Raheel Khan

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.

OBJECTIVE: In this study we aimed to determine, in pediatric patients, whether norovirus infection could be associated with exacerbations of inflammatory bowel disease (IBD) and ascertain whether the clinical expression of norovirus gastroenteritis was similar in patients with IBD compared with non-IBD controls. MATERIALS AND METHODS: We performed a case-control retrospective chart review, over a 10-month interval, of patients with IBD with an exacerbation of their disease. The presence of norovirus in stool and/or rectal swab samples, as determined by an enzyme-linked immunoassay, was assessed. In addition, sex, age, type of IBD, presence or absence of diarrhea, hematochezia, and the need for hospitalization were determined. A similar number of control patients who did not have IBD were used as controls. RESULTS: Nine patients with IBD (8 ulcerative colitis/1 Crohn disease) had exacerbations with diarrhea. Eight had norovirus antigen in at least 1 sample. All 9 patients with IBD presented with bloody diarrhea and 6 of the 8 norovirus-positive patients with IBD required hospitalization. All of the control patients experienced diarrhea; however, no hematochezia was noted and no hospitalization was required. Several patients with IBD and controls remained positive for norovirus months after the initial positive stool and/or rectal swab sample. The virus appeared to be more common during winter months. CONCLUSIONS: We conclude that norovirus may be associated with exacerbations of IBD. When norovirus accompanies IBD it is more likely to be associated with hematochezia than when the infection occurs in the absence of IBD.

Experience and Reason| February 01 1997 Treatment of Severe La Crosse Encephalitis With Intravenous Ribavirin Following Diagnosis by Brain Biopsy James E. McJunkin, MD; James E. McJunkin, MD Search for other works by this author on: This Site PubMed Google Scholar Raheel Khan, MD; Raheel Khan, MD Search for other works by this author on: This Site PubMed Google Scholar Emily C. de los Reyes, MD; Emily C. de los Reyes, MD Search for other works by this author on: This Site PubMed Google Scholar Debra L. Parsons, MD; Debra L. Parsons, MD Search for other works by this author on: This Site PubMed Google Scholar Linda L. Minnich, SM(AAM); Linda L. Minnich, SM(AAM) Search for other works by this author on: This Site PubMed Google Scholar Rebecca G. Ashley, MT; Rebecca G. Ashley, MT Search for other works by this author on: This Site PubMed Google Scholar Theodore F. Tsai, MD Theodore F. Tsai, MD Search for other works by this author on: This Site PubMed Google Scholar Address correspondence to: James E. McJunkin, MD, Robert C. Byrd Health Sciences Center, 830 Pennsylvania Avenue, Suite 104, Charleston, WV 25302–3389. Pediatrics (1997) 99 (2): 261–267. https://doi.org/10.1542/peds.99.2.261 Article history Received: December 04 1995 Accepted: April 10 1996 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation James E. McJunkin, Raheel Khan, Emily C. de los Reyes, Debra L. Parsons, Linda L. Minnich, Rebecca G. Ashley, Theodore F. Tsai; Treatment of Severe La Crosse Encephalitis With Intravenous Ribavirin Following Diagnosis by Brain Biopsy. Pediatrics February 1997; 99 (2): 261–267. 10.1542/peds.99.2.261 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP Grand RoundsAAP NewsAll AAP Sites Search Advanced Search Topics: brain biopsy, la crosse encephalitis, ribavirin, encephalitis, herpes simplex, la crosse virus, immunoglobulin m, immunoglobulin g La Crosse virus is a mosquito-borne bunyavirus that has been neglected as a cause of pediatric central nervous system (CNS) infection. The disease recurs every summer in endemic foci in the midwestern and mid-Atlantic United States in areas forested with hardwood trees, which provide breeding sites for the treehole-dwelling mosquito vector, Aedes triseriatus.1 During hyperendemic years, the prevalence of disease in some of these areas can be remarkably high, exceeding that of bacterial meningitis.1 2 Clinical manifestations in symptomatic cases of La Crosse encephalitis (LE) tend to cluster into a mild form or a severe form of the disease.3-10 The usual clinical course (80% to 90%) is the mild form in which headache, fever, and vomiting frequently occur on days 1 to 3. Lethargy, behavioral changes, and/or brief seizures may occur on days 3 and 4, followed by improvement over a 7- to 8-day period. The... You do not currently have access to this content.

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.