Madariaga Virus Infection Associated with a Case of Acute Disseminated Encephalomyelitis

Kathia Luciani Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama

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Iván Abadía Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama

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Alex O. Martínez-Torres Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama

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Julio Cisneros Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama

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Ilka Guerra Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama

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Mariana García Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama

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Dora Estripeaut Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama

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Jean-Paul Carrera Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama

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DOI:
https://doi.org/10.4269/ajtmh.14-0845
Volume/Issue:
Volume 92: Issue 6
Page(s):
1130–1132
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We present the first report of a pediatric case of acute disseminated encephalomyelitis (ADEM) associated with Madariaga virus infection (MADV, Alphavirus, Togaviridae; formerly known as South American variants of eastern equine encephalitis virus [EEEV]) in a patient of the 2010 alphaviral epidemic reported in Panama. The patient was admitted to the Hospital del Niño in Panama City with suspected meningitis, exhibited with decreased alertness and disorientation in space and time, hemiparesis, and left Babinski sign. The patient was transferred to the intensive care unit and treated with aciclovir and methylprednisolone. The magnetic resonance imaging (MRI) of the brain revealed multiple hyperintense lesions at T2-weighted images (T2) and fluid-attenuated inversion recovery (FLAIR) on the cortical–subcortical level. Sera samples obtained on days 6 and 12 were immunoglobulin M (IgM) positive for MADV. The findings on the clinical and cerebrospinal analyses, rapid symptom progression as well as neuroimaging, and serologic studies support our diagnosis. Our results suggest that MADV should be included in the etiologic differential diagnosis of ADEM in endemic countries.

Author Notes

* Address correspondence to Jean-Paul Carrera, Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, School of Medicine Columbus University, Justo Arosemena Avenue, 39th Street, Panama City, Panama 0816-02593. E-mail: jpcarrera@gorgas.gob.pa

Financial support: This study received financial support from the surveillance program of the Department of Research in Virology and Biotechnology by contract from the Secretaría Nacional de Ciencia, Tecnología e Innovación, Panama (60-4-FID09-103, to J-PC). Jean-Paul Carrera is also paid by research contract CU-VIP-P-003-2013 from Columbus University.

Authors' addresses: Kathia Luciani and Dora Estripeaut, Division of Pediatric Infection, Hospital del Nino, Panama City, Panama, E-mails: kathialuciani@gmail.com and destripeaut@gmail.com. Iván Abadía, Division of Pediatric Neurology, Hospital del Nino, Panama City, Panama, E-mail: iabadia@hotmail.com. Laboratorio de Microbiología Experimental y Aplicada - LAMEXA, Vicerrectoría de Investigación Postgrado, Universidad de Panamá, E-mail: amartinet13@hotmail.com. Julio Cisneros, Ilka Guerra, and Mariana García, Department of Virology and Biotechnology Research, University of Panama, Panama City, Panama, E-mails: jygcisneros@cwpanama.net, ilkaguerra@yahoo.com, and garciameijide@gmail.com. Jean-Paul Carrera, Department of Research in Virology and Biotechnology, Panama City, Panama, and School of Medicine Columbus University, Panama City, Panama, E-mail: jean1450@gmail.com.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2015
Received:
31 Dec 2014
|
Accepted:
04 Mar 2015
|
Published Online:
03 Jun 2015
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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