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Volume 23, Number 12—December 2017

Investigation of Acute Flaccid Paralysis Reported with La Crosse Virus Infection, Ohio, USA, 2008–2014

Morgan J. Hennessey, Daniel M. Pastula, Kimberly Machesky, Marc Fischer, Nicole P. Lindsey, Mary DiOrio, J. Erin StaplesComments to Author , and Sietske de Fijter
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M.J. Hennessey, D.M. Pastula); Centers for Disease Control and Prevention, Fort Collins, Colorado, USA (M.J. Hennessey, D.M. Pastula, M. Fischer, N.P. Lindsey, J.E. Staples); Ohio Department of Health, Columbus, Ohio, USA (K. Machesky, M. DiOrio, S. de Fijter)

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Table 2

Clinical characteristics and follow-up for 9 patients with La Crosse virus infection and reported acute flaccid paralysis, Ohio, USA, 2008–2014*

Case-patient no.
At time of acute illness

At time of follow-up investigation
Age, y/sex
Upper motor neuron†

Brain lesions‡
Upper motor neuron†
Rankin score§
1 12/F Yes Yes Yes No –¶ No 0
2 4/M Yes Yes Yes No
3 12/M Yes No Yes Yes No 0
4 12/M Yes No Yes No 6#
5 78/F Yes No Yes Yes 3
6 8/M No Yes Yes No 0
7 13/M No Yes Yes No 0
8 7/F No No Yes No No 1
9 12/F No No Yes Yes Yes 1

*EEG, electroencephalography; MRI, magnetic resonance imaging.
†Upper motor neuron signs included increased tone, increased reflexes, Babinski sign, or abnormally slow finger or foot taps, and patterns of weakness included hemiparesis or weakness preferentially involving the distal extensor muscles.
‡A brain lesion identified by MRI or EEG consistent with the patient’s pattern of weakness provided corroborating evidence of an upper motor neuron pathology.
§Modified Rankin score measures disability or dependence in daily activities for patients who have had a stroke or other neurologic disability. Scores range 0–6 as follows: 0, No symptoms; 1, No substantial disability and carries out all usual activities despite some symptoms; 2, Slight disability and able to look after own affairs without assistance but unable to carry out all previous activities; 3, Moderate disability requiring some help but able to walk unassisted; 4, Moderate disability requiring help with bodily needs and unable to walk unassisted; 5, Severe disability that requires constant nursing care; 6, Deceased.
¶Information was not available or not assessed.
#Patient had a primary immunodeficiency that required chronic steroid replacement. Several years after his acute La Crosse virus disease, the patient experienced acute gastroenteritis and subsequently died of an unknown etiology; no autopsy was performed.

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Page created: November 16, 2017
Page updated: November 16, 2017
Page reviewed: November 16, 2017
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.