4 instances of Powassan virus encephalitis

Powassan virus (POWV) could cause a uncommon however doubtlessly life-threatening illness together with encephalitis. On this case evaluate, the authors describe 4 sufferers with Powassan virus encephalitis, who had been all handled at a hospital in North Dakota. The sufferers resided in North Dakota and Wisconsin.

 

Powassan virus (POWV) could cause extreme illness, together with an infection of the mind (encephalitis) or an infection of the membranes across the mind and spinal wire (meningitis). Signs could embrace confusion, lack of coordination, problem talking, and seizures. An estimated 1 out of 10 individuals with POWV encephalitis or POWV meningitis will die from the illness, based on the CDC.¹

The examine entitled “Powassan virus infection: case series and literature review from a single institution,” by Raval and colleagues, highlights the elevated unfold of this tick-borne an infection, significantly within the central north United States, and the necessity for clinicians to pay attention to its diversified medical shows.²

18-year-old male with single seizure

The younger man introduced to the hospital with a 2-day historical past of complications and a single episode of seizure.

“He was at work, slicing bushes, and was suspended from a harness, the place he instantly skilled clenching of his proper higher extremity.”

CT scan was unremarkable. Remedy was not prescribed, because the man skilled solely an remoted seizure.

“He subsequently developed right-sided weak point, worsening complications, and somnolence and was subsequently transferred to our facility to obtain a better degree of care,” the authors wrote.

Regardless of remedy, the younger man’s complications continued to worsen. At this level, he reported to the clinicians that he beforehand had a tick chew. He was then prescribed antibiotics together with ceftriaxone, vancomycin, ampicillin, acyclovir and doxycycline.

Testing for the extra widespread tick-borne infections, reminiscent of Lyme disease and anaplasmosis, was damaging. Nevertheless, the person had a constructive serum evaluation for Powassan virus immunoglobulin M.

“Throughout his follow-up go to, he didn’t report any focal neurological deficits, seizures, or complications.”

READ MORE: What is Powassan Virus?

60-year-old male with mind hemorrhage

The affected person was admitted to the emergency division with fevers, complications and dizziness. Nevertheless, his examination was unremarkable and he was discharged.

On the way in which residence, “he misplaced consciousness and was discovered obtunded and unresponsive,” based on the authors.

The person was intubated and transferred to the ICU.  A CT scan of the mind revealed intraparenchymal hemorrhage with a subdural hematoma.

After 7 days, the affected person was stabilized and extubated. Though the person didn’t have focal neurological deficits, he did exhibit altered psychological standing, reminiscence loss and anhedonia with melancholy.

The person later examined constructive for Powassan virus and was handled symptomatically.

“His neurological perform recovered with return of his baseline purposeful standing on additional follow-up,” the authors wrote.

61-year-old male with altered psychological standing

A 61-year-old man, from northwestern Minnesota, introduced to the hospital with progressive complications, physique aches, high-grade fever, and altered psychological standing.

He loved outside actions and reported having frequent tick bites.

The affected person was initially handled with ceftriaxone, vancomycin and doxycycline. However testing for Lyme disease, anaplasmosis and ehrlichiosis had been damaging.

The person’s situation deteriorated and he was intubated and positioned on a ventilator.

“Antibiotics had been modified to vancomycin, acyclovir, piperacillin/tazobactam and micafungin,” the authors wrote.

His CSF evaluation was constructive by PCR and the person was recognized with Powassan virus encephalitis.

The “affected person stayed in rehabilitation facility for over a month and ultimately confirmed gradual enchancment and was discharged residence,” based on the authors.

69-year-old male with problem strolling

A 69-year-old man with a historical past of tick bites was admitted to the emergency room with progressive weak point, complications and fevers.

“He was recognized with a urinary tract an infection and was handled with ciprofloxacin,” based on the authors.

Nevertheless, his signs worsened. He continued having fevers, weak point and problem strolling and reportedly had uncontrollable actions of his limbs.

An infectious work-up was damaging, which included testing for tick-borne ailments. However he was empirically handled with IV doxycycline and steadily improved, regaining his power.

Three weeks after he was admitted to the hospital, he examined constructive for Powassan virus.

“He continued to enhance neurologically,” the authors wrote. Nevertheless, 4 months after his hospitalization, “he continued to have quadriceps muscle weak point and requires use of arm to rise up from chair and with restriction of vary of movement of decrease limb at knee joint because of his weak point.”

Authors conclude:

“This examine serves to focus on the elevated detection of Powassan virus an infection within the central north United States.”

“There’s a want for clinician vigilance and public consideration because of its growing detection, westward development and diversified medical shows.”