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        La Crosse Virus
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May 15, 2024
  Clinical Signs and Symptoms of La Crosse Virus Disease
          Key Points
            * La Crosse virus disease can present as an acute febrile illness or neuroinvasive disease.
            * The incubation period for La Crosse virus disease ranges from 5–15 days.
            * Most patients with La Crosse virus neuroinvasive disease survive; approximately 1% of cases are fatal and 6–15% have neurologic sequelae.
        Clinical presentation
        La Crosse virus disease should be considered in any person with an acute febrile or neurologic illness who has had recent exposure to mosquitoes, especially during the summer months in endemic areas of the United States. La Crosse virus disease is most common in children under the age of 16 years.
        Other causes of encephalitis and aseptic meningitis should also be considered, as appropriate (e.g., herpes simplex viruses, enteroviruses, West Nile virus, St. Louis encephalitis virus, Jamestown Canyon virus, Powassan virus).
        Signs and symptoms
        Most La Crosse virus infections are clinically inapparent, and the vast majority of infections remain undiagnosed. The incubation period for La Crosse virus disease ranges from 5 to 15 days.
        Initial symptoms include fever, headache, nausea, vomiting, fatigue, and lethargy. The disease can progress to encephalitis, meningoencephalitis, or aseptic meningitis. Symptoms of encephalitis can include altered mental status, seizures, speech problems (aphasia, dysarthria), paresis or paralysis, movement disorders, and cranial nerve palsies. La Crosse virus infection has not been associated with acute flaccid paralysis.
        Clinical assessment
        In acute La Crosse virus neuroinvasive disease cases, cerebrospinal fluid (CSF) examination typically shows a mildly elevated white blood cell count and normal glucose; CSF protein is elevated in about one third of cases. The peripheral white blood cell count is usually elevated. Computed tomography (CT) brain scans are usually normal, while electroencephalographic (EEG) abnormalities are more common. EEG results often resemble those seen in cases of herpes simplex encephalitis.
        Outcomes
        Approximately 1% of La Crosse virus neuroinvasive disease cases are fatal. Neurologic sequelae, including epilepsy, hemiparesis, and cognitive and neurobehavioral abnormalities, have been reported in 6%−15% of cases.
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  May 14, 2024
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        National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
        Sources
          * Vahey GM, Lindsey NP, Staples JE, Hills SL. La Crosse Virus Disease in the United States, 2003-2019. Am J Trop Med Hyg. 2021;105(3):807-812. doi: 10.4269/ajtmh.21-0294
          * Hennessey MJ, Pastula DM, Machesky K, Fischer M, Lindsey NP, DiOrio M, et al. Investigation of acute flaccid paralysis reported with La Crosse virus infection, Ohio, USA, 2008–2014. Emerg Infect Dis. 2017;23(12):2075-2077. doi: 10.3201/eid2312.170944
          * Gaensbauer JT, Lindsey NP, Messacar K, Staples JE, Fischer M. Neuroinvasive arboviral disease in the United States: 2003 to 2012. Pediatrics. 2014;134(3):e642-50. doi: 10.1542/peds.2014-0498
          * de los Reyes EC, McJunkin JE, Glauser TA, Tomsho M, O'Neal J. Periodic lateralized epileptiform discharges in La Crosse encephalitis, a worrisome subgroup: clinical presentation, electroencephalogram (EEG) patterns, and long-term neurologic outcome. J Child Neurol. 2008;23:167-172. doi: 10.1177/0883073807307984
          * Haddow AD and Odoni A. The Incidence risk, clustering, and clinical presentation of La Crosse virus infections in the eastern United States, 2003–2007. PLoS ONE, 2007; 4(7): e6145. doi: 10.1371/journal.pone.0006145
          * Hardin SG, Erwin PC, Patterson L, New D, Graber C, Halford SK. Clinical comparisons of La Crosse encephalitis and enteroviral central nervous system infections in a pediatric population: 2001 surveillance in East Tennessee. Am J Infect Control. 2003;31:508-510. doi: 10.1016/s0196-6553(03)00084-1
          * McJunkin JE, de los Reyes EC, Irazuzta JE, Caceres MJ, Khan RR, Minnich LL, et al. La Crosse encephalitis in children. N Engl J Med. 2001;344:801-807. doi: 10.1056/NEJM200103153441103
          * Sokol DK, Kleiman MB, Garg BP. La Crosse viral encephalitis mimics herpes simplex viral encephalitis. Pediatr Neurol. 2001;25:413-415. doi: 10.1016/s0887-8994(01)00337-x
          * Byrd BD, Williams CJ, Staples JE, Burkhalter KL, Savage HM, Doyle MS. Notes from the field: Spatially associated coincident and noncoincident cases of La Crosse encephalitis – North Carolina, 2002-2017. MMWR Morb Mortal Wkly Rep. 2018;67(39):1104-1105. doi: 10.15585/mmwr.mm6739a8
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