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Saint Louis Encephalitis Virus, Brazil LETTERS the present study, PARV4 and PARV5 4. Baylis SA, Shah N, Minor PD. Evaluation Amazon Basin. Subsequently, the have been identified in blood samples of different assays for the detection of virus was repeatedly isolated from ani- parvovirus B19 DNA in human plasma. J obtained from persons from the United Virol Methods. 2004;121:7–16. mals and arthropods in the Amazon Kingdom. For parvovirus B19, there is 5. Fryer JF, Kapoor A, Minor PD, Delwart region and São Paulo state (3). evidence of persistent virus infection, E, Baylis SA. Novel parvovirus and relat- Nonetheless, isolation of SLEV from at low levels, in bone marrow of previ- ed variant in human plasma. Emerg Infect humans is rare; only 2 isolates from Dis. 2006;12:151–4. ously exposed persons (7) and in plas- 6. Padley DJ, Lucas SB, Saldanha J. humans were described before 2005. ma of immunocompromised and Elimination of false-negative hepatitis C Each isolate was from a patient who immunocompetent persons (8,9). virus RNA results by removal of had jaundice and febrile illness with- There is also evidence for the lifelong inhibitors in cadaver-organ donor blood out any neurologic symptoms (1,3). specimens. Transplantation. persistence of parvovirus B19 (geno- 2003;76:432–4. Recently in São Paulo, SLEV was iso- types 1 and 2) in tissues such as skin 7. Heegaard ED, Petersen BL, Heilman CL, lated from a patient who had an incor- and synovia (10). PARV4 and PARV5 Hornsleth A. Prevalence of parvovirus rect diagnosis of dengue fever (2,4). virus genomes share only limited B19 and parvovirus V9 DNA and antibod- Despite the rare isolation of ies in paired bone marrow and serum sam- homology with parvovirus B19 (<30% ples from healthy individuals. J Clin SLEV from humans, antibodies to this amino acid similarity). Although they Microbiol. 2002;40:933–6. virus have been found in ≈5% of stud- have been detected in blood and plas- 8. Flunker G, Peters A, Wiersbitzky S, ied populations in the north and ma, nothing is known about the role of Modrow S, Seidel W. Persistent par- southeast regions of Brazil. However, vovirus B19 infections in immunocom- these viruses in human disease or their promised children. Med Microbiol because of antibody cross-reactivity ability to persist in infected persons, Immunol (Berl). 1998;186:189–94. among different flaviviruses and the healthy or otherwise. Further studies 9. Lefrere JJ, Servant-Delmas A, Candotti fact that this population is vaccinated will be required to determine the D, Mariotti M, Thomas I, Brossard Y, et against yellow fever and exposed to al. Persistent B19 infection in immuno- prevalence of PARV4 and PARV5 in competent individuals: implications for dengue virus (DENV), such results healthy persons compared with its transfusion safety. Blood. should be interpreted carefully. prevalence in those with chronic infec- 2005;106:2890–5. Nevertheless, in these areas, SLEV tions and at high risk, such as IVDUs, 10. Norja P, Hokynar K, Aaltonen LM, Chen may circulate and infect humans, R, Ranki A, Partio EK, et al. Bioportfolio: and to investigate the nature of persist- lifelong persistence of variant and proto- although most infections are undiag- ence of these novel viruses. typic erythrovirus DNA genomes in nosed (1,3,5). human tissue. Proc Natl Acad Sci U S A. In contrast to previous instances Jacqueline F. Fryer,* 2006;103:7450–3. in which the disease was detected in Sebastian B. Lucas,† only 1 patient, we describe the first Address for correspondence: Sally A. Baylis, David Padley,* community outbreak of SLEV in Division of Virology, National Institute for and Sally A. Baylis* Brazil. The outbreak was detected in Biological Standards and Control, Blanche *National Institute for Biological Standards São José do Rio Preto (population Lane, South Mimms, Potters Bar, and Control, Potters Bar, United Kingdom; 400,000), in northwest São Paulo and †Saint Thomas’ Hospital, London, Hertfordshire, EN6 3QG, United Kingdom; state. This outbreak was concurrent United Kingdom email: [email protected] with a large outbreak of DENV References serotype 3 (DENV-3), which occurred during the first half of 2006, with 1. Tattersall P. The evolution of parvovirus >15,000 possible cases reported to taxomomy. In: Kerr JR, Cotmore SF, Bloom ME, Linden RM, Parrish CR, edi- public health authorities. During this tors. Parvoviruses. London: Hodder time, we were involved in an epidemi- Arnold; 2006. p. 5–14. ologic study to monitor the disease. 2. Jones MS, Kapoor A, Lukashov VV, Saint Louis We tested ≈250 samples for DENV, Simmonds P, Hecht F, Delwart E. New and 65% were positive. We tested for DNA viruses identified in patients with Encephalitis Virus, acute viral infection syndrome. J Virol. SLEV only those patients who were in 2005;79:8230–6. Brazil our hospital or those who were 3. Allander T, Tammi MT, Eriksson M, To the Editor: Saint Louis referred to us for SLEV testing after Bjerkner A, Tiveljung-Lindell A, Andersson B. Cloning of a human par- encephalitis virus (SLEV), a member an initial diagnosis of SLEV or vovirus by molecular screening of respi- of the Flaviviridae family, is widely DENV. The protocol approved by our ratory tract samples. Proc Natl Acad Sci U dispersed in the Americas (1,2). In ethical committee allowed us to test S A. 2005;102:12891–6. Brazil, SLEV was first isolated in the only samples from these patients 1960s from a pool of mosquitoes at the (process no. 300/2004). 176 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 13, No. 1, January 2007 LETTERS We used a multiplex nested lence of antibodies in the Brazilian In Argentina, SLEV has been iso- reverse transcription–PCR (RT-PCR) population (1,3,6) suggests that SLEV lated several times from animals (8). assay to identify the most common infections are being misdiagnosed; its In some regions, SLEV seropreva- flaviviruses in Brazil (DENV-1, importance is underestimated. Brazil lence in humans is ≈13% (9), but the DENV-2, DENV-3, yellow fever has no SLEV surveillance programs, number of documented human infec- virus) as well as DENV-4, Ilheus and health professionals do not usual- tions is small (10). These findings virus, Iguape virus, Rocio virus, and ly consider SLEV among their differ- indicate either that SLEV is more SLEV. Of 54 samples (49 serum and 5 ential diagnoses. This SLEV outbreak prevalent than reported or that SLEV cerebrospinal fluid [CSF]) that were was detected in a large urban center is reemerging. The Brazilian cases negative for DENV and yellow fever and was not specifically linked to may parallel the situation in virus, SLEV RNA was detected in 6 patients who dwell in pockets of trop- Argentina. (4 serum and 2 CSF) (6). RT-PCR ical forests, as previously reported Our results clearly indicate an results were negative for all other test- (1–4). SLEV outbreak among this local pop- ed flaviviruses. Sequences of the This outbreak may represent the ulation in Brazil. This outbreak differs amplified SLEV cDNAs from the 2 first time that hemorrhagic signs have from isolated infections previously CSF samples were determined by been linked to SLEV infections. described and indicates that this dis- using an ABI377 automated SLEV-associated hemorrhagic mani- ease may be more prevalent in Brazil. sequencer (Applied Biosystems, festations have not been reported in In fact, the number of samples tested Foster City, CA, USA). The resulting the literature. However, of our 6 for SLEV during this DENV outbreak sequences (GenBank accession nos. SLEV-infected patients, 3 had hemor- was relatively small. Had more sam- DQ836336 and DQ836337) were rhagic signs. Substantiating a causal ples been investigated, more cases of identical and showed 96% homology link between SLEV infection and SLEV infection might have been to an Argentinean SLEV isolate such clinical manifestations is diffi- found. A more comprehensive epi- (AY6-32544). All 6 SLEV-infected cult because DENV is endemic in the demiologic study is required to fully patients had an initial diagnosis of studied region (7). Possibly, SLEV- assess the magnitude of SLEV infec- dengue fever or viral encephalitis; 3 infected patients with hemorrhagic tion in Brazil. had a diagnosis of viral meningoen- signs may have been previously cephalitis, and the other 3 had signs of infected by DENV. No reports have This work was supported by grants hemorrhagic disease (Table). linked hemorrhagic manifestations to from Conselho Nacional de Desen- Dengue is widely disseminated in sequential DENV and SLEV infec- volvimento Científico e Tecnológico Brazil and causes large outbreaks tions; this possible link needs to be (0401396/2004-5) to M.L.N. and Fundação almost every year. The high preva- carefully evaluated. Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 13, No. 1, January 2007 177 LETTERS de Amparo à Pesquisa do Estado de São 4. Santos CL, Sallum MA, Franco HM, Cryptococcus gattii Paulo (FAPESP) (04/11098-2, 06/0170-9, Oshiro FM, Rocco IM. Genetic character- ization of St. Louis encephalitis virus iso- Risk for Tourists and 03/03682-3) to M.L.N., F.C.N., and lated from human in São Paulo, Brazil. L.T.M.F., respectively. R.V.M.B. and Mem Inst Oswaldo Cruz. Visiting Vancouver I.L.S.C. received fellowships from FAPE- 2006;101:57–63. Island, Canada SP (grants 05/03260-7 and 06/00179-7). 5. de Sousa Lopes O, de Abreu Sacchetta L, Coimbra TL, Pereira LE. Isolation of St. This work was supported by the Viral Louis encephalitis virus in South Brazil. To the Editor: An unprecedented Diversity Genetic Network (VGDN- Am J Trop Med Hyg. 1979;28:583–5.
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