Jamestown Canyon encephalitis with NORSE and electrographic response to ribavirin: a case report

Abstract

SummaryNew‐onset refractory status epilepticus (NORSE) is a rare condition where refractory seizures occur with no obvious cause in an otherwise healthy individual. We report here the first case of a patient with NORSE caused by Jamestown Canyon virus, an emerging virus throughout North America. This is the first patient with Jamestown Canyon virus encephalitis treated by a specific antiviral agent, in this case intravenous ribavirin, with electroencephalography (EEG) evidence of improvement. This is finally the first reported death caused by this virus, here secondary to intensive care unit complications. Therefore, Jamestown Canyon virus should be considered as a NORSE etiology, and ribavirin may be an effective treatment of that condition, especially if used early.

Jamestown Canyon virus encephalitis in a heart transplant patient

“…Data supporting the use of ribavirin in the treatment of JtCV neuroinvasive disease are lacking. One report indicated that ribavirin was followed by improvement of the EEG findings as well as symptomatic improvement . Our patient demonstrated gradual recovery with no permanent neurological damage.…”

“…One report indicated that ribavirin was followed by improvement of the EEG findings as well as symptomatic improvement. 3 Our patient demonstrated gradual recovery with no permanent neurological damage.…”

“…JtCV is an underrecognized mosquito‐borne orthobunyavirus classified within the California serogroup. JtCV is transmitted by mosquito species, such as Aedes, Culex, and Coquillettidia, and is endemic in North America . JtCV infection is a nationally notifiable condition that can cause a variety of symptoms including febrile illness, meningitis, encephalitis, and acute flaccid paralysis.…”

“…Since JtCV was first detected in a patient with encephalitis in 1997, all cases of the neuroinvasive disease have been reported in immunocompetent patients. JtCV manifestation ranges from asymptomatic to a flu‐like syndrome, meningitis, and encephalitis . Patients with solid organ transplantation are predisposed to infections due to immunosuppressive agents, which may also alter the natural history of viral infections .…”

Jamestown Canyon virus in Massachusetts: clinical case series and vector screening

“…JCV infection likely remains under-recognized, with studies demonstrating seroprevalence in the range of 15-30% [10,11], and up to 54% (among 121 Alaskan reindeer herders) [12]. Mortality is rare [13] and may be related to sequelae from extended hospitalization [14], however, patients often have prolonged morbidity [3,15]. To characterize the clinical manifestations and outcome of JCV infection among patients diagnosed after the introduction of routine testing in Massachusetts, where the first case was reported in 2013, we abstracted data from nine patients between 2013 and 2017.…”