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Previous Volume 344:801-807 March 15, 2001 Number 11 Next

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ABSTRACT

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 deteriorated in the hospital had decreases in serum sodium levels (P=0.007) and increases in body temperature (P=0.003) at the time of deterioration. At admission, these patients more often had a history of vomiting (P=0.047) and a score of 12 or lower on the Glasgow Coma Scale (P=0.02) than the others; a trend toward a greater prevalence of seizures at admission was also evident in this group (P=0.07). All the patients survived, but 15 of them (12 percent) had neurologic deficits at discharge. Follow-up assessments, performed in 28 children, suggested an increase in cognitive and behavioral deficits 10 to 18 months after the episode of encephalitis.

Conclusions La Crosse virus infection should be considered in children who present with aseptic meningitis or encephalitis. Hyponatremia and increasing body temperature may be related to clinical deterioration.

Source Information

From the Charleston Division, Robert C. Byrd Health Sciences Center of West Virginia University (J.E.M., E.C.R., J.E.I., M.J.C., R.R.K., L.L.M., K.D.F.), and the Charleston Area Medical Center (L.L.M., G.D.L.) — both in Charleston, W.Va.; the Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colo. (T.T.); and Children's Hospital of Pittsburgh, Pittsburgh (A.T.).

Address reprint requests to Dr. McJunkin at the Department of Pediatrics, West Virginia University, P.O. Box 9214, Morgantown, WV 26506-9214, or at jmcjunkin{at}hsc.wvu.edu.

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