Diagnosis of acute deer tick virus encephalitis

Deer tick virus (DTV) is a tick-borne flavivirus that has only recently been appreciated as a cause of viral encephalitis. We describe the clinical presentation of a patient who had DTV encephalitis diagnosed before death and survived for 8 months despite severe neurologic dysfunction. Diagnosis was...

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Bibliographic Details
Published in:Clinical infectious diseases 2013-02, Vol.56 (4), p.e40-e47
Main Authors: El Khoury, Marc Y, Hull, Rene C, Bryant, Patrick W, Escuyer, Kay L, St George, Kirsten, Wong, Susan J, Nagaraja, Aarathi, Kramer, Laura, Dupuis, Alan P, Purohit, Treta, Shah, Tushar, Wormser, Gary P
Format: Article
Language:English
Subjects:
Aged
Animals
Anti-Bacterial Agents - therapeutic use
Borrelia
Cephalosporins - therapeutic use
Diagnosis, Differential
Encephalitis
Encephalitis Viruses, Tick-Borne - isolation & purification
Encephalitis, Tick-Borne - cerebrospinal fluid
Encephalitis, Tick-Borne - drug therapy
Fatal Outcome
Flavivirus
Humans
Ixodes
Ixodes scapularis
Ixodidae
Lyme disease
Magnetic Resonance Imaging
Male
Medical diagnosis
Neurological disorders
New York
Parasitic diseases
Phylogeny
Polymerase Chain Reaction
Reverse Transcriptase Polymerase Chain Reaction
Viruses
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Description
Summary:Deer tick virus (DTV) is a tick-borne flavivirus that has only recently been appreciated as a cause of viral encephalitis. We describe the clinical presentation of a patient who had DTV encephalitis diagnosed before death and survived for 8 months despite severe neurologic dysfunction. Diagnosis was made from a cerebrospinal fluid specimen, using a flavivirus-specific polymerase chain-reaction assay followed by sequence confirmation, and the phylogeny was analyzed. Serologic testing, including plaque reduction neutralization testing, was also performed. Molecular analysis indicated that the virus was closely related to 2 strains of DTV that had been detected in Ixodes scapularis ticks from Massachusetts in 1996 and in the brain of a patient from New York in 2007. DTV encephalitis should be considered in the differential diagnosis of encephalitis in geographic areas that are endemic for Lyme disease.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/cis938