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Volume 27, Number 8—August 2021
CME ACTIVITY - Synopsis

Four Human Cases of Eastern Equine Encephalitis in Connecticut, USA, during a Larger Regional Outbreak, 2019

Stacy C. Brown12, Justine Cormier1, Jessica Tuan, Audun J. Lier, Declan McGuone, Philip M. Armstrong, Firas Kaddouh3, Sunil Parikh, Marie Louise Landry, and Kevin T. GobeskeComments to Author 
Author affiliations: Yale University, New Haven, Connecticut, USA (S.C. Brown, J. Cormier, J. Tuan, A.J. Lier, D. McGuone, F. Kaddouh, S. Parikh, M.L. Landry, K.T. Gobeske); Connecticut Agricultural Experiment Station, New Haven (P.M. Armstrong)

Main Article

Figure 2

Mechanisms of injury in 4 human cases of Eastern equine encephalitis, Connecticut, USA, 2019. A) Magnetic resonance imaging (MRI) representative axial section from day 2 of a patient’s illness shows early development of edema around the thalamus, basal ganglia, and limbic cortical (arrows) and subcortical (arrowheads) regions. B) Representative MRI axial section from day 4 of a patient’s illness shows progression of injury in these regions and the diencephalon, basal forebrain, and subcortical areas (arrowheads). C) MRI axial section after 1 week of a patient’s illness shows expanding patchy and confluent cortical edema (arrows) and diffuse swelling in basal regions (arrowheads). D) Hematoxylin and eosin (HE)–stained photomicrograph shows the gray-white matter interface with perivascular lymphocytic cuffing and hypoxic-ischemic change in adjacent cortex. Original magnification ×40. E) HE-stained photomicrograph shows a recent gray matter microinfarction, including ischemic neurons with red cell change (5-pointed star) and perineuronal vacuolation (4-pointed star). Original magnification ×200. F) HE-stained photomicrograph shows details of acute hypoxemic-ischemic change with perineuronal (4-pointed stars) and nonspecific vacuolation, red neurons (5-pointed star), rarefaction, and pyknotic cellular debris. Original magnification ×400.

Figure 2. Mechanisms of injury in 4 human cases of Eastern equine encephalitis, Connecticut, USA, 2019. A) Magnetic resonance imaging (MRI) representative axial section from day 2 of a patient’s illness shows early development of edema around the thalamus, basal ganglia, and limbic cortical (arrows) and subcortical (arrowheads) regions. B) Representative MRI axial section from day 4 of a patient’s illness shows progression of injury in these regions and the diencephalon, basal forebrain, and subcortical areas (arrowheads). C) MRI axial section after 1 week of a patient’s illness shows expanding patchy and confluent cortical edema (arrows) and diffuse swelling in basal regions (arrowheads). D) Hematoxylin and eosin (HE)–stained photomicrograph shows the gray-white matter interface with perivascular lymphocytic cuffing and hypoxic-ischemic change in adjacent cortex. Original magnification ×40. E) HE-stained photomicrograph shows a recent gray matter microinfarction, including ischemic neurons with red cell change (5-pointed star) and perineuronal vacuolation (4-pointed star). Original magnification ×200. F) HE-stained photomicrograph shows details of acute hypoxemic-ischemic change with perineuronal (4-pointed stars) and nonspecific vacuolation, red neurons (5-pointed star), rarefaction, and pyknotic cellular debris. Original magnification ×400.

Main Article

1These authors contributed equally to this article.

2Current affiliation: University of Hawai’i, Honolulu, Hawaii, USA.

3Current affiliation: University of Texas Health Science Center San Antonio, Texas, USA.

Page created: May 27, 2021
Page updated: July 21, 2021
Page reviewed: July 21, 2021
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