WEE, Eastern & Western Equine Encephalitis

Review

• Nearly 96% of infected patients remain asymptomatic. Symptomatic have three different syndromes:

1. Febrile systemic illness (like DHF)
2. Hemorrhagic fever (seen in DHF and YF)
3. Encephalitis (VEE, JE, and LAC)

• Symptoms usually start with fever, headache, malaise, chills, arthralgias, nausea, and vomiting
• Less than 5% of the infected population will develop meningitis or encephalitis.
• Neurologic symptoms: Usually Altered mental status and seizures. Less frequently, paresthesia and focal weakness have also be seen
• According to CDC, many patients who recover are left with long-term physical or mental impairments, which can range from mild brain dysfunction to severe intellectual impairment, personality disorders, seizures, paralysis, and cranial nerve dysfunction. So I think encepahlopathy is not a dynamic sign / symptom of these viruses.

Entities

• Encephalomyelitis , Encephalitis:
  • Cranial nerve palsies
  • Confusion, Stupefaction. Coma + Mental retardation + Sleepiness
  • Behavioral changes, Sleeplessness, Agitation
    

• UMNS: Hyper reflxia + Spastic Paralysis + Twitching + Myoclonic jerking + Tonic-clonic Seizure

• Meningitis: Increased intracerebral pressure (ICP) + Headache + Bilateral papilla edema + Buldging fontanelles in infants + CSF lymphocytosis + Neck stiffness + Nausea and vomiting
• Respiratory depression, Cyanosis
  

• Conjunctivitis: Lachrymation+ Photophobia + Red discoloration

• Parkinsonism: Tremor +
• Hyporeflexia, Depressed Tendons reflexes + Paralysis

Face Edema; peri-orbital.

Involuntary stool.

Diarrhea.

Pressing pains. Rapid pulse. Edema

Arthropathy

Leukocytosis.

Hyponatremia. CSF; lymphocytosis

Bones, tendons,

Myocardium.

Lungs, stomach, kidneys, and spleen have also been described in EEEV infection.[9] Brain histopathology is unspecific, including perivascular lymphohistiocytic cuffing, as noted with other viral encephalitides. Other findings include leptomeningeal vascular congestion, hemorrhage, encephalomalacia, and rarely pyogenic meningeal exudate.[11][12] Immunostaining of EEEV antigen can be detected in affected tissues.[13] A case report from Duke University also described optic histopathologic findings consistent with brain findings in a case of EEE.[11] Some authors also described focal infiltration of neutrophils and macrophages in the brain parenchyma, causing neuronal destruction, focal necrosis, and local demyelination, resulting in glial nodules. Cortical atrophy described in the autopsy of patients dying later in the course of illness.[12]

WEE virus belongs to the genus Alphavirus of the family Togaviridae. WEE virus is present in the Americas and can cause disease in both humans and equids with encephalitis in most clinical cases. WEE is typically maintained in nature by alternating between vertebrate hosts and vector mosquitoes. Encephalitis caused by this virus occurs sporadically in horses and humans from mid-summer to late autumn in temperate regions but can occur year-round in tropical regions, depending on climate conditions that support the presence of the mosquito vector.

Clinical disease in horses is characterized by

• Fever / Anorexia / Depression.
• It can progress to
  • Hyperexcitability,
  • Blindness
  • Ataxia, incoordination
  • Severe mental depression, Recumbency,
  • Convulsions
  • Tremors
  • Paralysis

Meningitis (inflammation of the meninges, the membranes covering the brain) and

Encephalitis (inflammation of the brain itself). Resulting symptoms may include giddiness, intolerance of bright light (Photophobia), confusion,

Agitation, (coma), rigidity of muscles (spasticity),

Seizures)

Learning difficulties.

Note

• WEE is a neuralgic virus. It has 2 distinct image (Depression and Agitation). Depression is more predominant.
• Nero-cognition features: WEE has both of them (Motion and Motivation), but Motion is more involved.
• Briefly saying WEE mostly make its victims
  • Weak, Paralytic, Lethargic, Brady kinetic
  • With low ability to be happy and low cognitive abilities
• Here we have good remedies such as Phos, Hell, Alum, Nux-m which cover the most prominent image of WEE.
  

Remedies

5. Phos
6. Hyos, Sul, Merc, Op, Rhus-t, Bell, Verat, Nux-m, Hell, Bufo, Alum