LaCrosse viral encephalitis mimics herpes simplex viral encephalitis

Commonly Reported Mosquito-Borne Viruses in the United States: A Primer for Pharmacists

Mosquito-borne diseases are a public health concern. Pharmacists are often a patient's first stop for health information and may be asked questions regarding transmission, symptoms, and treatment of mosquito borne viruses (MBVs). The objective of this paper is to review transmission, geographic location, symptoms, diagnosis and treatment of MBVs. We discuss the following viruses with cases in the US in recent years: Dengue, West Nile, Chikungunya, LaCrosse Encephalitis, Eastern Equine Encephalitis Virus, and Zika. Prevention, including vaccines, and the impact of climate change are also discussed.

Modeling a single season of Aedes albopictus populations based on host-seeking data in response to temperature and precipitation in eastern Tennessee

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.

Virus and Immune-Mediated Encephalitides: Epidemiology, Diagnosis, Treatment, and Prevention

Virus encephalitis remains a major cause of acute neurological dysfunction and permanent disability among children worldwide. Although some disorders, such as measles encephalomyelitis, subacute sclerosing panencephalitis, and varicella-zoster virus-associated neurological conditions, have largely disappeared in resource-rich regions because of widespread immunization programs, other disorders, such as herpes simplex virus encephalitis, West Nile virus-associated neuroinvasive disease, and nonpolio enterovirus-induced disorders of the nervous system, cannot be prevented. Moreover, emerging viral disorders pose new, potential threats to the child's nervous system. This review summarizes current information regarding the epidemiology of virus encephalitis, the diagnostic methods available to detect central nervous system infection and identify viral pathogens, and the available treatments. The review also describes immune-mediated disorders, including acute disseminated encephalomyelitis and N-methyl-D-aspartate receptor antibody encephalitis, conditions that mimic virus encephalitis and account for a substantial proportion of childhood encephalitis.

Impacts of climate, land use, and biological invasion on the ecology of immature Aedes mosquitoes: implications for La Crosse emergence

Arthropod-borne viruses (arboviruses) cause many diseases worldwide and their transmission is likely to change with land use and climate changes. La Crosse virus (LACV) is historically transmitted by the native mosquito Aedes triseriatus (Say) in the upper Midwestern US, but the invasive congeners Aedes albopictus (Skuse) and A. japonicus (Theobald), which co-occur with A. triseriatus in water-holding containers, may be important accessory vectors in the Appalachian region where La Crosse encephalitis is an emerging disease. This review focuses on evidence for how climate, land use, and biological invasions may have direct abiotic and indirect community-level impacts on immature developmental stages (eggs and larvae) of Aedes mosquitoes. Because vector-borne diseases usually vary in space and time and are related to the ecology of the vector species, we propose that the ecology of its mosquito vectors, particularly at their immature stages, has played an important role in the emergence of La Crosse encephalitis in the Appalachian region and represents a model for investigating the effects of environmental changes on other vector-borne diseases. We summarize the health effects of LACV and associated socioeconomic costs that make it the most important native mosquito-borne disease in the US. We review of the transmission of LACV, and present evidence for the impacts of climate, land use, and biological invasions on Aedes mosquito communities. Finally, we discuss important questions about the ecology of LACV mosquito vectors that may improve our understanding of the impacts of environmental changes on LACV and other arboviruses.

Safety and pharmacokinetics of ribavirin for the treatment of la crosse encephalitis

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 trial development.

METHODS

In phase I, 7 children with life-threatening LACVE were treated with emergency use RBV using a moderate IV dose (8.33 mg/kg/dose q 8 hours day 1, 5 mg/kg/dose q 8 hours days 2-10). In phase IIA, 12 children with severe LACVE were enrolled: 8 treated with RBV (same dose as phase I) and 4 with placebo. In phase IIB an escalated dose was used (33 mg/kg dose 1, then 16 mg/kg/dose q 6 hours for 4 days, and 8 mg/kg/dose q 8 hours for 3 days).

RESULTS

In a group of 15 children treated in phase I and phase IIA, RBV appeared safe at moderate dose, but based on steady-state RBV levels of 9.3 μM, estimated cerebrospinal fluid levels were less than 20% of the EC50 of RBV for LACVE. At the escalated dose used in phase IIB, adverse events occurred, likely related to RBV, and therefore the trial was discontinued. Nevertheless, valuable pharmacokinetic (PK) and safety data were obtained at moderate dose, with potential treatment implications for other indications.

CONCLUSIONS

Although the results do not support the use of RBV for LACVE, this nevertheless is the largest study of antiviral treatment for LACVE to date and the largest pharmacokinetic analysis of IV RBV in children for any indication.

La crosse virus encephalitis preceding neurosarcoidosis diagnosed by brain biopsy

Childhood neurosarcoidosis is rare, and its etiology is unknown. La Crosse virus is one of the most common causes of encephalitis in North America. We report the case of a 12-year-old boy who had La Crosse virus encephalitis and subsequently developed imaging and pathologic findings suggestive of neurosarcoidosis. He presented with acute onset of transient aphasia 4 months after an episode of encephalitis; serology results at the time of aphasia were positive for La Crosse virus. Brain MRI revealed diffuse subcortical nodular lesions. His serum angiotensin-converting enzyme level was elevated, and brain biopsy revealed noncaseating granuloma. It is interesting to note that he has had no recurrence of aphasia; repeat MRI showed significant improvement of nodular lesions without therapy. To our knowledge, this is the first case of La Crosse virus encephalitis associated with neurosarcoid findings.

The spatial epidemiology and clinical features of reported cases of La Crosse virus infection in West Virginia from 2003 to 2007

BACKGROUND

La Crosse virus (LACV) is a major cause of pediatric encephalitis in the United States. Since the mid-1980s, the number of reported cases of LACV infection in West Virginia has continued to rise and the state currently reports the most cases in the United States. The purpose of this study was to investigate and describe the spatial epidemiology and clinical presentation of LACV infection cases reported in West Virginia, as well as to provide a description of the environmental conditions present at the residences of the LACV infection cases.

METHODS

Descriptive and spatial analyses were performed on LACV infection cases reported to the West Virginia Department of Health from 2003 to 2007. Clinical and environmental variables were available for 96 cases and residence data were available for 68 of these cases. Spatial analyses using the global Moran's I and Kulldorff's spatial scan statistic were performed using the population 15 years and younger at both the county and census tract levels to identify those geographic areas at the highest risk of infection.

RESULTS

Two statistically significant (p < 0.05) high-risk clusters, involving six counties, were detected at the county level. At the census tract level, one statistically significant high-risk cluster involving 41 census tracts spanning over six counties was identified. The county level cumulative incidence for those counties in the primary high-risk cluster ranged from 100.0 to 189.0 cases per 100,000 persons (median 189.0) and the census tract level cumulative incidence for those counties in the high-risk cluster ranged from 61.7 to 505.9 cases per 100,000 persons (median 99.0). The counties and census tracts within high-risk clusters had a relative risk four to nine times higher when compared to those areas not contained within high-risk clusters. The majority of LACV infection cases were reported during the summer months in children 15 years and younger. Fever, vomiting, photophobia, and nausea were the most commonly reported signs and symptoms. A case fatality rate (CFR) of 3.1% was observed. Wooded areas and containers were present at the majority of case residences.

CONCLUSIONS

The cumulative incidences of LACV infection from 2003 to 2007 were considerably higher than previously reported for West Virginia, and statistically significant high-risk clusters for LACV infection were detected at both the county and census tract levels. The finding of a high CFR and the identification of those areas at highest risk for infection will be useful for guiding future research and intervention efforts.

La Crosse virus infectivity, pathogenesis, and immunogenicity in mice and monkeys

BACKGROUND

La Crosse virus (LACV), family Bunyaviridae, was first identified as a human pathogen in 1960 after its isolation from a 4 year-old girl with fatal encephalitis in La Crosse, Wisconsin. LACV is a major cause of pediatric encephalitis in North America and infects up to 300,000 persons each year of which 70-130 result in severe disease of the central nervous system (CNS). As an initial step in the establishment of useful animal models to support vaccine development, we examined LACV infectivity, pathogenesis, and immunogenicity in both weanling mice and rhesus monkeys.

RESULTS

Following intraperitoneal inoculation of mice, LACV replicated in various organs before reaching the CNS where it replicates to high titer causing death from neurological disease. The peripheral site where LACV replicates to highest titer is the nasal turbinates, and, presumably, LACV can enter the CNS via the olfactory neurons from nasal olfactory epithelium. The mouse infectious dose50 and lethal dose50 was similar for LACV administered either intranasally or intraperitoneally. LACV was highly infectious for rhesus monkeys and infected 100% of the animals at 10 PFU. However, the infection was asymptomatic, and the monkeys developed a strong neutralizing antibody response.

CONCLUSION

In mice, LACV likely gains access to the CNS via the blood stream or via olfactory neurons. The ability to efficiently infect mice intranasally raises the possibility that LACV might use this route to infect its natural hosts. Rhesus monkeys are susceptible to LACV infection and develop strong neutralizing antibody responses after inoculation with as little as 10 PFU. Mice and rhesus monkeys are useful animal models for LACV vaccine immunologic testing although the rhesus monkey model is not optimal.

Emerging infectious diseases: TheBunyaviridae

The Bunyaviridae are a large group of viruses that infect a diversity of arthropod vectors and animal hosts. They have a worldwide distribution and can be the cause of human illness ranging from mild asymptomatic infection to hemorrhagic fever and fatal encephalitis. The growth of the human population, the expansion of agricultural and economic development, climatic changes, and the speed and frequency of global transportation all favor the emergence of bunyaviruses and other arthropod borne viruses. International monitoring of the Bunyaviridae and a greater understanding of their ecology and biology are needed to prepare for future outbreaks.

Rapid detection of human pathogenic orthobunyaviruses

Modern detection and identification tools can help to provide answers to urgent questions about the incidence, prevalence, and epidemiology of currently emerging diseases. We developed highly sensitive one-step TaqMan reverse transcription-PCR assays with sensitivities ranging from 10(4) to 10(1) molecules for 11 human pathogens of the orthobunyaviruses. We compared the performances of these assays on three currently available cyclers (ABI-PRISM 7700, LightCycler, and SmartCycler). The assay for Oropouche virus (OROV) was tested using sera collected from days 1 to 5 after onset of OROV disease and was found to be greatly superior to an established nested PCR system. A mean copy number of 1.31 x 10(7) OROV RNA/ml of serum was detected. Diagnostic RNA detection can be used as early as day 1 after onset of OROV disease. The use of a mobile SmartCycler and a hands-on time of less than 3 h could help to intensify outbreak surveillance and control, especially in field studies.