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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

Table

Clinical and laboratory findings of 4 patients hospitalized with Eastern equine encephalitis, Connecticut, 2019*

Characteristics and diagnostic testing Case 1
 Case 2
 Case 3
 Case 4
Age, y/sex 77/F 73/M 64/M 42/M
Date of illness onset Aug 28 Sep 11 Sep 12 Aug 21
Signs and symptoms Fever, confusion, headache, shock, coma, seizures, flaccid paralysis Stupor, left-sided weakness Fever, right arm clumsiness; rapid progression to coma Neck pain, fever, dysarthria, confusion, seizures
Day of brain MRI; result
 Day 4; diffuse T2 hyperintensity cerebrum, cerebellum, brainstem
 Day 4; hyperintensity bilateral basal ganglia, right occipital regions
 Day 5; left thalamic enhancement, T2 hyperintensity temporal lobe
 Day 3; leptomeningeal enhancement right frontal and parietal lobes, T1 hyperintense signal globi pallidi
Days postadmission
Laboratory findings 3
 7
 13
 2
 4
 9
 2†
 4
 2
 9
 21
CSF values
Protein, mg/dL 90 238 94 112 119 174 108 146 236 288 ND
Glucose, mg/dL 57 74 53 62 64 81 65 78 225 79 ND
Leukocytes/mm3 60‡ 13 9 428 62 40 1,162 33 343 142 13
Neutrophils, % 22 2 0 86 9 0 76 8 80 0 2
Lymphocytes, % 38 73 100 9 78 85 11 87 14 89 79
Immunoassay, CSF
Reference lab§
IgM IFA – ND ND ND – ND ND – ND – ND
IgG IFA – ND ND ND – ND ND – ND – ND
CDC
IgM MIA + ND ND ND + ND ND + ND + +
PRNT¶ 1:4 ND ND ND 1:32 ND ND 1:16 ND ND 1:4,096#
Immunoassay, serum
Reference lab** Day 7
IgM IFA – ND ND ND ND ND ND – ND ND ND
IgG IFA – ND ND ND ND ND ND +; 1:16
 ND ND ND
CDC Day 6
IgM MIA ND ND ND ND ND ND ND + ND ND ND
PRNT#
 ND
 ND
 ND
 ND
 ND
 ND
 ND
 ND
 ND
 ND
 ND
Outcome Death on day 22
 Death on day 10
 Death on day 8
 Severe sequelae

*CDC, Centers for Disease Control and Prevention; CSF, cerebrospinal fluid; IFA, indirect immunofluorescence assay; lab, laboratory; MIA, microparticle immunoassay; ND, not done; PRNT, plaque reduction neutralization test; –, negative; +, positive. †CSF from outside hospital laboratory before transfer. ‡CSF with 40% mononuclear cells. §CSF IFA >1:4 is positive. ¶CSF PRNT >1:2 is positive. #CSF contaminated with blood. **Serum IFA >1:16 positive.

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
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.
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