- THE WESTERN Journal of Medicine Refer to: Kaplan AM, Longhurst WL, Randall DL: St. Louis

encephalitis in children. West J Med 128:279-281, Apr 1978

St.

Louis Encephalitis in Children

ALLEN M. KAPLAN, MD; WILLIAM L. LONGHURST, MD, and DONALD L. RANDALL, MD, Phoenix, Arizona

St. Louis encephalitis is not an uncommon cause of seasonal meningoencephalitis in children. The clinical presentation is variable and may range from inapparent infection to a severe illness with diverse neurologic signs. A review of three recent cases of St. Louis encephalitis in children in Phoenix, Arizona, stresses the need to consider this type of encephalitis in patients with signs of brain stem dysfunction or acute cerebellar ataxia. The appearance of these clinical signs is supported by the pathologic changes that have been documented to occur, most frequently in the thalamus and brain stem. The importance of serologic identification to facilitate early vector control is emphasized.

ST. LouIS ENCEPHALITIS (SLE) is one of several Group B arbor viruses causing seasonal meningoencephalitis in humans. Although children are less frequently affected than adults, several cases of SLE have occurred in the pediatric age group over the past several summers in the Phoenix area. The clinical presentation of SLE in children is quite variable, but usually conforms to the established clinical classification, which includes (1) encephalitis, (2) aseptic meningitis, (3) febrile illness with headache and (4) nonspecific illness types.' The majority of infections due to SLE, however, are subclinical or inapparent and have been estimated to occur in a 64 to 1 ratio of subclinical to clinical cases.2 The purpose of this report is to review the Phoenix cases of SLE From the Department of Pediatric Neurology, Good Samaritan Hospital, Phoenix, and the Department of Pediatrics, Phoenix Indian Medical Center, Phoenix. Submitted October 3, 1977. Reprint requests to: Allen M. Kaplan, MD, Good Samaritan Hospital, 1033 East McDowell Road, Phoenix, AZ 85006.

in children and emphasize the need to consider SLE in patients with signs of brain stem or acute

cerebellar dysfunction.

Reports of Cases CASE 1. A 4-year-old American Indian child was admitted to the Phoenix Indian Medical Center in the late summer with a five-day history of fever and progressive lethargy. On physical examination at admission the child was febrile and somnolent, with no apparent neurologic localizing signs. A leukocyte count was 20,600 with 81 percent polymorphonuclear leukocytes (PMN), 8 percent bands and 10 percent lymphocytes. A lumbar puncture showed clear cerebrospinal fluid (CSF) with 86 leukocytes per cu mm with 90 percent lymphocytes. The CSF glucose was 59 mg per dl, and the total protein was 42 mg per dl. Viral cultures of the throat, stool and CSF were negative. Acute and convalescent sera for SLE titers THE WESTERN JOURNAL OF MEDICINE

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ST. LOUIS ENCEPHALITIS TABLE 1.-St. Louis Encephalitis Antibody Titers Case

1. 2. 3.

Acute Sera

St. Louis encephalitis in children.

- THE WESTERN Journal of Medicine Refer to: Kaplan AM, Longhurst WL, Randall DL: St. Louis encephalitis in children. West J Med 128:279-281, Apr 1978...
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