Daniel M. Pastula

Novel Thogotovirus Associated with Febrile Illness and Death, United States, 2014

Bourbon virus is a newly discovered pathogen associated with human illness and death.

Acute Flaccid Myelitis in the United States, August–December 2014: Results of Nationwide Surveillance

BACKGROUND During late summer/fall 2014, pediatric cases of acute flaccid myelitis (AFM) occurred in the United States, coincident with a national outbreak of enterovirus D68 (EV-D68)-associated severe respiratory illness. METHODS Clinicians and health departments reported standardized clinical, epidemiologic, and radiologic information on AFM cases to the Centers for Disease Control and Prevention (CDC), and submitted biological samples for testing. Cases were ≤21 years old, with acute onset of limb weakness 1 August-31 December 2014 and spinal magnetic resonance imaging (MRI) showing lesions predominantly restricted to gray matter. RESULTS From August through December 2014, 120 AFM cases were reported from 34 states. Median age was 7.1 years (interquartile range, 4.8-12.1 years); 59% were male. Most experienced respiratory (81%) or febrile (64%) illness before limb weakness onset. MRI abnormalities were predominantly in the cervical spinal cord (103/118). All but 1 case was hospitalized; none died. Cerebrospinal fluid (CSF) pleocytosis (>5 white blood cells/µL) was common (81%). At CDC, 1 CSF specimen was positive for EV-D68 and Epstein-Barr virus by real-time polymerase chain reaction, although the specimen had >3000 red blood cells/µL. The most common virus detected in upper respiratory tract specimens was EV-D68 (from 20%, and 47% with specimen collected ≤7 days from respiratory illness/fever onset). Continued surveillance in 2015 identified 16 AFM cases reported from 13 states. CONCLUSIONS Epidemiologic data suggest this AFM cluster was likely associated with the large outbreak of EV-D68-associated respiratory illness, although direct laboratory evidence linking AFM with EV-D68 remains inconclusive. Continued surveillance will help define the incidence, epidemiology, and etiology of AFM.

Enterovirus D68 Infection in Children with Acute Flaccid Myelitis, Colorado, USA, 2014

Odds of this viral infection in the nasopharynx were 10 times greater for children with this condition than for controls.

Zika Virus as an Emerging Global Pathogen: Neurological Complications of Zika Virus

IMPORTANCE Zika virus (ZIKV) is an emerging arthropod-borne virus (arbovirus) in the genus Flavivirus that has caused a widespread outbreak of febrile illness, is associated with neurological disease, and has spread across the Pacific to the Americas in a short period. OBSERVATIONS In this review, we discuss what is currently known about ZIKV, neuroimmunologic complications, and the impact on global human health. Zika virus spread across Africa and Asia in part owing to unique genomic evolutionary conditions and pressures resulting in specific human disease manifestations, complications, and pathogenesis. Recent data suggest that acute ZIKV infection in pregnant women may result in acute infection of fetal tissue and brain tissue, causing microcephaly and potentially severe debilitation of the infant or even death of the fetus. Cases of acute ZIKV are also associated with Guillain-Barré syndrome. With the increased number of cases, new complications such as ocular involvement and sexual transmission have been reported. CONCLUSIONS AND RELEVANCE Zika virus is an emerging viral pathogen with significant consequences on human health throughout the world. Ongoing research into this pathogen is urgently needed to produce viable vaccine and therapeutic options.

Four emerging arboviral diseases in North America: Jamestown Canyon, Powassan, chikungunya, and Zika virus diseases.

Arthropod-borne viruses, or arboviruses, are viruses that are transmitted through the bites of mosquitoes, ticks, or sandflies. There are numerous arboviruses throughout the world capable of causing human disease spanning different viral families and genera. Recently, Jamestown Canyon, Powassan, chikungunya, and Zika viruses have emerged as increasingly important arboviruses that can cause human disease in North America. Unfortunately, there are currently no proven disease-modifying therapies for these arboviral diseases, so treatment is largely supportive. Given there are also no commercially available vaccines for these four arboviral infections, prevention is the key. To prevent mosquito or tick bites that might result in one of these arboviral diseases, people should wear long-sleeved shirts and pants while outside if feasible, apply insect repellant when going outdoors, using window screens or air conditioning to keep mosquitoes outside, and perform tick checks after being in wooded or brushy outdoor areas.

Guillain-Barré Syndrome and Healthcare Needs during Zika Virus Transmission, Puerto Rico, 2016

To assist with public health preparedness activities, we estimated the number of expected cases of Zika virus in Puerto Rico and associated healthcare needs. Estimated annual incidence is 3.2–5.1 times the baseline, and long-term care needs are predicted to be 3–5 times greater than in years with no Zika virus.

Zika Virus Disease and Associated Neurologic Complications

Purpose of ReviewThe purpose of this article is to review what is currently known about Zika virus (ZIKV) disease and associated neurologic complications.Recent FindingsZIKV is a mosquito-borne or sexually transmitted flavivirus rapidly spreading throughout the Americas. While ZIKV infection is usually asymptomatic, it may cause a non-specific illness with fever, rash, myalgia, headache, and/or non-purulent conjunctivitis. Additionally, ZIKV has been associated with a number of neurologic complications including microcephaly and other birth defects, Guillain-Barré syndrome, meningoencephalitis, myelitis, and various ophthalmologic abnormalities.SummaryTreatment for ZIKV disease is supportive. Those in ZIKV endemic areas should protect themselves from mosquito bites by wearing insect repellent, wearing long-sleeved shirts and pants when outdoors, and/or using air conditioning or window screens when indoors. Furthermore, unprotected sexual intercourse should be temporarily avoided by those who recently traveled to endemic areas. Suspected ZIKV disease cases should be reported to local, state, or territorial health departments.

Jamestown Canyon Virus Disease in the United States—2000–2013

Jamestown Canyon virus (JCV) is a mosquito-borne orthobunyavirus in the California serogroup that can cause an acute febrile illness, meningitis, or meningoencephalitis. We describe epidemiologic and clinical features for JCV disease cases occurring in the United States during 2000-2013. A case of JCV disease was defined as an acute illness in a person with laboratory evidence of a recent JCV infection. During 2000-2013, we identified 31 cases of JCV disease in residents of 13 states. The median age was 48 years (range, 10-69) and 21 (68%) were male. Eleven (35%) case patients had meningoencephalitis, 6 (19%) meningitis, 7 (23%) fever without neurologic involvement, and 7 (23%) had an unknown clinical syndrome. Fifteen (48%) were hospitalized and there were no deaths. Health-care providers and public health officials should consider JCV disease in the differential diagnoses of viral meningitis and encephalitis, obtain appropriate specimens for testing, and report cases to public health authorities.

Zika virus disease for neurologists

PURPOSE OF REVIEW Zika virus (ZIKV) was not initially thought to be an important cause of neurologic disease, but with the recent epidemic in the Western Hemisphere, there is a growing body of evidence for possible neurologic complications. This review discusses these in addition to what is known about modes of transmission, testing for the virus, as well as future directions. RECENT FINDINGS ZIKV disease has been associated with microcephaly and congenital eye disease in infants, as well as with Guillain-Barré syndrome, uveitis, myelitis, and meningoencephalitis in adults. SUMMARY Even though most infections are asymptomatic, there are important possible neurologic complications of ZIKV disease in both children and adults of which neurologists should be aware.

No Geographic Correlation between Lyme Disease and Death Due to 4 Neurodegenerative Disorders, United States, 2001-2010.

Death rates for these disorders were not associated with incidence of confirmed Lyme disease cases.