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St. Louis Encephalitis

Saint Louis Encephalitis


Presentation

  • All cases had a clinical presentation of encephalitis and were confirmed serologically. Clinically most cases presented with fever, meningitis syndrome with altered mental status. Tremors were common (56% of cases). There were three deaths.[ncbi.nlm.nih.gov]
  • The results of the present nonrandomized, unblinded, interventional pilot study of the use of IFN-α2b therapy for St.[doi.org]
  • Forecast skill is demonstrated, and a real-time seasonal forecast of epidemic SLEV transmission is presented.[ncbi.nlm.nih.gov]
  • This distribution of MR imaging abnormality in cases of StLE mirrors the reports presented in the literature that implicate the substantia nigra as peculiarly susceptible to the StLE virus.[ncbi.nlm.nih.gov]
Fever
  • Evidence of yellow fever infection was observed in 10 species, with high prevalence recorded in howler monkey (18%) and agouti (20%). Antibodies against DENV-2 and SLEV were found sporadically in various species.[ncbi.nlm.nih.gov]
  • […] immunology West Nile Fever/transmission West Nile Fever/veterinary* West Nile Fever/virology West Nile virus/genetics* West Nile virus/immunology West Nile virus/physiology Substance Viral Nonstructural Proteins Grant support AI065359 /NH/NIH HHS/United[ncbi.nlm.nih.gov]
  • People with mild illness often have only a headache and fever.[cdc.gov]
  • Symptomatology on admission included fever, chills, severe headache, abdominal pain, myalgia, arthralgia and jaundice. SLE virus was isolated from her blood drawn on the 8th day of illness and subsequent seroconversion was documented.[ncbi.nlm.nih.gov]
  • The mild form of the disease results in fever and headaches. Serious cases of the illness include symptoms such as high fever, neck stiffness and persisting headaches.[mosquitonix.com]
High Fever
  • Severe Symptoms: Headache High fever Neck stiffness Stupor Disorientation Coma Tremors Additional Resources: California Department of Public Health: St Louis Encephalitis Centers for Disease Control and Prevention: St Louis Encephalitis[shastamosquito.org]
  • Louis Encephalitis will have no symptoms or signs and never feel sick Mild Symptoms: Most of those who do have symptoms or signs will have a fever and headaches Severe Symptoms: Few of those infected have the severe symptoms such as high fever, severe[smcmvcd.org]
  • When infection is more severe the person may experience headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, occasional convulsions and spastic paralysis. Fatality ranges from 3–30%.[en.wikipedia.org]
  • Serious cases of the illness include symptoms such as high fever, neck stiffness and persisting headaches. As the disease progresses, infected people may develop tremors, convulsions, stupor, disorientation and spastic paralysis.[mosquitonix.com]
Rigor
  • Common symptoms were fever, rigors, diarrhea, headache, and confusion. One patient died 3 days after hospitalization.[ncbi.nlm.nih.gov]
  • Epidemiology United States statistics Determining the true incidence of encephalitis is impossible, because reporting policies are neither standardized nor rigorously enforced.[emedicine.medscape.com]
Chills
  • Symptomatology on admission included fever, chills, severe headache, abdominal pain, myalgia, arthralgia and jaundice. SLE virus was isolated from her blood drawn on the 8th day of illness and subsequent seroconversion was documented.[ncbi.nlm.nih.gov]
Nausea
  • Symptoms of illness include fever, headache, nausea, vomiting, and tiredness. Some people may have neuroinvasive disease that often involves encephalitis, an inflammation of the brain. Arboviral diseases home Last Revised: May 13, 2019[dhs.wisconsin.gov]
  • Signs and symptoms include the sudden onset of drowsiness, headache and nausea (due to the encephalitis), pain in the abdomen, a rash, and swollen glands (lymphadenopathy). These features are usually but not always mild.[medicinenet.com]
  • Those who do become ill experience flu-like symptoms — fever, headache, nausea, vomiting, and fatigue. The more severe version of the disease involves inflammation of the brain, and occurs most commonly in older adults.[idahostatesman.com]
  • Other symptoms include fever, nausea, stiff neck/back, light sensitivity, confusion, drowsiness, irritability, and motor skill impairment. Wild bird populations are central to the transmission cycle.[amcdsjc.org]
  • This may be an upper respiratory infection, or an illness that causes diarrhea, nausea, and vomiting. Encephalitis can also happen after a bacterial infection such as Lyme disease, tuberculosis, or syphilis.[stlouischildrens.org]
Vomiting
  • Symptoms of illness include fever, headache, nausea, vomiting, and tiredness. Some people may have neuroinvasive disease that often involves encephalitis, an inflammation of the brain. Arboviral diseases home Last Revised: May 13, 2019[dhs.wisconsin.gov]
  • Those who do become ill experience flu-like symptoms — fever, headache, nausea, vomiting, and fatigue. The more severe version of the disease involves inflammation of the brain, and occurs most commonly in older adults.[idahostatesman.com]
  • This may be an upper respiratory infection, or an illness that causes diarrhea, nausea, and vomiting. Encephalitis can also happen after a bacterial infection such as Lyme disease, tuberculosis, or syphilis.[stlouischildrens.org]
  • Initial symptoms of those who become ill include fever, headache, nausea, vomiting and tiredness. Severe presentation of the disease, including coma, convulsions or paralysis, occurs more commonly in older adults.[cbs4local.com]
Hypertension
  • Hypertension and vascular disease may predispose to neuroinvasive disease, but this epidemiologic study has not ruled out the confounding effects of age.[ncbi.nlm.nih.gov]
  • Half the case patients were over age 60, and nearly half had hypertension. The serosurvey confirmed that infection with the SLE virus was not new to Pine Bluff, and that most infections in 1991 were asymptomatic.[ncbi.nlm.nih.gov]
  • No host factors were significantly associated with risk of acquiring SLE, but more cases were cigarette smokers and had family histories of hypertension or cerebrovascular disease.[ncbi.nlm.nih.gov]
  • Male sex is a risk factor Most SLEV infection outbreaks occur in people of low socioeconomic status, which is probably due to less access to heath care and poor environmental control of mosquitoes Comorbidity with atherosclerosis, heart disease, and hypertension[emedicine.medscape.com]
Vascular Disease
  • Hypertension and vascular disease may predispose to neuroinvasive disease, but this epidemiologic study has not ruled out the confounding effects of age.[ncbi.nlm.nih.gov]
Diplopia
  • Additional signs noted at, or after, admission to the hospital were nystagmus, diplopia, ophthalmoplegia, respiratory insufficiency, tremor, ataxia, peripheral weakness, confusion, or decreased level of consciousness.[dx.doi.org]
Photophobia
  • From an epidemiologic and pathophysiologic perspective, encephalitis is distinct from meningitis, though on clinical evaluation both can be present, with signs and symptoms of meningeal inflammation, such as photophobia, headache, or stiff neck.[emedicine.medscape.com]
Dysuria
  • […] encephalitis include the following: Encephalitis caused by varicella-zoster virus (VZV), Epstein-Barr virus (EBV), cytomegalovirus (CMV), measles virus, or mumps virus: Rash, lymphadenopathy, hepatosplenomegaly, and parotid enlargement St Louis encephalitis: Dysuria[emedicine.medscape.com]
Headache
  • People with mild illness often have only a headache and fever.[cdc.gov]
  • Symptomatology on admission included fever, chills, severe headache, abdominal pain, myalgia, arthralgia and jaundice. SLE virus was isolated from her blood drawn on the 8th day of illness and subsequent seroconversion was documented.[ncbi.nlm.nih.gov]
  • STUDY DESIGN: From January to May 2005, patients with symptoms of encephalitis, meningitis, or fever with severe headache were evaluated and an etiologic diagnosis achieved by detection of flavivirus-specific antibody sera and cerebrospinal fluid.[ncbi.nlm.nih.gov]
  • The majority of infections result in mild illness, including fever and headache.[en.wikipedia.org]
  • Common symptoms were fever, rigors, diarrhea, headache, and confusion. One patient died 3 days after hospitalization.[ncbi.nlm.nih.gov]
Confusion
  • SLEV infections can be unrecognized or confused with other ones caused by an arbovirus, such as dengue.[ncbi.nlm.nih.gov]
  • Common symptoms were fever, rigors, diarrhea, headache, and confusion. One patient died 3 days after hospitalization.[ncbi.nlm.nih.gov]
  • Headache, fever, nuchal rigidity, confusion, and tremor were outstanding clinical features. Prospective sequential clinical studies commonly showed isolated cranial-nerve dysfunction, pathological reflexes, and nystagmus.[annals.org]
  • Other symptoms include fever, nausea, stiff neck/back, light sensitivity, confusion, drowsiness, irritability, and motor skill impairment. Wild bird populations are central to the transmission cycle.[amcdsjc.org]
  • Severe symptoms include fever, headache, stiff neck, confusion, and altered level of consciousness. Coma, convulsions, paralysis, and sometimes death may occur (with a 5-15% overall case fatality ratio).[abc30.com]
Seizure
  • Evaluate the patient's neurologic status; check level of consciousness (LOC); observe and document evidence of seizure activity; institute seizure precautions, as appropriate.[quizlet.com]
  • Louis encephalitis in a 19-day-old infant who presented with fever and seizure activity. To our knowledge, this is the youngest case of St. Louis encephalitis ever reported.[ncbi.nlm.nih.gov]
  • Of the 9 patients who were examined with electroencephalography, all 9 had seizures or other abnormalities, and 1 had nonconvulsive status epilepticus. Two of 6 patients who had MRIs showed substantia nigra edema.[ncbi.nlm.nih.gov]
  • As indicated in previous reports, 1 , 3 prognosis was worse among patients with seizures. Of 4 patients with seizures, 2 died and 2 had a prolonged hospital course.[jamanetwork.com]
  • This leads to changes in a child's nervous system that can include confusion, changes in alertness, and seizures. Meningitis often happens at the same time as encephalitis.[stlouischildrens.org]
Irritability
  • Other symptoms include fever, nausea, stiff neck/back, light sensitivity, confusion, drowsiness, irritability, and motor skill impairment. Wild bird populations are central to the transmission cycle.[amcdsjc.org]
  • Do not apply insect repellent to a child’s hands, eyes, mouth, cuts, or irritated skin. Adults: Spray insect repellent onto your hands and then apply to a child’s face. Tips for Everyone Always follow the product label instructions.[cdc.gov]
  • Louis encephalitis, 20% develop sequelae, including irritability, memory loss, various types of movement disorders, or motor deficits.[emedicine.medscape.com]
  • Symptoms of irritability, sleeplessness, depression, memory loss, and headaches can last up to 3 years. Areas of outbreaks since 1933 have involved the western United States, Texas, the Ohio-Mississippi Valley, and Florida.[mayomedicallaboratories.com]
Neck Stiffness
  • More severe disease is marked by fever, headache, neck stiffness, stupor, disorientation, coma, tremors, occasional convulsions (especially in infants) and spastic (but rarely flaccid) paralysis.[cdc.gov]
  • Severe Symptoms: Headache High fever Neck stiffness Stupor Disorientation Coma Tremors Additional Resources: California Department of Public Health: St Louis Encephalitis Centers for Disease Control and Prevention: St Louis Encephalitis[shastamosquito.org]
  • When infection is more severe the person may experience headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, occasional convulsions and spastic paralysis. Fatality ranges from 3–30%.[en.wikipedia.org]
  • Clonus and neck stiffness were detected at physical exam. Cerebrospinal fluid revealed mononuclear leukocytosis; bilateral ischemic compromise was observed in thalamus by magnetic resonance.[ncbi.nlm.nih.gov]
  • Serious cases of the illness include symptoms such as high fever, neck stiffness and persisting headaches. As the disease progresses, infected people may develop tremors, convulsions, stupor, disorientation and spastic paralysis.[mosquitonix.com]

Workup

Periodic Lateralized Epileptiform Discharges
  • Electroencephalograms were obtained for 9 patients and results on all were abnormal, showing status epilepticus (1 patient) ( Figure 1 ), bilateral periodic lateralized epileptiform discharges (1 patient), and background diffuse slowing (7 patients).[jamanetwork.com]
Hyponatremia
  • Of this group, 13 patients appeared to have hyponatremia due to inappropriate secretion of antidiuretic hormone; the remaining patients were probably hyponatremic from salt depletion.[annals.org]
  • The medical literature also contains reports of syndrome of inappropriate antidiuretic hormone secretion (SIADH) and hyponatremia in patients with St.[emedicine.medscape.com]
  • , MRI or, if that is unavailable, contrast-enhanced head CT) before LP Additional treatment considerations include the following: Management of hydrocephalus and increased ICP Treatment of systemic complications (eg, hypotension or shock, hypoxemia, hyponatremia[emedicine.medscape.com]
Hypocapnia
  • In two of the conscious patients cerebral blood flow was normal despite normal arterial oxygen tension and systemic hypocapnia; inflammatory cerebral vasodilatation may have accounted for the findings.[annals.org]

Treatment

  • Treatment significantly reduced the levels of viral RNA in the serum, brain, and spleen [ 8 ].[doi.org]
  • No specific antiviral treatment for SLE is available. Patients with suspected SLE should be evaluated by a healthcare provider, appropriate serologic and other diagnostic tests ordered, and supportive treatment provided.[cdc.gov]
  • There is currently no therapeutic treatment for SLE. Current methods consist primarily of symptom treatment and supportive care. Many SLE epidemics have been documented in North America. In 1990, there were 223 cases in Florida.[floridahealth.gov]
  • Treatment There is no specific treatment for St. Louis encephalitis. Treatment will focus on managing your symptoms and complications, such as through supporting breathing and providing fluids. Prevention There is no vaccine against St.[cancercarewny.com]

Prognosis

  • The EEG proved valuable in diagnosis and prognosis. Results of brain scans were normal. Virus in CSF or urine was not demonstrated, nor was viral antigen in CSF or urine sediments.[archinte.jamanetwork.com]
  • Prognosis The mortality rate of St. Louis encephalitis is 2-30%. This figure is higher in older patients. [7] Of persons who survive St.[emedicine.medscape.com]
  • As indicated in previous reports, 1 , 3 prognosis was worse among patients with seizures. Of 4 patients with seizures, 2 died and 2 had a prolonged hospital course.[jamanetwork.com]

Etiology

  • Louis encephalitis virus (SLEV) as the etiologic agent.[ncbi.nlm.nih.gov]
  • We cannot dismiss the association of genotype II and V as etiological agents during the outbreak.[ncbi.nlm.nih.gov]
  • Etiology and Pathophysiology St. Louis encephalitis is caused by an enveloped, single-stranded, positive-sense ribonucleic acid (RNA) virus of the Flaviviridae subgroup. St.[emedicine.medscape.com]
  • Louis Encephalitis Tree Number: B04.820.230.475.330 B04.820.250.350.300.330 Definition English : A species of FLAVIVIRUS, one of the Japanese encephalitis virus group ( ENCEPHALITIS VIRUSES, JAPANESE), which is the etiologic agent of ST.[decs.bvs.br]

Epidemiology

  • Louis/epidemiology* Encephalitis, St. Louis/history Encephalitis, St. Louis/transmission Encephalitis, St.[ncbi.nlm.nih.gov]
  • Louis/epidemiology Encephalitis, St. Louis/genetics* Genome, Viral* Genotype Humans Phylogeny* United States/epidemiology Vero Cells Viral Proteins/genetics* Substance Viral Proteins[ncbi.nlm.nih.gov]
  • It has become clear that viral swarm characterization is required if we are to fully evaluate the relationship between viral genomes, viral evolution, and epidemiology.[ncbi.nlm.nih.gov]
  • Epidemiological investigations where the patient worked and lived revealed no evidence of extensive transmission of SLE virus.[ncbi.nlm.nih.gov]
  • SLE epidemiology, clinical presentation, diagnosis, and preventive measures are reviewed.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Abstract Studies of pathophysiology in epidemic St. Louis encephalitis were undertaken during the 1966 Dallas epidemic. Eighteen of 52 patients were hyponatremic during their acute illness.[annals.org]
  • Etiology and Pathophysiology St. Louis encephalitis is caused by an enveloped, single-stranded, positive-sense ribonucleic acid (RNA) virus of the Flaviviridae subgroup. St.[emedicine.medscape.com]
  • Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test The onset of St.[mayomedicallaboratories.com]
  • The Canadian equivalent, West Nile Virus: Primer for Family Physicians, was published on June 10, 2005, in Canadian Family Physician. [3] Pathophysiology Portals of entry are virus specific.[emedicine.medscape.com]

Prevention

  • Prevent mosquito bites. There is no vaccine or preventive drug. Use insect repellent containing DEET, picaridin, IR3535 or oil of lemon eucalyptus on exposed skin and/or clothing.[cdc.gov]
  • SLE epidemiology, clinical presentation, diagnosis, and preventive measures are reviewed.[ncbi.nlm.nih.gov]
  • Louis encephalitis (SLE) are preventable by means of surveillance and vector abatement. This view is examined in the light of epidemic activity during the last decade (1977-1986), in which 9 discrete outbreaks occurred.[ncbi.nlm.nih.gov]
  • Prevention There is no vaccine against St. Louis encephalitis. Prevention of this disease centers on controlling mosquitoes and avoiding mosquito bites. Steps you can take to avoid mosquitoes include: Stay inside between dusk and dark.[winchesterhospital.org]
  • This fact indicates that there is an urgent need to increase the current knowledge about this virus in order to control and prevent future cases.[ncbi.nlm.nih.gov]

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