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Infection with Saint Louis Encephalitis Virus in the City of Ribeirao Preto, Brazil

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Infection with Saint Louis Encephalitis Virus in the City of Ribeirao Preto, Brazil International Journal of Infectious Diseases 26 (2014) e96–e97 Contents lists available at ScienceDirect International Journal of Infectious Diseases jou rnal homepage: www.elsevier.com/locate/ijid Case Report Infection with Saint Louis encephalitis virus in the city of Ribeirao Preto, Brazil: report of one case Felipe Gonc¸alves Motta Maia, Juliana Helena Cha´vez, William Marciel de Souza, Marilia Farignoli Romeiro, Luiza Antunes de Castro-Jorge, Benedito Antoˆnio Lopes da Fonseca, Luiz Tadeu Moraes Figueiredo * Virology Research Center, School of Medicine of Ribeirao Preto, University of Sao Paulo, Av. Bandeirantes, 3900, 14049-900, Ribeirao Preto, Sa˜o Paulo, Brazil A R T I C L E I N F O S U M M A R Y Article history: Saint Louis encephalitis virus (SLEV) is a mosquito-borne flavivirus from the Americas. In this report we Received 18 March 2014 describe aspects of the laboratory diagnosis of a patient with an acute febrile illness induced by SLEV that Received in revised form 19 May 2014 was initially diagnosed as dengue by positive IgM-ELISA. Infection with this virus is probably not rare in Accepted 20 May 2014 Brazil, but cases remain undiagnosed. It is necessary to improve the surveillance system, including Corresponding Editor: Eskild Petersen, laboratories, for the diagnosis of SLEV in Brazil. Aarhus, Denmark ß 2014 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by- Keywords: nc-nd/3.0/). Saint Louis encephalitis virus Arbovirus Flavivirus Brazil 10,11 1. Introduction concomitantly with a large dengue outbreak. In this outbreak, one case of co-infection with SLEV–dengue type 3 virus was 12 Saint Louis encephalitis virus (SLEV) is an important mosquito- observed. Herein, we report SLEV infection in one patient living borne flavivirus in the Americas. When infecting man, SLEV can in Ribeirao Preto, SP, Brazil. produce disease ranging from a mild febrile illness to severe encephalitis. SLEV was first identified in Saint Louis, Missouri, USA, 1 2. Case report in 1933. Several outbreaks have recently occurred in the Americas, and the fatality rate has ranged from 5% to 20%. There 2,3 In April 2008, a retired 74-year-old man sought medical care is no specific treatment or vaccine available for SLEV. after 24 h of fever, headache, diarrhea, muscle pain, arthralgia, and The seroprevalence of SLEV in the Brazilian population ranges 4,5 lipothymia. The patient lived in the urban area of Ribeirao Preto, from 3% to 43%. SLEV has also been reported to infect wild birds, had not been out of town in the last 15 days, and had been mosquitoes, and marsupials, and was recently isolated from the 6,7 vaccinated for yellow fever in 2003. The patient was clinically brain of a horse with encephalitis in Minas Gerais State. diagnosed for dengue infection and a blood sample was collected Human disease induced by SLEV has rarely been reported in for laboratory diagnosis. The patient probably recovered without Brazil. The first case with a serological diagnosis occurred in Belem, 8 sequelae. Para State, in 1978. Another case, diagnosed by RT-PCR, was 9 The patient’s serum was first tested by ELISA (Panbio, Brisbane, reported in Sao Paulo State (SP) in 2005. In 2006, an outbreak of Australia), showing IgM and IgG antibodies to dengue virus. The acute febrile disease with meningoencephalitis and/or hemor- serum was then tested for the presence of NS1 dengue antigen by rhagic manifestations involving at least 14 cases was reported in capture ELISA Platelia (Bio-Rad Laboratories, France), giving a Sao Jose do Rio Preto, SP. Interestingly, this outbreak occurred negative result. The dengue virus genome was not amplified in the 13 patient’s serum by conventional RT-PCR. Further investigations were done for other flaviviruses by ELISA and RT-PCR. Anti-SLEV antibodies were detected by an in-house ELISA using recombinant * Corresponding author. Tel.: +55 16 3602 4580; fax: +55 16 3602 3376. domain III (rDIII) of the envelope protein of the virus as antigen, as E-mail addresses: [email protected] (W.M. de Souza), 14 ltmfi[email protected] (L.T.M. Figueiredo). reported previously. Corroborating these results, neutralizing http://dx.doi.org/10.1016/j.ijid.2014.05.018 1201-9712/ß 2014 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/). F.G.M. Maia et al. / International Journal of Infectious Diseases 26 (2014) e96–e97 e97 Table 1 remain undiagnosed, it is necessary to improve the surveillance Diagnosis of Saint Louis encephalitis virus in a patient with suspected dengue fever system, including laboratories, for the diagnosis of SLEV in Brazil. Method Reference Result SLEV circulates in the state of Sao Paulo, the most populated region of Brazil. This virus, probably brought in by birds, is Dengue IgM capture ELISA Panbio Reactive Dengue IgG indirect ELISA Panbio Reactive transmitted to man in urban areas by Culex mosquitoes. However, Dengue NS1 antigen Platelia-Bio-Rad Non-reactive the epidemiology of SLEV in urban areas is completely unknown. capture ELISA Further studies are necessary to better understand the epidemiol- Dengue RT-PCR Lanciotti et al., 2002 Negative ogy of SLEV in Brazil. SLEV in-house IgG ELISA Chaves et al., 2013 Reactive Classic neutralization test Shope and Sather, 1979 Neutralizing Flavivirus RT-PCR Bronzoni et al., 2005 Positive Acknowledgements SLEV, Saint Louis encephalitis virus. This study was supported by a grant from FAPESP – Fundac¸a˜o de Amparo a` Pesquisa do Estado de Sa˜o Paulo (No. 08/50617-6), Fellowship No. 06/01179-0, 12/02836-6, and 12/24150-9, and anti-SLEV antibodies (logarithm neutralization index of 2.14) were CNPq – Conselho Nacional de Pesquisa No. 301677/2013-1. obtained in the serum by a classic neutralization test in baby mice Conflict of interest: The author declares no competing interest in 15 (Table 1). publishing this case report. In addition, RNA was extracted from the patient’s serum using the QIAamp viral RNA mini kit (Qiagen, Hilden, Germany) and was References subjected to an RT-PCR using non-structural protein 5 gene (NS5) 1. Reisen WK. Epidemiology of St. Louis encephalitis virus. Adv Virus Res flavivirus generic primers. An amplicon of approximately 800 base 16 2003;61:139–83. pairs (bp) was obtained, as expected for a flavivirus. The 2. Tsai TF, Mitchell CJ. St Loius encephalitis. In: Monath TP, editor. The Arboviruses: amplicon was purified with the QIAquick gel extraction kit Epidemiology and Ecology. Boca Raton, FL: CRC Press; 1988. p. 431–58. 3. Kopp A, Gillespie TR, Hobelsberger D, Estrada A, Harper JM, Miller RA, et al. (Qiagen, Hilden, Germany) and sequenced using the same Provenance and geographic spread of St. Louis encephalitis virus. MBio flavivirus generic primers and the Big Dye Terminator v3.1 Cycle 2013;4:e00322–413. Sequencing Kit (Applied Biosystems, Foster City, CA, USA) in a 4. Pauvolid-Correa A, Tavares FN, Costa EV, Burlandy FM, Murta M, Pellegrin AO, et al. Serologic evidence of the recent circulation of Saint Louis encephalitis sequencer Genetic Analyzer 3130 (Applied Biosystems, Foster City, virus and high prevalence of equine encephalitis viruses in horses in the CA, USA). An 804-bp sequence was obtained and its SLEV origin Nhecolandia sub-region in South Pantanal, Central-West Brazil. Mem Inst was confirmed by BLAST (Basic Local Alignment Search Tool). This Oswaldo Cruz 2010;105:829–33. 5. Pauvolid-Correa A, Campos Z, Juliano R, Velez J, Nogueira RM, Komar N. nucleotide sequence was deposited in GenBank (accession number Serological evidence of widespread circulation of West Nile virus and other KJ528400) and also compared to other NS5 SLEV sequences. The flaviviruses in equines of the Pantanal, Brazil. PLoS Negl Trop Dis 2014;8:e2706. sequence showed a very high identity (100%) with that of the SLEV 6. Figueiredo LT. The Brazilian flaviviruses. Microbes Infect 2000;2:1643–9. 7. Rosa R, Costa EA, Marques RE, Oliveira TS, Furtini R, Bomfim MR, et al. Isolation strain BeAn 246262 (GenBank accession number EU088424.1), of Saint Louis encephalitis virus from a horse with neurological disease in Brazil. identified in a Didelphis marsupialis black-eared opossum in Belem, PLoS Negl Trop Dis 2013;7:e2537. Para State, in 1973. A high identity (100%) of the sequence with 800 8. Pinheiro FP, LeDuc JW, Travassos da Rosa AP, Leite OF. Isolation of St. Louis nucleotides of the NS5 of SLEV identified in Sao Jose do Rio Preto encephalitis virus from a patient in Belem, Brazil. Am J Trop Med Hyg 1981;30:145–8. (EF219166.1; DQ836337.1; DQ836336.1) and high homology with 9. Rocco IM, Santos CL, Bisordi I, Petrella SM, Pereira LE, Souza RP, et al. St. Louis other Brazilian strains of SLEV was also observed. encephalitis virus: first isolation from a human in Sao Paulo State, Brazil. Rev Inst Med Trop Sao Paulo 2005;47:281–5. 10. Mondini A, Cardeal IL, Lazaro E, Nunes SH, Moreira CC, Rahal P, et al. Saint Louis encephalitis virus, Brazil. Emerg Infect Dis 2007;13:176–8. 3. Discussion 11. Terzian AC, Mondini A, Bronzoni RV, Drumond BP, Ferro BP, Cabrera EM, et al. Detection of Saint Louis encephalitis virus in dengue-suspected cases during a dengue 3 outbreak. Vector Borne Zoonotic Dis 2011;11:291–300. More than 10 pathogenic flaviviruses have been described in 12. Mondini A, Bronzoni RV, Cardeal IL, dos Santos TM, Lazaro E, Nunes SH, et al.
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