St. Louis Encephalitis in Argentina: the First Case Reported in the Last Seventeen Years.

SPINSANTI LORENA; BASQUIERA ANA; BULACIO SEBASTIÁN,; KIM STEPHANO; SOMALE VERÓNICA; RÉ VIVIANA; RABBAT DAMIÁN; ZÁRATE ABEL; PALACIO SANTIAGO; ZLOCOWSKI JUAN; QUIROGA MAYOR CARLOS; CONTIGIANI MARTA.

EMERGING INFECTIOUS DISEASES

Dr. Peter Drotman, MD, MPH

Lugar: Giorgia; Año: 2003 vol. 9 p. 271 - 273

1080-6040

Herein, we report a case of SLE that occurred in the province of Cordoba, Argentina. A 61 year-old male was admitted to the hospital in February of 2002, complaining of headache, fever and diplopia. The patient was a right handed businessman, native from Cordoba, Argentina. He was married and had no risk factors for sexually transmitted diseases. He had not traveled inside or outside the country during the last year. He lived near a river with a high density population of mosquitoes. Routine laboratory analysis were unremarkable and serology for coxsackie virus, echovirus and HIV were all negative.  HIV-1 RNA by polymerase chain reaction (PCR), and p24 antigen were also negative. Cerebral spinal fluid (CSF) study revealed: WBC count of 18/mm3 (80% lymphocytes), a glucose level of 48 mg/dL, and a protein level of 87 mg/dL. Cryptococcal antigen, antibodies for syphilis, HSV-1, and HSV-2, and PCR for VZV and HSV, all negative. An electroencephalogram and a chest radiography were normal. Therapy with intravenous acyclovir was initiated. A magnetic resonance imaging (MRI) scan of the brain evidenced a striking signal change on T2 in the substantia nigra of the midbrain, mainly at the right side. SLE virus immunoglobulin (Ig) M antibodies by indirect immunoflourescence assay (IFA) were positive. Seroconversion for IgG antibodies was demonstrated by IFA, and HAI. These results were confirmed by neutralization test using the reduction of plates technique in Vero cells culture. While the typical clinical manifestations of viral encephalitis (fever, headache and altered level of consciousness) are indistinguishable one from the other, tremor and other extrapyramidal signs are described in SLE and Japanese encephalitis. Interestingly, the typical MRI finding of patients with SLE is localized in the substantia nigra.