#Jamestown Canyon Virus #Encephalitis in a #Heart #Transplant Patient (Transpl Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Transpl Infect Dis. 2019 Nov 12:e13210. doi: 10.1111/tid.13210. [Epub ahead of print]

Jamestown Canyon Virus Encephalitis in a Heart Transplant Patient.

Askar W1, Menaria P2, Thohan V3, Brummitt CF4.

Author information: 1 Department of Internal Medicine Residency, Aurora Healthcare, Milwaukee, WI. 2 Department of Hospital Medicine, Aurora St. Luke’s Medical Center, Aurora Healthcare, Milwaukee, WI. 3 Department of Advanced Heart Failure Therapies, Mission Health System, Asheville, NC. 4 Department of Infectious Diseases, Aurora Healthcare, Milwaukee, WI.



Jamestown Canyon virus (JtCV) is an arbovirus and a member of the California serogroup. To our knowledge, all the cases of JtCV have been reported in immunocompetent patients since it was first detected in 1997. We report a case of JtCV encephalitis in a solid organ transplant patient. A 48-year-old female from Wisconsin had multiple hospital admissions for symptoms of progressive confusion, visual hallucinations, and inability to perform self-care. Initial evaluation was significant for lymphocytes in cerebrospinal fluid (CSF), and multiple infectious and metabolic causes were excluded. Further investigation found JtCV IgM in serum, and CSF. The patient’s clinical course was compatible with JtCV encephalitis and she was treated with ribavirin in addition to reduction of her immunosuppressive medications. She showed gradual and significant improvement in her mental and functional status. JtCV can cause a variety of symptoms that range from a flu-like syndrome to encephalitis. There have been an increased number of reported cases in recent years which is attributed to increased physician awareness and the availability of laboratory testing. Optimal treatment is still not known.

© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

PMID: 31713971 DOI: 10.1111/tid.13210

Keywords: Jamestown Canyon Virus; Arbovirus; Encephalitis; USA; Wisconsin; Organ transplantation.


#Prediction of unfavorable #outcomes in #WNV #neuroinvasive #infection – result of a multinational ID-IRI study (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology / Available online 11 November 2019, 104213 / In Press, Journal Pre-proof

Prediction of unfavorable outcomes in West Nile virus neuroinvasive infection – result of a multinational ID-IRI study

Corneliu Petru Popescu a,b,c,1, Simin Aysel Florescu a,b,1, Rodrigo Hasbun d, Arjan Harxhi e, Razi Evendar f, Hasip Kahraman g, Ami Neuberger f, Daniel Codreanu b, Mihaela Florentina Zaharia a,b,c, Selma Tosun h, Emanoil Ceausu b, Simona Maria Ruta a,i, Gorana Dragovacj, k, Natalia Pshenichnaya l,m, Galina Gopatsa n, Olga Shmaylenko o, Éva Nagy, p, Jelena Djekic Malbasaj k, Mirjana Strbac j, Nenad  Pandak q, Husnu Pullukcu g, Botond Lakatos p, Yasemin Cag r, Antonio Cascio s, Ilaria Coledan t, Serkan Oncu u, Hakan Erdemc v

{a} University of Medicine and Pharmacy Carol Davila Bucharest, Romania; {b} Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases Bucharest, Romania; {c} ESCMID Study Group for Infectious Diseases of the Brain – ESGIB, Switzerland; {d} Department of Infectious Diseases, UT Health McGovern Medical School, Houston, TX, USA; {e} Service of Infectious Disease, University Hospital Center of Tirana, Tirana, Albania; {f} Infectious Diseases Institute, Rambam Health Care Campus, Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel; {g}
Ege University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Izmir, Turkey; {h} Department of Infectious Diseases and Clinical Microbiology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey; {i} Stefan S. Nicolau Institute of Virology, Bucharest, Romania; {j} Institute of Public Health of Vojvodina, Department of Prevention and Control of Diseases, Novi Sad, Serbia; {k}
University of Novi Sad, Faculty of Medicine, Department of Epidemiology, Novi Sad, Serbia; {l} National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, Russia; {m} Central Scientific Research Laboratory, Rostov State Medical University, Rostov-on-Don, Russia; {n} Department of Infectious Diseases, Rostov State Medical University, Rostov-on-Don, Russia; {o} Department of Infectious Diseases #5, City Hospital #1 named after N.A. Semashko, Rostov-on-Don, Russia; {p}
National Institute of Hematology and Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary; {q} General Hospital Slavonski Brod, Department for Infectious Diseases, School of Medicine, University of Split, Split, Croatia; {r} Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey; {s} Section of Infectious and Tropical Diseases, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Italy; {t} Department of Diagnostics and Public Health, Section of Infectious Diseases, University of Verona, Verona, Italy; {u} Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University School of Medicine, Aydin, Turkey; {v} ID-IRI, Ankara, Turkey

Received 30 August 2019, Revised 31 October 2019, Accepted 7 November 2019, Available online 11 November 2019. DOI: https://doi.org/10.1016/j.jcv.2019.104213



  • Prognosis of unfavorable outcomes in West Nile virus neuroinvasive infection.
  • The relative risk for death by age.
  • Encephalitis, meningoencephalitis, meningitis.
  • Glasgow coma score was correlated with evolution to death.
  • Risk score was calculated according to age, co-morbidities, clinical manifestations.




WNV causes 1.4% of all central nervous system infections and is the most common cause of epidemic neuro-invasive disease in humans.


Our main objective was to investigate retrospectively West Nile virus neuroinvasive disease (WNND) cases hospitalized during 2010- 2017 and identified factors that can influence prognosis.

Study design

We documented the demographic, epidemiologic, clinical and laboratory data of WNND and identified factors that can influence prognosis. The data were recruited through Infectious Diseases International Research Initiative (ID-IRI), which serves as a network for clinical researches.


We investigated 165 patients with WNND in 10 countries from three continents. 27 patients died and the mortality rate was 16.4%. In an univariate analysis age, congestive heart failure, neoplasm and ischemic heart disease (p < 0.001), neuropsychiatric disorders (p = 0.011), chronic hepatitis (p = 0.024) and hypertension (p = 0.043) were risk factors for death. Fatal evolution was also correlated with ICU addmission, disorientation, speech disorders, change in consciousnes, coma, a low Glasgow coma score, obtundation, confusion (p < 0.001), history of syncope (p = 0.002) and history of unconsciousness (p = 0.037). In a binomial logistic regresssion analysis only age and coma remained independent prediction factors for death. We created an equation that was calculated according to age, co-morbidities and clinical manifestations that may be used to establish the prognosis of WNND patients.


WNND remain an important factor for morbidity and mortality worldwide, evolution to death or survival with sequelae are not rare. Our study creates an equation that may be used in the future to establish the prognosis of WNND patients.

Keywords: West Nile virus – WNV – meningitis – encephalitis – neuroinvasive – death

{1} These authors contributed equally to this article.

© 2019 Elsevier B.V. All rights reserved.

Keywords: WNV; WNND; Neuroinvasion; Encephalitis; Meningitis; European Region.


The Use of Large-Particle #Aerosol Exposure to #Nipah Virus to Mimic #Human #Neurological Disease Manifestations in the African Green #Monkey (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

The Use of Large-Particle Aerosol Exposure to Nipah Virus to Mimic Human Neurological Disease Manifestations in the African Green Monkey

Ji Hyun Lee, Dima A Hammoud, Yu Cong, Louis M Huzella, Marcelo A Castro, Jeffrey Solomon, Joseph Laux, Matthew Lackemeyer, J Kyle Bohannon, Oscar Rojas, Russ Byrum, Ricky Adams, Danny Ragland, Marisa St Claire, Vincent Munster, Michael R Holbrook

The Journal of Infectious Diseases, jiz502, https://doi.org/10.1093/infdis/jiz502

Published: 05 November 2019



Nipah virus (NiV) is an emerging virus associated with outbreaks of acute respiratory disease and encephalitis. To develop a neurological model for NiV infection, we exposed 6 adult African green monkeys to a large-particle (approximately 12-μm) aerosol containing NiV (Malaysian isolate). Brain magnetic resonance images were obtained at baseline, every 3 days after exposure for 2 weeks, and then weekly until week 8 after exposure. Four of 6 animals showed abnormalities reminiscent of human disease in brain magnetic resonance imaging. Abnormalities ranged from cytotoxic edema to vasogenic edema. The majority of lesions were small infarcts, and a few showed inflammatory or encephalitic changes. Resolution or decreased size in some lesions resembled findings reported in patients with NiV infection. Histological lesions in the brain included multifocal areas of encephalomalacia, corresponding to known ischemic foci. In other regions of the brain there was evidence of vasculitis, with perivascular infiltrates of inflammatory cells and rare intravascular fibrin thrombi. This animal model will help us better understand the acute neurological features of NiV infection and develop therapeutic approaches for managing disease caused by NiV infection.

Nipah virus, Paramyxovirus, Magnetic resonance imaging, Computed tomography, pathology

Issue Section: Supplement Article

Keywords: Nipah virus; Encephalitis; Animal models.


Minimal #Cerebrospinal Concentration of #Miltefosine Despite Therapeutic #Plasma Levels During the #Treatment of Amebic #Encephalitis (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Minimal Cerebrospinal Concentration of Miltefosine Despite Therapeutic Plasma Levels During the Treatment of Amebic Encephalitis

Marguerite L. Monogue [PharmD], Durward Watson [PA-C], Julie S. Alexander [DO], Dominick Cavuoti [DO], Laura M. Doyle [MS], Michael Zhuo Wang [PhD], Bonnie C. Prokesch [MD]

DOI: 10.1128/AAC.01127-19



Miltefosine is an alkylphosphocholine compound used primarily for treatment of leishmaniasis that also demonstrates in vitro and in vivo anti-amebic activity against Acanthamoeba species. As such, recommendations for treatment of amebic encephalitis generally include miltefosine therapy. Data supports a minimum amebicidal concentration of at least 16 mcg/mL is required for most Acanthamoeba species. Although there is a high level of mortality associated with amebic encephalitis, a paucity of data regarding miltefosine levels in the plasma and cerebrospinal fluid in vivo exists in the literature. We found that despite aggressive dosing (miltefosine 50 mg orally every 6 hours) and therapeutic plasma levels, cerebrospinal fluid miltefosine concentration was negligible in a patient with Acquired Immunodeficiency Syndrome (AIDS) and Acanthamoeba encephalitis.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Acanthamoeba spp.; Encephalitis; Miltefosine.


#Clinical, #laboratory and immune aspects of #zika virus-associated #encephalitis in #children (Int J Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Int J Infect Dis. 2019 Oct 30. pii: S1201-9712(19)30424-2. doi: 10.1016/j.ijid.2019.10.030. [Epub ahead of print]

Clinical, laboratory and immune aspects of zika virus-associated encephalitis in children.

Salgado DM1, Vega R2, Rodríguez JA2, Niño Á2, Rodríguez R2, Ortiz Á2, DeLaura I3, Bosch I4, Narváez CF5.

Author information: 1 Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Departamento de Pediatría, Hospital Universitario de Neiva, Neiva, Huila, Colombia; Especialización Médica en Pediatría, Postgrados Clínicos, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia. Electronic address: dpanqueba@gmail.com. 2 Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Departamento de Pediatría, Hospital Universitario de Neiva, Neiva, Huila, Colombia; Especialización Médica en Pediatría, Postgrados Clínicos, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia. 3 Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Harvard College, Fulbright U.S. Program, Cambridge, MA 02138, USA. 4 E25Bio Inc. The Engine of MIT. 501 Massachusetts Ave. Cambridge, MA 02139, USA; Mount Sinai School of Medicine. Department of Medicine, 10029-6500, NY, USA. 5 Programa de Medicina, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia; Especialización Médica en Pediatría, Postgrados Clínicos, Facultad de Salud, Universidad Surcolombiana, Neiva, Huila, Colombia. Electronic address: cfnarvaez@usco.edu.co.




To evaluate the clinical, laboratory and immune characteristics of ZIKV-associated encephalitis in pediatric patients after the epidemic in Huila, southern Colombia.


A pediatric neuro-surveillance hospital study was conducted in a referral health center in southern Colombia, from October 2016 to October 2017. Cases of encephalitis were confirmed by nucleic acid amplification tests and serological methods in cerebrospinal fluid (CSF), plasma and/or urine. Levels of six cytokines were evaluated by flow cytometry. Patients underwent daily clinical and laboratory follow-ups.


Twenty children with probable encephalitis were included for further studies and 16 of them were confirmed. Four cases of S. pneumoniae, group B Streptococcus, S. epidermidis, and E. coli. bacterial meningoencephalitis and 12 cases of viral encephalitis were identified, six of them associated with ZIKV infection. Other viral encephalitis were caused by Herpes viruses (n = 3), enterovirus (n = 2) and one DENV-2 infection. ZIKV-associated encephalitis symptoms subsided faster compared to those of patients with encephalitis caused by other agents. CSF analysis revealed lymphocytic pleocytosis. Compared to healthy controls, children with ZIKV-associated encephalitis presented with modest plasma IL-10 but not IL-2, IL-4, IL-6, IFN-γ, or TNF-α. Cytokine expression was differentially regulated as dramatically elevated IL-6, IL-10 and IFN-γ levels were observed in CSF but not in paired plasma in one of the patients with ZIKV detectable in CSF.


This study provides evidence that ZIKV is responsible for pediatric encephalitis in endemic areas and the local presence of virus may induce cephalic but not systemic expression of cytokines.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: Dengue virus; Neurologic surveillance; Pediatric; Viral encephalitis; Zika virus

PMID: 31678190 DOI: 10.1016/j.ijid.2019.10.030

Keywords: Zika Virus; Encephalitis; Pediatrics; Neurology.


#Clinical Manifestations of #Nipah Virus-Infected #Patients Who Presented to the #Emergency Department During an #Outbreak in #Kerala State in #India, May 2018 (Clin Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Clin Infect Dis. 2019 Oct 18. pii: ciz789. doi: 10.1093/cid/ciz789. [Epub ahead of print]

Clinical Manifestations of Nipah Virus-Infected Patients Who Presented to the Emergency Department During an Outbreak in Kerala State in India, May 2018.

Chandni R1, Renjith TP1, Fazal A1, Yoosef N1, Ashhar C1, Thulaseedharan NK1, Suraj KP1, Sreejith MK1, Sajeeth Kumar KG1, Rajendran VR1, Remla Beevi A2, Sarita RL3, Sugunan AP4, Arunkumar G5, Mourya DT6, Murhekar M7.

Author information: 1 Government Medical College, Kozhikode, Kerala, India. 2 Directorate of Medical Education, Thiruvananthapuram, Kerala, India. 3 Directorate of Health Services, Thiruvananthapuram, Kerala, India. 4 Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Port Blair, Andaman & Nicobar Islands, India. 5 Manipal Institute of Virology, Manipal Academy of Higher Education (Institute of Eminence Deemed to be University), Manipal, Karnataka, India. 6 ICMR-National Institute of Virology, Pune, Maharashtra, India. 7 ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India.




An outbreak of Nipah virus (NiV) disease occurred in the Kozhikode district of Kerala State in India in May 2018. Several cases were treated at the emergency medicine department (ED) of the Government Medical College, Kozhikode (GMCK). The clinical manifestations and outcome of these cases are described.


The study included 12 cases treated in the ED of GMCK. Detailed clinical examination, laboratory investigations, and molecular testing for etiological diagnosis were performed.


The median age of the patients was 30 years and the male to female ratio was 1.4:1.0. All the cases except the index case contracted the infection from hospitals. The median incubation period was 10 days, and the case fatality ratio was 83.3%. Ten (83.3%) patients had encephalitis and 9 out of 11 patients whose chest X-rays were obtained had bilateral infiltrates. Three patients had bradycardia and intractable hypotension requiring inotropes. Encephalitis, acute respiratory distress syndrome, and myocarditis were the clinical prototypes, but there were large overlaps between these. Ribavirin therapy was given to a subset of the patients. Although there was a 20% reduction in NiV encephalitis cases treated with the drug, the difference was not statistically significant. The outbreak ended soon after the introduction of total isolation of patients and barrier nursing.


The outbreak of NiV disease in Kozhikode in May 2018 presented as encephalitis, acute respiratory distress and myocarditis or combinations of these. The CFR was high. Ribavirin therapy was tried but no evidence for its benefit could be obtained.

Twelve cases of Nipah virus disease were treated in the emergency department of a referral hospital in Kozhikode, India, in May 2018. The case fatality ratio was 83.3%. Ten cases each had encephalitis and acute respiratory distress syndrome and 3 had myocarditis. Transmission was mostly nosocomial.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

KEYWORDS: Kerala-India; Nipah clinical manifestations Kozhikode; Nipah epidemic; Nipah virus; encephalitis

PMID: 31627214 DOI: 10.1093/cid/ciz789

Keywords: Nipah Virus; India; Kerala; ARDS; Encephalitis; Myocarditis; Nosocomial outbreaks.


Increased #detection of #enterovirus A71 #infections, #Germany, 2019 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Increased detection of enterovirus A71 infections, Germany, 2019

Sindy Böttcher1, Sabine Diedrich1, Kathrin Keeren2, the Laboratory Network for Enterovirus Diagnostic (LaNED)3

Affiliations: 1 National Reference Centre for Poliomyelitis and Enteroviruses, Robert Koch Institute, Berlin, Germany; 2 Secretary of the National Commission for Polio Eradication in Germany, Robert Koch Institute, Berlin, Germany; 3 The members of the network are listed at the end of the article

Correspondence:  Sindy Böttcher

Citation style for this article: Böttcher Sindy, Diedrich Sabine, Keeren Kathrin, the Laboratory Network for Enterovirus Diagnostic (LaNED). Increased detection of enterovirus A71 infections, Germany, 2019. Euro Surveill. 2019;24(39):pii=1900556. https://doi.org/10.2807/1560-7917.ES.2019.24.39.1900556

Received: 05 Sep 2019;   Accepted: 26 Sep 2019



We report on the increased circulation of enterovirus A71 in Germany in 2019. Strains were mainly identified in hospitalised patients with suspected aseptic meningitis/encephalitis. Molecular analysis showed co-circulation of EV-A71 sub-genogroups C1 and C4, a signal for physicians and public health authorities to include/intensify EV diagnostic in patients showing signs of aseptic meningitis, encephalitis or acute flaccid paralysis/myelitis.

© This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: EV-A71; Encephalitis; AFP; AFM; Germany.