±55. 4. Dean AD, Dean JQ, Coulombier D, et al. Epi-Info. Version 6: a word pro-cessing, database and statistics program for epidemiology on microcom
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La Crosse Encephalitis surveilLance using single versus paired serologic testing.
Zoonoses and public health, 2011Co-Authors: Rendi Murphree, William Schaffner, James R. Dunn, Timothy F. JonesAbstract:We evaluated the validity of single versus paired serologic testing for La Crosse virus (LaCV) Encephalitis surveilLance. Compared with paired serology, a single positive IgG or IgM immunoflourescent antibody titre appears useful for LaCV Encephalitis surveilLance with sensitivity, 75%; specificity, 98%; positive predictive value, 95%; and overall test efficiency 92%.
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La Crosse Encephalitis in Eastern Tennessee: Clinical, Environmental, and Entomological Characteristics from a Blinded Cohort Study
American journal of epidemiology, 2002Co-Authors: Paul Campbell Erwin, Timothy F. Jones, Lori E. R. Patterson, Roger S. Nasci, Reid R. Gerhardt, Sandy K. Halford, A. Brent Smith, Kristy L. Gottfried, Kristen L. Burkhalter, William SchaffnerAbstract:A blinded cohort study was conducted in 2000 to better understand the emergence of La Crosse virus infection in eastern Tennessee, with special emphasis on the potential mosquito vector(s). Children with suspected central nervous system infection were enrolled at the time of clinical presentation at a Large pediatric referral hospital. Clinical, environmental, and entomological data were collected prior to case confirmation. Sixteen of the 40 children included in the final analysis were confirmed to have La Crosse infection by a fourfold increase in antibody titers between collection of acute- and convalescent-phase sera. Factors significantly associated with La Crosse infection included average number of hours per day spent outdoors (5.9 for La Crosse virus cases vs. 4.0 for noncases, p = 0.049); living in a residence with one or more tree holes within 100 m (reLative risk = 3.96 vs. no tree holes within 100 m, p = 0.028); and total burden of Aedes albopictus (number of female and male Larvae and adults collected at a site), which was more than three times greater around the residences of La Crosse virus cases versus noncases (p = 0.013). Evidence is accumuLating that the newly introduced mosquito species Ae. albopictus may be involved in the emergence of La Crosse virus infection in eastern Tennessee.
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Serological Survey and Active SurveilLance for La Crosse Virus Infections among Children in Tennessee
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2000Co-Authors: Timothy F. Jones, Paul Campbell Erwin, Allen S. Craig, Philip E Baker, Kristen E. Touhey, Lori E. R. Patterson, William SchaffnerAbstract:In 1998 and 1999, we performed a serosurvey and active surveilLance for La Crosse Encephalitis at a children's hospital in eastern Tennessee. Fifteen cases of La Crosse Encephalitis were confirmed. Only 5 (0.5%) of 1000 serum samples being tested at the state Laboratory for other diseases had evidence of antibodies to La Crosse virus. These findings suggest that La Crosse virus is newly endemic to eastern Tennessee.
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Newly recognized focus of La Crosse Encephalitis in Tennessee.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 1999Co-Authors: Timothy F. Jones, Paul Campbell Erwin, Allen S. Craig, Lori E. R. Patterson, Roger S. Nasci, Reid R. Gerhardt, Xilla T. Ussery, William SchaffnerAbstract:La Crosse virus is a mosquito-borne arbovirus that causes Encephalitis in children. Only nine cases were reported in Tennessee during the 33-year period from 1964-1996. We investigated a cluster of La Crosse Encephalitis cases in eastern Tennessee in 1997. Medical records of all suspected cases of La Crosse virus infection at a pediatric referral hospital were reviewed, and surveilLance was enhanced in the region. Previous unreported cases were identified by surveying 20 hospitals in the surrounding 16 counties. Mosquito eggs were collected from five sites. Ten cases of La Crosse Encephalitis were serologically confirmed. None of the patients had been discharged from hospitals in the region with diagnosed La Crosse Encephalitis in the preceding 5 years. Aedes triseriatus and Aedes albopictus were collected at the case sites; none of the mosquitos had detectable La Crosse virus. This cluster may represent an extension of a recently identified endemic focus of La Crosse virus infection in West Virginia.
Timothy F. Jones - One of the best experts on this subject based on the ideXlab platform.
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La Crosse Encephalitis surveilLance using single versus paired serologic testing.
Zoonoses and public health, 2011Co-Authors: Rendi Murphree, William Schaffner, James R. Dunn, Timothy F. JonesAbstract:We evaluated the validity of single versus paired serologic testing for La Crosse virus (LaCV) Encephalitis surveilLance. Compared with paired serology, a single positive IgG or IgM immunoflourescent antibody titre appears useful for LaCV Encephalitis surveilLance with sensitivity, 75%; specificity, 98%; positive predictive value, 95%; and overall test efficiency 92%.
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La Crosse Encephalitis in Eastern Tennessee: Clinical, Environmental, and Entomological Characteristics from a Blinded Cohort Study
American journal of epidemiology, 2002Co-Authors: Paul Campbell Erwin, Timothy F. Jones, Lori E. R. Patterson, Roger S. Nasci, Reid R. Gerhardt, Sandy K. Halford, A. Brent Smith, Kristy L. Gottfried, Kristen L. Burkhalter, William SchaffnerAbstract:A blinded cohort study was conducted in 2000 to better understand the emergence of La Crosse virus infection in eastern Tennessee, with special emphasis on the potential mosquito vector(s). Children with suspected central nervous system infection were enrolled at the time of clinical presentation at a Large pediatric referral hospital. Clinical, environmental, and entomological data were collected prior to case confirmation. Sixteen of the 40 children included in the final analysis were confirmed to have La Crosse infection by a fourfold increase in antibody titers between collection of acute- and convalescent-phase sera. Factors significantly associated with La Crosse infection included average number of hours per day spent outdoors (5.9 for La Crosse virus cases vs. 4.0 for noncases, p = 0.049); living in a residence with one or more tree holes within 100 m (reLative risk = 3.96 vs. no tree holes within 100 m, p = 0.028); and total burden of Aedes albopictus (number of female and male Larvae and adults collected at a site), which was more than three times greater around the residences of La Crosse virus cases versus noncases (p = 0.013). Evidence is accumuLating that the newly introduced mosquito species Ae. albopictus may be involved in the emergence of La Crosse virus infection in eastern Tennessee.
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Serological Survey and Active SurveilLance for La Crosse Virus Infections among Children in Tennessee
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2000Co-Authors: Timothy F. Jones, Paul Campbell Erwin, Allen S. Craig, Philip E Baker, Kristen E. Touhey, Lori E. R. Patterson, William SchaffnerAbstract:In 1998 and 1999, we performed a serosurvey and active surveilLance for La Crosse Encephalitis at a children's hospital in eastern Tennessee. Fifteen cases of La Crosse Encephalitis were confirmed. Only 5 (0.5%) of 1000 serum samples being tested at the state Laboratory for other diseases had evidence of antibodies to La Crosse virus. These findings suggest that La Crosse virus is newly endemic to eastern Tennessee.
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Newly recognized focus of La Crosse Encephalitis in Tennessee.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 1999Co-Authors: Timothy F. Jones, Paul Campbell Erwin, Allen S. Craig, Lori E. R. Patterson, Roger S. Nasci, Reid R. Gerhardt, Xilla T. Ussery, William SchaffnerAbstract:La Crosse virus is a mosquito-borne arbovirus that causes Encephalitis in children. Only nine cases were reported in Tennessee during the 33-year period from 1964-1996. We investigated a cluster of La Crosse Encephalitis cases in eastern Tennessee in 1997. Medical records of all suspected cases of La Crosse virus infection at a pediatric referral hospital were reviewed, and surveilLance was enhanced in the region. Previous unreported cases were identified by surveying 20 hospitals in the surrounding 16 counties. Mosquito eggs were collected from five sites. Ten cases of La Crosse Encephalitis were serologically confirmed. None of the patients had been discharged from hospitals in the region with diagnosed La Crosse Encephalitis in the preceding 5 years. Aedes triseriatus and Aedes albopictus were collected at the case sites; none of the mosquitos had detectable La Crosse virus. This cluster may represent an extension of a recently identified endemic focus of La Crosse virus infection in West Virginia.
R. T. Trout Fryxell - One of the best experts on this subject based on the ideXlab platform.
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Spatial-temporal clusters of host-seeking Aedes albopictus, Aedes japonicus, and Aedes triseriatus collections in a La Crosse virus endemic county (Knox County, Tennessee, USA).
PloS one, 2020Co-Authors: R.d. Rowe, D. Paulsen, Agricola Odoi, Abelardo C. Moncayo, R. T. Trout FryxellAbstract:A bite from a La Crosse virus (LaCV) infected Aedes mosquito can cause La Crosse Encephalitis (LaCE), which is a neuro-invasive disease that disproportionately affects children under the age of 16 in Southern AppaLachia. The three vectors for LaCV are Aedes albopictus (Skuse), Ae. japonicus (Theobald), and Ae. triseriatus (Say). Localized maps of the geographic distribution of vectors are practical tools for mosquito management personnel to target areas with high mosquito abundance. This study hypothesized that LaCV vectors have unique species-specific spatial and temporal clusters. To test this, 44 sites were identified in Knox County, Tennessee for their Land use/type. At each site, host-seeking mosquitoes were collected approximately every other week from May-October 2018. Spatial clusters of host-seeking mosquito collections for each of the three mosquito species were investigated using Kulldorff's spatial scan statistic, specifying a retrospective space-time Bernoulli model. Most vector clusters were identified in south-central Knox County while the seasonality of clusters varied by mosquito species. Clusters of Ae. albopictus were observed throughout the entire study period while clusters of Ae. japonicus and Ae. triseriatus only occurred May-June. The findings indicate that the reLative abundance of LaCV vectors were more abundant in south-central Knox County compared to the rest of the county. Of interest, these clusters spatially overLapped with previous LaCE diagnosed cases. These findings are useful in guiding decisions on targeted mosquito control in Knox County and may be applied to other counties within Southern AppaLachia.
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Modeling a single season of Aedes albopictus popuLations based on host-seeking data in response to temperature and precipitation in eastern Tennessee.
Journal of vector ecology : journal of the Society for Vector Ecology, 2018Co-Authors: James Nance, R. T. Trout Fryxell, Suzanne LenhartAbstract:In the southern AppaLachia of the U.S., Aedes mosquitoes maintain and transmit La Crosse virus (LaCV) which causes La Crosse Encephalitis, a neuroinvasive disease of children. In response to mosquito outbreaks, communities organize prevention, detection, and response measures that are dependent on local characteristics of the mosquito popuLation and the community. Knowing Ae. albopictus is an accessory vector of LaCV and a nuisance biter, our objective was to build a system of ordinary differential equations to model dynamics in a single season using our data and readily avaiLable environmental variables that can reflect the abundance and activity of Ae. albopictus. Consequently, we built an Ae. albopictus single-season mathematical model for eastern Tennessee to fit our 2013 mosquito collection data in order to understand the popuLation fluctuations. We included precipitation, temperature, and rate of change of temperature in the model because Aedes mosquitoes oviposit desiccant tolerant eggs with peak activity occurring over 26° C and those data are readily avaiLable and used frequently as forecast predictors. Our ordinary differential equation model accurately fits the data and facilitates predictions and better understanding of Ae. albopictus popuLations in southern AppaLachia.
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La Crosse Virus Vectors Are Host-Seeking and Ovipositing After 1700 H in Eastern Tennessee.
Journal of the American Mosquito Control Association, 2017Co-Authors: C. Urquhart, D. Paulsen, R. T. Trout FryxellAbstract:La Crosse virus (LaCV) is transmitted via the bites of infected Aedes mosquitoes (Ae. triseriatus, Ae. albopictus, and Ae. japonicus) and causes La Crosse Encephalitis, which is the most commonly diagnosed arbovirus in eastern Tennessee children. This study identified host-seeking and oviposition activity of LaCV vectors over a diel period, as it reLates to traditional working hours. Nineteen sites in Knox County, TN, were monitored with host-seeking (Centers for Disease Control and Prevention [CDC] miniature light traps) and oviposition traps (CDC gravid traps) during 2 diel periods (0900–1700 h and 1700–900 h). We collected 2,444 adult mosquitoes, comprising 19 different species of which 1,337 (54.7%) were LaCV vectors: Ae. albopictus (1,207 specimens), Ae. triseriatus (85 specimens), and Ae. japonicus (45 specimens). These species were active throughout the sampling period, but significantly more were collected from 1700–0900 h. The CDC gravid trap was the most effective method for monitoring Ae. japonicus; there were no trap effects or trap × time interactive effects for Ae. albopictus or Ae. triseriatus. Overall, significantly more LaCV vectors were collected from 1700–0900 h compared to 0900–1700 h. Information gathered in this study improves vector surveilLance, helps communities control mosquito popuLations, and minimizes nontarget effects.
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Cemeteries are effective sites for monitoring La Crosse virus (LaCv) and these environments may pLay a role in LaCv infection.
PloS one, 2015Co-Authors: R. T. Trout Fryxell, D. Paulsen, Kimberly Freyman, Armando Ulloa, Brian B. M. Hendricks, Agricola Odoi, Abelardo C. MoncayoAbstract:La Crosse Encephalitis (LaC) is the leading arboviral disease among children, and was previously limited to the upper Midwest. In 2012 nine pediatric cases of LaC occurred in eastern Tennessee, including one fatal case. In an attempt to identify sites near an active LaCv infection and describe the abundance and distribution of potential LaCv vectors near a fatal LaC case in the AppaLachian region, we initiated an end of season study using a combination of questing and oviposition mosquito traps pLaced at forty-nine sites consisting of cemeteries and houses within 16 radial kilometers of two pediatric infections. LaCv was isoLated from three Aedes triseriatus pools collected from cemeteries and spatial clustering analysis identified clusters of Ae. triseriatus and Ae. albopictus popuLations that overLapped in the same area as the 2012 LaCv cases. Results indicate cemeteries are effective sites for monitoring LaCv. The role of cemeteries and specific environmental features will be the focus of future investigations.
Raheel R. Khan - One of the best experts on this subject based on the ideXlab platform.
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Safety and pharmacokinetics of ribavirin for the treatment of La Crosse Encephalitis.
The Pediatric infectious disease journal, 2011Co-Authors: James E. Mcjunkin, Raheel R. Khan, Emily De Los Reyes, Manuel J. Caceres, Linda L. Minnich, Milap C. Nahata, W. Garrett Hunt, Mouna G. Chebib, Sasidharan Taravath, Roxane R. CarrAbstract:Background:La Crosse viral Encephalitis (LaCVE) is associated with residual epilepsy and neurocognitive deficits in survivors. This report summarizes 3 phases of clinical studies of children treated with intravenous (IV) ribavirin (RBV), each one exploring a different phase (I, IIA, IIB) of clinical
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La Crosse Encephalitis in children.
The New England journal of medicine, 2001Co-Authors: James E. Mcjunkin, Raheel R. Khan, Theodore F. Tsai, Emily De Los Reyes, Jose E. Irazuzta, Manuel J. Caceres, Linda L. Minnich, Gretchen D. Lovett, Ann ThompsonAbstract:Background La Crosse Encephalitis is a mosquito-borne disease that can be mistaken for herpes simplex Encephalitis. It has been reported in 28 states but may be underrecognized. Methods We investigated the manifestations and clinical course of La Crosse Encephalitis in 127 patients hospitalized from 1987 through 1996. The diagnosis was established by serologic testing for IgM and IgG antibodies to La Crosse virus. Data were collected by chart review. Results Most of the patients were school-aged children (mean [±SD] age, 7.8±3.5 years; range, 0.5 to 15.0). Symptoms included headache, fever, and vomiting (each in 70 percent or more of the patients), seizures (in 46 percent), and disorientation (in 42 percent). Thirteen percent had aseptic meningitis. Hyponatremia developed in 21 percent, and there were signs of increased intracranial pressure in 13 percent. Six patients, including three with cerebral herniation, underwent intracranial-pressure monitoring. The 13 patients (11 percent) whose condition deteri...
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california La Crosse Encephalitis
Infectious Disease Clinics of North America, 1998Co-Authors: James E. Mcjunkin, Raheel R. Khan, Theodore F. TsaiAbstract:La Crosse Encephalitis, a mosquito-borne viral disease that can be mistaken for herpes simplex Encephalitis, is under-recognized in the United States, despite case reports from 28 states and an incidence in endemic areas (20-30/100,000) exceeding that of bacterial meningitis. The disease recurs every summer in endemic foci in the midwestern and mid-AtLantic United States in areas forested with hardwood trees, which provide breeding sites for the treehole-dwelling mosquito vector, Aedes triseriatus. La Crosse Encephalitis should be considered in the child presenting with meningoEncephalitis in summer and early fall, particuLarly for children living in (or recent travel to) endemic areas in mid-AtLantic and midwestern states.
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CALIFORNIA–La Crosse Encephalitis
Infectious disease clinics of North America, 1998Co-Authors: James E. Mcjunkin, Raheel R. Khan, Theodore F. TsaiAbstract:La Crosse Encephalitis, a mosquito-borne viral disease that can be mistaken for herpes simplex Encephalitis, is under-recognized in the United States, despite case reports from 28 states and an incidence in endemic areas (20-30/100,000) exceeding that of bacterial meningitis. The disease recurs every summer in endemic foci in the midwestern and mid-AtLantic United States in areas forested with hardwood trees, which provide breeding sites for the treehole-dwelling mosquito vector, Aedes triseriatus. La Crosse Encephalitis should be considered in the child presenting with meningoEncephalitis in summer and early fall, particuLarly for children living in (or recent travel to) endemic areas in mid-AtLantic and midwestern states.
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Treatment of Severe La Crosse Encephalitis With Intravenous Ribavirin Following Diagnosis by Brain Biopsy
Pediatrics, 1997Co-Authors: James E. Mcjunkin, Raheel R. Khan, Linda L. Minnich, E. C. De Los Reyes, D. L. Parsons, R. G. Ashley, Theodore F. TsaiAbstract:* Abbreviations: CNS = : central nervous system • LE = : La Crosse Encephalitis • HSE = : herpes simplex Encephalitis • ICP = : intracranial pressure • IgM = : immunoglobulin M • IgG = : immunoglobulin G • FDA = : Food and Drug Administration • CSF = : cerebrospinal fluid • ER = : emergency room • CT = : computed tomography • EEG = : electroencephalogram • PLEDs = : periodic Lateralizing epileptiform discharges • SIADH = : syndrome of inappropriate antidiuretic hormone • MRI = : magnetic resonance imaging • CDC = : Centers for Disease Control and Prevention • HIV = : human immunodeficiency virus La Crosse virus is a mosquito-borne bunyavirus that has been neglected as a cause of pediatric central nervous system (CNS) infection. The disease recurs every summer in endemic foci in the midwestern and mid-AtLantic United States in areas forested with hardwood trees, which provide breeding sites for the treehole-dwelling mosquito vector, Aedes triseriatus .1 During hyperendemic years, the prevalence of disease in some of these areas can be remarkably high, exceeding that of bacterial meningitis.1,2 Clinical manifestations in symptomatic cases of La Crosse Encephalitis (LE) tend to cluster into a mild form or a severe form of the disease.3-10 The usual clinical course (80% to 90%) is the mild form in which headache, fever, and vomiting frequently occur on days 1 to 3. Lethargy, behavioral changes, and/or brief seizures may occur on days 3 and 4, followed by improvement over a 7- to 8-day period. The less common (10% to 20%), more severe presentation includes abrupt fever and headache, disorientation and seizures, occurring within the first 8 to 24 hours of symptomatology, sometimes progressing to deep coma, associated in rare cases with cerebral edema. Overall, symptomatic children present with seizures in about 50% of cases and status epilepticus occurs in 10% to 15%. Focal signs are present in 16% to 25% of individuals with LE. Studies of neurologic outcome of LE indicate residual seizures in 6% to 13%, persistent hemiparesis in roughly 1%, and cognitive morbidity in a small, ill-defined number of cases (see “Discussion”). The case fatality rate approaches 1% of symptomatic cases. Mild cases of LE resemble enteroviral meningoEncephalitis (also common in the summertime) but LE has no rash, less often shows meningeal signs, and is much more often complicated by seizures. Severe cases of LE may mimic herpes simplex Encephalitis (HSE),1 …
