Jamestown Canyon virus encephalitis in a heart transplant patient

Abstract

Jamestown Canyon virus (JtCV) is an arbovirus and a member of the California serogroup. To our knowledge, all the cases of JtCV have been reported in immunocompetent patients since it was first detected in 1997. We report a case of JtCV encephalitis in a solid organ transplant patient. A 48‐year‐old woman from Wisconsin had multiple hospital admissions for symptoms of progressive confusion, visual hallucinations, and inability to perform self‐care. Initial evaluation was significant for lymphocytes in cerebrospinal fluid (CSF), and multiple infectious and metabolic causes were excluded. Further investigation found JtCV IgM in serum, and CSF. The patient's clinical course was compatible with JtCV encephalitis, and she was treated with ribavirin in addition to reduction of her immunosuppressive medications. She showed gradual and significant improvement in her mental and functional status. JtCV can cause a variety of symptoms that range from a flu‐like syndrome to encephalitis. There have been an increased number of reported cases in recent years which is attributed to increased physician awareness and the availability of laboratory testing. Optimal treatment is still not known.

Jamestown Canyon Virus (JCV) Encephalitis Mimicking Acute Stroke in Michigan: A Case Report and Review of the Literature

“…2 It is a vector born disease, and mosquitos, like Aedes, Culex, and Coquillettidia, serve as its primary vectors. 3 In the 1960s, JCV related human infections were first described in forest workers in Wisconsin as a nonspecific minor illness. 2 The CDC reports 181 cases between 2009-2018; mainly in Wisconsin and Minnesota.…”

“…1 Historically, JCV cases have male predominance and most patients were immunocompetent. 3 Typical presentation includes headache, altered mental status, fever and occasional seizures. 7 Sweats and chills are less commonly reported.…”

“…7 An immunocompromised transplant patient diagnosed with JCV encephalitis, was placed on Ribavirin for 6 weeks resulting in significant improvement in memory and cognition. 3 Following general mosquito-based prevention can decrease the incidence of this disease. 4…”

Encephalitis Caused by Jamestown Canyon Virus in a Liver Transplant Patient, North Carolina, USA, 2017

“…Although IVIG has been used to treat other viral encephalitides, such as West Nile virus, to our knowledge, this is the first report of its use and association with a clinical response for JCV [ 19 ]. There is 1 case report of JCV encephalitis in a solid organ transplant recipient who was treated with ribavirin and had a similarly prolonged course but also ultimately achieved complete recovery [ 20 ].…”