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. 2023 Feb 8;76(3):e1114-e1122.
doi: 10.1093/cid/ciac403.

La Crosse Virus Neuroinvasive Disease in Children: A Contemporary Analysis of Clinical/Neurobehavioral Outcomes and Predictors of Disease Severity

Angelique E Boutzoukas  1   2 , Daniel A Freedman  3 , Christine Koterba  4   5 , Garrett W Hunt  4   6 , Kathy Mack  4   7 , Jennifer Cass  4   5 , Vedat O Yildiz  8 , Emily de Los Reyes  4   9 , Jaime Twanow  4   9 , Melissa G Chung  4   9   10 , Christopher P Ouellette  4   6   11
Affiliations

La Crosse Virus Neuroinvasive Disease in Children: A Contemporary Analysis of Clinical/Neurobehavioral Outcomes and Predictors of Disease Severity

Angelique E Boutzoukas et al. Clin Infect Dis. .

Abstract

Background: La Crosse virus (LACV) is the most common neuroinvasive arboviral infection in children in the United States. However, data regarding predictors of disease severity and neurologic outcome are limited. Additionally, long-term neurologic and neurobehavioral outcomes remain relatively sparse.

Methods: This was a single-center, retrospective cohort study, followed by recruitment for a cross-sectional analysis of long-term neurobehavioral outcomes, among children aged 0-18 years with proven or probable LACV neuroinvasive disease (LACV-ND) between January 2009 and December 2018. Case ascertainment was assured by International Classification of Diseases, Ninth and Tenth Revision, Clinical Modification codes cross-referenced with laboratory results detecting LACV. Demographics, diagnostics, radiographs, and outcomes were evaluated. Recruitment of patients with prior diagnosis of LACV-ND occurred from January 2020 to March 2020, with assessment performed by validated pediatric questionnaires.

Results: One-hundred fifty-two children (83 males; median age, 8 years [interquartile range, 5-11.5 years]) were diagnosed with proven (n = 61 [47%]) and probable (n = 91 [60%]) LACV-ND. Sixty-five patients (43%) had severe disease. Altered mental status (AMS) (odds ratio [OR], 6.36 [95% confidence interval {CI}, 2.03-19.95]; P = .0002) and seizures at presentation (OR, 10.31 [95% CI, 3.45-30.86]; P = .0001) were independent predictors of severe disease. Epileptiform discharges on electroencephalogram (EEG) were independently associated with epilepsy diagnosis at follow-up (OR, 13.45 [95% CI, 1.4-128.77]; P = .024). Fifty-four patients were recruited for long-term neurobehavioral follow-up, with frequent abnormal assessments identified (19%-54%) irrespective of disease severity.

Conclusions: Severe disease was observed frequently among children with LACV-ND. Seizures and AMS at presentation were independent predictors of severe disease. EEG may help determine long-term epilepsy risk. Long-term neurobehavioral issues are frequent and likely underrecognized among children with LACV-ND.

Keywords: La Crosse virus; encephalitis; pediatric.

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Conflict of interest statement

Potential conflicts of interest . The authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.

Figures

Figure 1.
Figure 1.
Epidemiology of children hospitalized with La Crosse virus (LACV) neuroinvasive disease from 2009 to 2018 at a single institution. Figure shows number of cases by year (A) and by month (B).
See this image and copyright information in PMC

References

    1. Thompsom WH, Kalfayan B, Anslow RO. Isolation of California encephalitis group virus from a fatal human illness. Am J Epidemiol 1965; 81:245–53. - PubMed
    1. Gaensbauer JT, Lindsey NP, Messacar K, Staples JE, Fischer M. Neuroinvasive arboviral disease in the United States: 2003 to 2012. Pediatrics 2014; 134:e642–50. - PMC - PubMed
    1. McDonald E, Martin SW, Landry K, et al. . West Nile virus and other domestic nationally notifiable arboviral diseases—United States, 2018. MMWR Morb Mortal Wkly Rep 2019; 68:673–8. - PMC - PubMed
    1. Goldstein SL, Graham N, Warady BA, et al. . Measuring health-related quality of life in children with ESRD: performance of the generic and ESRD-specific instrument of the Pediatric Quality of Life Inventory (PedsQL). Am J Kidney Dis 2008; 51:285–97. - PubMed
    1. McJunkin JE, de los Reyes EC, Irazuzta JE, et al. . La Crosse encephalitis in children. N Engl J Med 2001; 344:801–7. - PubMed

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