Clinical Information

California (LaCrosse) Virus:

California (LaCrosse) virus is a member of the Bunyaviridae family, and it is one of the arthropod-borne encephalitides. It is transmitted by various Aedes and Culex mosquitoes and is found in such intermediate hosts as rabbits, squirrels, chipmunks, and field mice. California meningoencephalitis is usually mild and occurs in late summer. Ninety percent of infections are seen in children and adolescents younger than 15 years, usually from rural areas. The incubation period is estimated to be 7 days, and acute illness lasts 10 days or less in most instances. Typically, the first symptoms are nonspecific, lasting 1 to 3 days, and are followed by the appearance of central nervous system (CNS) signs and symptoms, such as stiff neck, lethargy, and seizures, which usually abate within 1 week. Symptomatic infection is almost never recognized in those older than 18 years. The most important sequela of California virus encephalitis is epilepsy, which occurs in about 10% of children; almost always in patients who have had seizures during the acute illness. An estimated 2% of patients have persistent paresis. Learning disabilities or other objective cognitive deficits have been reported in a small proportion (2%) of patients. Learning performance and behavior of most recovered patients are not distinguishable from comparison groups in these same areas.

Eastern Equine Encephalitis:

Eastern equine encephalitis (EEE) is within the alphavirus group. It is a low-prevalence cause of human disease in the eastern and Gulf Coast states. EEE is maintained by a cycle of mosquito/wild bird transmission, peaking in the summer and early fall, when humans may become an adventitious host. The most common clinically apparent manifestation is a mild undifferentiated febrile illness, usually with headache. CNS involvement is demonstrated in only a minority of infected individuals and is more abrupt and more severe than with other arboviruses, with children being more susceptible to severe disease. Fatality rates are approximately 70%.

St Louis Encephalitis:

Areas or outbreaks of St Louis encephalitis since 1933 have involved the western United States, Texas, the Ohio-Mississippi Valley, and Florida. The vector of transmission is the mosquito. Peak incidence occurs in summer and early autumn. Disease onset is characterized by generalized malaise, fever, chills, headache, drowsiness, nausea, and sore throat or cough, followed in 1 to 4 days by meningeal and neurologic signs. The severity of illness increases with advancing age; persons older than 60 years have the highest frequency of encephalitis. Symptoms of irritability, sleeplessness, depression, memory loss, and headaches can last up to 3 years.

Western Equine Encephalitis:

The virus that causes Western equine encephalitis (WEE) is widely distributed throughout the United States and Canada; disease occurs almost exclusively in the western states and Canadian provinces. The relative absence of the disease in the eastern United States probably reflects a paucity of the vector mosquito species, Culex tarsalis, and possibly a lower pathogenicity of local virus strains. The disease usually begins suddenly with malaise, fever, and headache, often with nausea and vomiting. Vertigo, photophobia, sore throat, respiratory symptoms, abdominal pain, and myalgia are also common. Over a few days, the headache intensifies; drowsiness and restlessness may merge into a coma in severe cases. In infants and children, the onset may be more abrupt than for adults. WEE should be suspected in any case of febrile CNS disease from an endemic area. Infants are highly susceptible to CNS disease, with about 20% of cases in patients younger than 1 year. There is an excess of male patients with WEE clinical encephalitis, averaging about twice the number of infections detected in female patients. After recovery from the acute disease, patients may require from several months to 2 years to overcome the fatigue, headache, and irritability. Infants and children are at a higher risk of permanent brain damage after recovery than adults.