Saint Louis encephalitis

Saint Louis Encephalitis virus
Virus classification
Group: Group IV ((+)ssRNA)
Family: Flaviviridae
Genus: Flavivirus
Species: Saint Louis encephalitis virus
Saint Louis encephalitis
Classification and external resources
Specialty infectious disease
ICD-10 A83.3
ICD-9-CM 062.3
DiseasesDB 29860
MeSH D004674

Saint Louis encephalitis is a disease caused by the Mansonia pseudotitillans mosquito borne Saint Louis encephalitis virus. Saint Louis encephalitis virus is related to Japanese encephalitis virus and is a member of the Flaviviridae subgroup. This disease mainly affects the United States. Occasional cases have been reported from Canada and Mexico.

History

The name of the virus goes back to 1933 when within five weeks in autumn an encephalitis epidemic of explosive proportions broke out in the vicinity of St. Louis, Missouri, and the neighboring St. Louis County.[1][2] Over 1,000 cases were reported to the local health departments and the newly constituted National Institute of Health of the United States was appealed to for epidemiological and investigative expertise.[3] The previously unknown virus that caused the epidemic was isolated by the NIH team first in monkeys and then in white mice.[4]

Life cycle

Mosquitoes, from the genus Culex, become infected by feeding on birds infected with the Saint Louis encephalitis virus. Infected mosquitoes then transmit the Saint Louis encephalitis virus to humans and animals during the feeding process. The Saint Louis encephalitis virus grows both in the infected mosquito and the infected bird, but does not make either one sick. Only infected mosquitoes can transmit Saint Louis encephalitis virus. Once a human has been infected with the virus it is not transmissible from that individual to other humans.

Presentation

The majority of infections result in mild illness, including fever and headache. When infection is more severe the person may experience headache, high fever, neck stiffness, stupor, disorientation, coma, tremors, occasional convulsions and spastic paralysis. Fatality ranges from 3–30%. Aged people are more likely to have a fatal infection.

Epidemiology

Human incidence of Saint Louis encephalitis in the United States, 1964-1998.

In the United States an average of 128 cases of Saint Louis encephalitis are recorded annually. In temperate areas of the United States, Saint Louis encephalitis cases occur primarily in the late summer or early fall. In the southern United States where the climate is milder Saint Louis encephalitis can occur year round.

Treatment

There are no vaccines or any other treatments specifically for Saint Louis encephalitis virus, although one study showed that early use of interferon-alpha2b may decrease the severity of complications.[5]

Genetics

Five evolutionary genetic studies of SLE virus have been published of which four[6][7][8][9] focused on phylogeny, genetic variation, and recombination dynamics by sequencing the envelope protein gene and parts of other genes.

A recent evolutionary study[10] based on 23 new full open reading frame sequences (near-complete genomes) found that the North American strains belonged to a single clade. Strains were isolated at different points in time (from 1933 to 2001) which allowed for the estimation of divergence times of SLE virus clades and the overall evolutionary rate. Furthermore, this study found an increase in the effective population size of the SLE virus around the end of the 19th century that corresponds to the split of the latest North American clade, suggesting a northwards colonization of SLE virus in the Americas. Scans for natural selection showed that most codons of the SLE virus ORF were evolving neutrally or under negative selection. Positive selection was statistically detected only at one single codon coding for amino acids belonging to the hypothesized N-linked glycosylation site of the envelope protein. Nevertheless, the latter can be due to selection in vitro (laboratory) rather than in vivo (host). In an independent study[9] 14 out of 106 examined envelope gene sequences were found not to contain a specific codon at position 156 coding for this glycosylation site (Ser→Phe/Tyr).

Another study estimated the evolutionary rate to be 4.1 × 10−4 substitutions/site/year (95% confidence internal 2.5-5.7 × 10−4 substitutions/site/year).[11] The virus seems to have evolved in northern Mexico and then spread northwards with migrating birds.

References

  1. ↑ "ENCEPHALITIS IN ST. LOUIS". American Journal of Public Health and the Nation's Health. 23 (10): 1058–60. October 1933. PMC 1558319Freely accessible. PMID 18013846.
  2. ↑ Washington Post Magazine, October 8, 1933
  3. ↑ Bredeck JF (November 1933). "The Story of the Epidemic of Encephalitis in St. Louis". American Journal of Public Health and the Nation's Health. 23 (11): 1135–40. PMC 1558406Freely accessible. PMID 18013860.
  4. ↑ Edward A. Beeman: Charles Armstrong, M.D.: A Biography; 2007; p. 305; also online here (PDF).
  5. ↑ Rahal JJ, Anderson J, Rosenberg C, Reagan T, Thompson LL. Effect of interferon-alpha2b therapy on St. Louis viral meningoencephalitis: clinical and laboratory results of a pilot study. J Infect Dis. 2004;15;190(6):1084-7.
  6. ↑ Kramer LD, Presser SB, Hardy JL, Jackson AO. (1997) Genotypic and phenotypic variation of selected Saint Louis encephalitis viral strains isolated in California. American Journal of Tropical Medicine and Hygiene 57(2):222–229. Abstract
  7. ↑ Kramer LD, Chandler LJ. (2001) Phylogenetic analysis of the envelope gene of St. Louis encephalitis virus. Archives of Virology 146(12):2341–2355. doi:10.1007/s007050170007.
  8. ↑ Twiddy SS, Holmes EC. (2003) The extent of homologous recombination in members of the genus Flavivirus. Journal of General Virology 84:429-440. doi:10.1099/vir.0.18660-0.
  9. 1 2 May FJ, Li L, Zhang S, Guzman H, Beasley DW, Tesh RB, Higgs S, Raj P, Bueno R Jr, Randle Y, Chandler L, Barrett AD. (2008) Genetic variation of St. Louis encephalitis virus. Journal of General Virology 89(8):1901-1910. doi:10.1099/vir.0.2008/000190-0.
  10. ↑ Baillie GJ, Kolokotronis SO, Waltari E, Maffei JG, Kramer LD, Perkins SL. (2008) Phylogenetic and evolutionary analyses of St. Louis encephalitis virus genomes. Molecular Phylogenetics and Evolution 47(2):717-728. doi:10.1016/j.ympev.2008.02.015.
  11. ↑ Auguste AJ, Pybus OG, Carrington CV (2009). Evolution and dispersal of St. Louis encephalitis virus in the Americas. Infect Genet Evol 9(4):709-715.
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