Clinical and Serological Findings of Madariaga and Venezuelan Equine Encephalitis Viral Infections: A Follow-up Study 5 Years After an Outbreak in Panama

Abstract Background Human cases of Madariaga virus (MADV) infection were first detected during an outbreak in 2010 in eastern Panama, where Venezuelan equine encephalitis virus (VEEV) also circulates. Little is known about the long-term consequences of either alphavirus infection. Methods A follow-up study of the 2010 outbreak was undertaken in 2015. An additional survey was carried out 2 weeks after a separate 2017 alphavirus outbreak in a neighboring population in eastern Panama. Serological studies and statistical analyses were undertaken in both populations. Results Among the originally alphavirus-seronegative participants (n = 35 of 65), seroconversion was observed at a rate of 14.3% (95% CI, 4.8%–30.3%) for MADV and 8.6% (95% CI, 1.8%–23.1%) for VEEV over 5 years. Among the originally MADV-seropositive participants (n = 14 of 65), VEEV seroconversion occurred in 35.7% (95% CI, 12.8%–64.9%). In the VEEV-seropositive participants (n = 16 of 65), MADV seroconversion occurred in 6.3% (95% CI, 0.2%–30.2%). MADV seroreversion was observed in 14.3% (95% CI, 1.8%–42.8%) of those who were originally seropositive in 2010. VEEV seroconversion in the baseline MADV-seropositive participants was significantly higher than in alphavirus-negative participants. In the population sampled in 2017, MADV and VEEV seroprevalence was 13.2% and 16.8%, respectively. Memory loss, insomnia, irritability, and seizures were reported significantly more frequently in alphavirus-seropositive participants than in seronegative participants. Conclusions High rates of seroconversion to MADV and VEEV over 5 years suggest frequent circulation of both viruses in Panama. Enhanced susceptibility to VEEV infection may be conferred by MADV infection. We provide evidence of persistent neurologic symptoms up to 5 years following MADV and VEEV exposure.

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Clinical and serological findings of Madariaga and Venezuelan equine encephalitis viral infections: A follow-up study five years after an outbreak in Panama

10.1101/2020.02.13.20022798 ◽

2020 ◽

Author(s):

Jean-Paul Carrera ◽

Yaneth Pittí ◽

Juan C. Molares-Matrínez ◽

Eric Casal ◽

Reneé Pereyra-Elias ◽

...

Keyword(s):

Viral Infections ◽

Memory Loss ◽

Venezuelan Equine Encephalitis ◽

Equine Encephalitis Virus ◽

Follow Up Study ◽

Serological Studies ◽

Neighboring Population ◽

Alphavirus Infection

AbstractBackgroundHuman cases of Madariaga virus (MADV) infection were first detected during an outbreak in 2010 in eastern Panama, where Venezuelan equine encephalitis virus (VEEV) also circulates. Little is known about the long-term consequences of either alphavirus infection.MethodsA follow-up study of the 2010 outbreak was undertaken in 2015. An additional survey was carried out two weeks after a separate 2017 alphavirus outbreak in a neighboring population in eastern Panama. Serological studies and statistical analysis were undertaken in both populations.ResultsAmongst the originally alphavirus-seronegative subjects (n=35 of 65), seroconversion was observed at a rate of 14.3% (95% CI: 4.8%-30.3%) for MADV and 8.6% (95% CI: 1.8%-23.1%) for VEEV over 5 years. Amongst the originally MADV seropositive subjects (n=14 of 65), VEEV seroconversion occurred in 35.7% (95% CI: 12.8%-64.9%). In the VEEV seropositive subjects (n=16 of 65), MADV seroconversion occurred in 6.3% (95% CI: 0.2%-30.2%). MADV seroreversion was observed in 14.3% (95% CI: 1.8%-42.8%) of those originally seropositive in 2010. VEEV seroconversion in the baseline MADV-seropositive subjects was significantly higher than in alphavirus-negative subjects. In the population sampled in 2017, MADV and VEEV seroprevalence was 13.2% and 16.8%, respectively. Memory loss, insomnia, irritability and seizures were reported significantly more frequently in alphavirus-seropositive subjects than in seronegative.ConclusionsHigh rates of 5-year seroconversions to MADV and VEEV suggest continuous circulation of both viruses in Panama. Enhanced susceptibility may be conferred by MADV towards VEEV. We provide evidence of persistent neurologic symptoms up to 5 years following MADV and VEEV exposure.summaryWe estimate seroconversion rates over a 5-year period to Madariaga (MADV) and Venezuelan equine encephalitis (VEEV) alphaviruses in Panama. Individuals with MADV antibodies seroconverted to VEEV at a rate greater than individuals who were alphavirus-negative at baseline. This was not observed in individuals with VEEV antibodies, suggesting asymmetric cross-immunity. Neurological sequelae were reported more frequently by MADV and/or VEEV seropositive-versus seronegative subjects.

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Long-Term Follow-up Study of MRI-Guided Bilateral Anterior Capsulotomy in Patients With Refractory Anorexia Nervosa

Neurosurgery ◽

10.1093/neuros/nyx366 ◽

2017 ◽

Vol 83 (1) ◽

pp. 86-92 ◽

Cited By ~ 9

Author(s):

Wei Liu ◽

Dianyou Li ◽

Fafa Sun ◽

Xiaoxiao Zhang ◽

Tao Wang ◽

...

Keyword(s):

Anorexia Nervosa ◽

Memory Loss ◽

Novel Treatments ◽

Follow Up Study ◽

Life Saving ◽

Scale Scores ◽

Long Term Follow Up ◽

Anterior Capsulotomy

Abstract BACKGROUND Anorexia nervosa (AN) is one of the most challenging psychiatric disorders to treat. The poor clinical outcomes warrant novel treatments for AN, especially in severe and persistent cases. OBJECTIVE To explore the feasibility of magnetic resonance imaging-guided bilateral anterior capsulotomy in the treatment of refractory AN. METHODS Seventy-four patients diagnosed with refractory AN who underwent capsulotomy completed this 3-yr follow-up study. Outcomes included body mass index (BMI) and results from a series of psychiatric scales (for obsessive, depressive, and anxious symptoms) that were implemented at baseline (presurgery), and 1 mo, 1 yr, and 3 yr after surgery. RESULTS Compared to presurgical levels, BMI increased significantly at 1-yr and 3-yr follow-ups. Compared to presurgery scores, psychiatric scale scores were significantly improved at 1-mo postsurgery, and continued to remain low at the 1-yr and 3-yr follow-ups. In addition, Mini-Mental State Examination (MMSE) scores were in the normal range during the long-term follow-up. The most common short-term side effects included urinary incontinence (n = 7), sleep disorders (n = 8), and fatigue (n = 6). Long-term complications included disinhibition (n = 6), memory loss (n = 3), and lethargy (n = 4). No patient in this study experienced death or disability. CONCLUSION Capsulotomy enabled patients with refractory AN to normalize their weight, especially those in life-threatening conditions. While it appears to be an acceptable life-saving treatment, it is indicated only when fulfilling strict criteria given its complications and irreversibility.

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