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==Differentiating California Encephalitis Virus from other Diseases==
==Differentiating California Encephalitis Virus from other Diseases==
California encephalitis virus must be differentiated from other diseases that cause [[fever]], [[headache]], [[seizures]], and [[altered mental status]], such as:<ref name=Mandell1> M.D. JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Expert Consult Premium Edition. Saunders; 2014.</ref><ref name="pmid14978145">{{cite journal| author=Kennedy PG| title=Viral encephalitis: causes, differential diagnosis, and management. | journal=J Neurol Neurosurg Psychiatry | year= 2004 | volume= 75 Suppl 1 | issue=  | pages= i10-5 | pmid=14978145 | doi= | pmc=PMC1765650 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14978145  }} </ref><ref name=NYDeptofHealth> Arboviral Infections (arthropod-borne encephalitis, eastern equine encephalitis, St. Louis encephalitis, California encephalitis, Powassan encephalitis, West Nile encephalitis). New York State Department of Health (2006). https://www.health.ny.gov/diseases/communicable/arboviral/fact_sheet.htm Accessed on February 23, 2016 </ref>
California encephalitis virus must be differentiated from other diseases that cause [[fever]], [[headache]], [[seizures]], and [[altered mental status]], such as:<ref name=Mandell1> M.D. JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Expert Consult Premium Edition. Saunders; 2014.</ref><ref name="pmid14978145">{{cite journal| author=Kennedy PG| title=Viral encephalitis: causes, differential diagnosis, and management. | journal=J Neurol Neurosurg Psychiatry | year= 2004 | volume= 75 Suppl 1 | issue=  | pages= i10-5 | pmid=14978145 | doi= | pmc=PMC1765650 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14978145  }} </ref><ref name=NYDeptofHealth> Arboviral Infections (arthropod-borne encephalitis, eastern equine encephalitis, St. Louis encephalitis, California encephalitis, Powassan encephalitis, West Nile encephalitis). New York State Department of Health (2006). https://www.health.ny.gov/diseases/communicable/arboviral/fact_sheet.htm Accessed on February 23, 2016 </ref><ref name="pmid21932127">{{cite journal| author=Eckstein C, Saidha S, Levy M| title=A differential diagnosis of central nervous system demyelination: beyond multiple sclerosis. | journal=J Neurol | year= 2012 | volume= 259 | issue= 5 | pages= 801-16 | pmid=21932127 | doi=10.1007/s00415-011-6240-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21932127  }} </ref><ref name="pmid11260760">{{cite journal| author=De Kruijk JR, Twijnstra A, Leffers P| title=Diagnostic criteria and differential diagnosis of mild traumatic brain injury. | journal=Brain Inj | year= 2001 | volume= 15 | issue= 2 | pages= 99-106 | pmid=11260760 | doi=10.1080/026990501458335 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11260760  }} </ref>


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 50px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Similarities}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Differentials}}
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[La Crosse encephalitis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Meningitis]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |[[La Crosse encephalitis]] presents with acute [[inflammation]] of the [[brain]], caused by a [[viral infection]]; complications include severe [[brain]] damage. Other findings include [[nausea]], [[headache]], [[vomit]]ing in milder cases and [[seizure]]s, [[coma]], [[paralysis]] and permanent [[brain damage]] in severe cases.
| style="padding: 5px 5px; background: #F5F5F5;" | Classic triad of [[fever]], [[nuchal rigidity]], and [[altered mental status]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Photophobia]], [[phonophobia]], [[rash]] associated with [[meningococcemia]], concomitant [[sinusitis]] or [[otitis]], swelling of the [[fontanelle]] in infants (0-6 months)
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Brain abscess]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | [[Fever]], [[headache]], [[hemiparesis]]
| style="padding: 5px 5px; background: #F5F5F5;" |Varies depending on the location of the abscess; clinically, [[visual disturbance]] including [[papilledema]], decreased [[sensation]]; on imaging, a [[lesion]] demonstrates both ring enhancement and central restricted diffusion
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Vector-borne encephalitis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Demyelinating disease]]s'''
| style="padding: 5px 5px; background: #F5F5F5;" |[[Vector-borne encephalitis]] presents with acute [[inflammation]] of the [[brain]], caused by a [[bacterial infection]]; complications include severe [[brain]] damage as the inflamed [[brain]] pushes against the [[skull]], potentially leading to [[mortality]]. {{see also|Tick-borne encephalitis|Eastern equine encephalitis|Western equine encephalitis|Japanese encephalitis|West Nile encephalitis}}
| style="padding: 5px 5px; background: #F5F5F5;" | [[Ataxia]], [[lethargy]]
| style="padding: 5px 5px; background: #F5F5F5;" |[[Multiple sclerosis]]: clinically, [[nystagmus]], [[internuclear ophthalmoplegia]], [[Lhermitte's sign]]; on imaging, well-demarcated ovoid lesions with possible T1 hypointensities (“black holes”)
[[Acute disseminated encephalomyelitis]]: clinically, [[somnolence]], [[myoclonic]] movements, and [[hemiparesis]]; on imaging, diffuse or multi-lesion enhancement, with indistinct lesion borders
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Viral encephalitis]] '''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Substance abuse]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |[[Viral encephalitis]] presents with acute [[inflammation]] of the [[brain]], caused by a [[viral infection]]; complications include severe [[brain]] damage as the inflamed [[brain]] pushes against the [[skull]], potentially leading to [[mortality]]. {{see also|Herpes simplex encephalitis|VZV encephalitis}}
| style="padding: 5px 5px; background: #F5F5F5;" | [[Tremor]], [[headache]], [[altered mental status]]
| style="padding: 5px 5px; background: #F5F5F5;" |Varies depending on type of substance: prior history, drug-seeking behavior, attention-seeking behavior, [[paranoia]], sudden [[panic]], [[anxiety]], [[hallucination]]s
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Encephalopathy]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Electrolyte disturbance]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |[[Encephalopathy]] presents with steady [[depression]], generalized [[seizures]]. Generally absent are [[fever]], [[headache]], [[leukocytosis]], and [[pleocytosis]]; [[MRI]] often appears normal.
| style="padding: 5px 5px; background: #F5F5F5;" | [[Fatigue]], [[headache]], [[nausea]]
| style="padding: 5px 5px; background: #F5F5F5;" |Varies depending on deficient ions; clinically, [[edema]], [[constipation]], [[hallucination]]s; on [[EKG]], abnormalities in [[T wave]], [[P wave]], [[QRS complex]]; possible presentations include [[arrhythmia]], [[dehydration]], [[renal failure]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Meningitis]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Stroke]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |[[Meningitis]] presents with [[headache]], [[altered mental status]], and [[inflammation]] of the [[meninges]]. It may have an indolent evolution, resolving on its own, or may present as an rapidly evolving [[inflammation]], causing neurologic damage and possible [[mortality]]. {{see also|bacterial meningitis|viral meningitis|fungal meningitis}}
| style="padding: 5px 5px; background: #F5F5F5;" | [[Ataxia]], [[aphasia]], [[dizziness]]
| style="padding: 5px 5px; background: #F5F5F5;" |Varies depending on classification of stroke; presents with positional [[vertigo]], high [[blood pressure]], [[extremities|extremity]] weakness
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Brain abscess]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Intracranial hemorrhage]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |[[Brain abscess]] presents with an [[abscess]] in the [[brain]] caused by the [[inflammation]] and accumulation of [[infected]] material from local or remote infectious areas of the body; the infectious agent may also be introduced as a result of head [[trauma]] or [[neurosurgery|neurological procedures]].
| style="padding: 5px 5px; background: #F5F5F5;" | [[Headache]], [[coma]], [[dizziness]]
| style="padding: 5px 5px; background: #F5F5F5;" | Lobar [[hemorrhage]], [[numbness]], [[tingling]], [[hypertension]], [[hemorrhagic diathesis]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Acute disseminated encephalomyelitis]] (ADEM)'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Trauma]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |[[Acute disseminated encephalomyelitis]] presents with scattered foci of [[demyelination]] and perivenular [[inflammation]]; it can cause focal neurological signs and decreased ability to focus.
| style="padding: 5px 5px; background: #F5F5F5;" | [[Headache]], [[altered mental status]]
| style="padding: 5px 5px; background: #F5F5F5;" | [[Amnesia]], [[loss of consciousness]], [[dizziness]], [[concussion]], [[contusion]]
|-
|-
|}
|}
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==Epidemiology and Demographics==
==Epidemiology and Demographics==
===Incidence===
===Incidence===
There are approximately 70-115 cases of California encephalitis virus per year in the United States.<ref name=CecilMedicine> Goldman L, Schafer AI. Goldman's Cecil Medicine. Elsevier Health Sciences; 2011. </ref>
There are approximately 70-115 cases of California encephalitis virus per year in the United States.


===Age===
===Age===
California encephalitis virus commonly affects individuals between 6 months old and 15 years of age.<ref name=CecilMedicine> Goldman L, Schafer AI. Goldman's Cecil Medicine. Elsevier Health Sciences; 2011. </ref>
California encephalitis virus commonly affects individuals between 6 months old and 15 years of age.


===Seasonal===
===Seasonal===
The majority of California encephalitis virus cases are reported between in the summer months between July and September, and peaks in August.<ref name=CecilMedicine> Goldman L, Schafer AI. Goldman's Cecil Medicine. Elsevier Health Sciences; 2011. </ref>
The majority of California encephalitis virus cases are reported in the summer months between July and September, and peaks in August.


===Geographic Location===
===Geographic Location===
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==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
===Natural History===
===Natural History===
California encephalitis virus usually clears in 1 to 2 weeks and rarely recurs. Less than 1% of cases result in [[mortality]].<ref name=OHIOPubHealth> La Crosse Encephalitis. Ohio Department of Health. http://www.odh.ohio.gov/pdf/idcm/lac.pdf Accessed on February 25, 2016.</ref>
California encephalitis virus usually clears in 1 to 2 weeks and rarely recurs.  


===Complications===
===Complications===
Line 87: Line 100:


===Prognosis===
===Prognosis===
Prognosis for California encephalitis virus is generally good, with most individuals returning to full health in 2-3 weeks. However, approximately 20% of patients have [[residual]] [[seizure]]s.  
Prognosis for California encephalitis virus is generally good, with most individuals returning to full health in 2-3 weeks. Less than 1% of cases result in [[mortality]].<ref name=OHIOPubHealth> La Crosse Encephalitis. Ohio Department of Health. http://www.odh.ohio.gov/pdf/idcm/lac.pdf Accessed on February 25, 2016.</ref> However, approximately 20% of patients have [[residual]] [[seizure]]s.


==Diagnosis==
==Diagnosis==
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The diagnostic method of choice for California encephalitis virus is laboratory testing. Laboratory findings consistent with the diagnosis of California encephalitis virus include:<ref name=OHIOPubHealth> La Crosse Encephalitis. Ohio Department of Health. http://www.odh.ohio.gov/pdf/idcm/lac.pdf Accessed on February 25, 2016.</ref>
The diagnostic method of choice for California encephalitis virus is laboratory testing. Laboratory findings consistent with the diagnosis of California encephalitis virus include:<ref name=OHIOPubHealth> La Crosse Encephalitis. Ohio Department of Health. http://www.odh.ohio.gov/pdf/idcm/lac.pdf Accessed on February 25, 2016.</ref>
*[[Serologic]] [[cross-reactivity]]
*[[Serologic]] [[cross-reactivity]]
*Presence [[IgM]] [[antibody|antibodies]]
*Presence of [[IgM]] [[antibody|antibodies]]
*Persistence of [[IgG]] and neutralizing [[antibody|antibodies]]
*Persistence of [[IgG]] and neutralizing [[antibody|antibodies]]
*Confirmation of arboviral-specific neutralizing antibodies in [[enzyme linked immunosorbent assay (ELISA)]]
*Confirmation of arboviral-specific neutralizing antibodies in [[enzyme linked immunosorbent assay (ELISA)]]
Line 128: Line 141:


===Surgery===
===Surgery===
Surgical intervention is not recommended for the management of California encephalitis virus.
Surgical intervention is not recommended for the management of California encephalitis virus.<ref name=Mandell1> M.D. JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Expert Consult Premium Edition. Saunders; 2014.</ref>


===Prevention===
===Prevention===
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[[Category:Viruses]]
[[Category:Viruses]]
[[Category:Disease]]
[[Category:Viral diseases]]
[[Category:Viral diseases]]
[[Category: Infectious Disease Project]]
 




{{WikiDoc Help Menu}}
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Latest revision as of 17:18, 18 September 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anthony Gallo, B.S. [2]

Synonyms and keywords: CEV; CVE; California virus encephalitis; CE virus

See also: La Crosse encephalitis

Overview

California encephalitis virus is a mild infection of the central nervous system. California encephalitis virus belongs to the Group V negative-sense ssRNA virus within the Bunyaviridae family of viruses. It is also known as an arbovirus. California encephalitis virus is usually transmitted via mosquitos to the human host.[1] California encephalitis virus contains negative-sense viral RNA; this RNA is complementary to mRNA and thus must be converted to positive-sense RNA by an RNA polymerase before translation. California encephalitis virus is contracted by the bite of an infected mosquito, primarily Aedes triseriatus. California encephalitis virus must be differentiated from other diseases that cause fever, headache, seizures, and altered mental status. There are approximately 70-115 cases of California encephalitis virus per year in the United States, most commonly affecting infants and children between the ages of 6 months and 15 years old. California encephalitis virus usually clears in 1 to 2 weeks and rarely recurs. Less than 1% of cases result in mortality.[2] However, approximately 20% of patients have residual seizures. The diagnostic method of choice for California encephalitis virus is laboratory testing. There is no treatment for California encephalitis virus; the mainstay of therapy is supportive care.[3]

Historical Perspective

California encephalitis virus was first discovered in 1943 in Kern County, California. In 1945, the first human cases of encephalitis were attributed to this new virus. Three cases in total were reported, and all three cases were Kern County residents. In all three cases there was strong laboratory evidence confirming infection, due to the presence of neutralizing antibodies linked to California encephalitis.[4]

Classification

There is no classification system established for California encephalitis virus. California encephalitis virus belongs to the Group V negative-sense ssRNA virus within the Bunyaviridae family of viruses, and the genus Orthobunyavirus. California encephalitis virus is also known as an arbovirus, or an arthropod-borne virus.[1] The California encephalitis serogroup, which contains genetically similar viruses such as the La Crosse virus, shares its name with the virus.

Pathophysiology

California encephalitis virus is usually transmitted via mosquitos to the human host.[1] California encephalitis virus contains negative-sense viral RNA; this RNA is complementary to mRNA and thus must be converted to positive-sense RNA by an RNA polymerase before translation. California encephalitis virus is made up of an enveloped virion with a helically symmetrical capsid. The envelope contains G1 glycoproteins. Neutralizing antibodies against these proteins block fusion of the virus with host cells and inhibit hemagglutination. The virus genome is over 12000 nucleotides in length and consists of three segments of various sized single-stranded RNA (negative sense and ambi-sense).

California encephalitis virus is contracted by the bite of an infected mosquito, primarily Aedes triseriatus. The virus is maintained and amplified in Aedes triseriatus populations through transovarial and venereal transmission. The virus overwinters in the mosquito egg. Amplification also occurs in chipmunks and squirrels, upon which mosquitos feed. Humans are dead-end hosts for the virus, meaning there is an insufficient amount of California encephalitis virus in the blood stream to infect a mosquito. Subsequently, the disease cannot be spread to other humans. The incubation period is 5-15 days.[2]

Causes

California encephalitis virus causes encephalitis in humans.

Differentiating California Encephalitis Virus from other Diseases

California encephalitis virus must be differentiated from other diseases that cause fever, headache, seizures, and altered mental status, such as:[1][5][6][7][8]

Disease Similarities Differentials
Meningitis Classic triad of fever, nuchal rigidity, and altered mental status Photophobia, phonophobia, rash associated with meningococcemia, concomitant sinusitis or otitis, swelling of the fontanelle in infants (0-6 months)
Brain abscess Fever, headache, hemiparesis Varies depending on the location of the abscess; clinically, visual disturbance including papilledema, decreased sensation; on imaging, a lesion demonstrates both ring enhancement and central restricted diffusion
Demyelinating diseases Ataxia, lethargy Multiple sclerosis: clinically, nystagmus, internuclear ophthalmoplegia, Lhermitte's sign; on imaging, well-demarcated ovoid lesions with possible T1 hypointensities (“black holes”)

Acute disseminated encephalomyelitis: clinically, somnolence, myoclonic movements, and hemiparesis; on imaging, diffuse or multi-lesion enhancement, with indistinct lesion borders

Substance abuse Tremor, headache, altered mental status Varies depending on type of substance: prior history, drug-seeking behavior, attention-seeking behavior, paranoia, sudden panic, anxiety, hallucinations
Electrolyte disturbance Fatigue, headache, nausea Varies depending on deficient ions; clinically, edema, constipation, hallucinations; on EKG, abnormalities in T wave, P wave, QRS complex; possible presentations include arrhythmia, dehydration, renal failure
Stroke Ataxia, aphasia, dizziness Varies depending on classification of stroke; presents with positional vertigo, high blood pressure, extremity weakness
Intracranial hemorrhage Headache, coma, dizziness Lobar hemorrhage, numbness, tingling, hypertension, hemorrhagic diathesis
Trauma Headache, altered mental status Amnesia, loss of consciousness, dizziness, concussion, contusion

Epidemiology and Demographics

Incidence

There are approximately 70-115 cases of California encephalitis virus per year in the United States.

Age

California encephalitis virus commonly affects individuals between 6 months old and 15 years of age.

Seasonal

The majority of California encephalitis virus cases are reported in the summer months between July and September, and peaks in August.

Geographic Location

The majority of California encephalitis virus cases are reported in the Midwestern United States, especially those living in rural and suburban settings surrounded by deciduous forests.[9]

Risk Factors

Common risk factors in the development of California encephalitis virus include:

  • Young age
  • Residing or working in rural and suburban settings
  • Mosquito contact
  • Summer season
  • Outdoor activities such as camping or hunting

Natural History, Complications, and Prognosis

Natural History

California encephalitis virus usually clears in 1 to 2 weeks and rarely recurs.

Complications

Common complications of California encephalitis virus include:

Prognosis

Prognosis for California encephalitis virus is generally good, with most individuals returning to full health in 2-3 weeks. Less than 1% of cases result in mortality.[2] However, approximately 20% of patients have residual seizures.

Diagnosis

History and Symptoms

If possible, a detailed and thorough history from the patient is necessary. In rare cases, California encephalitis virus presents with symptoms mimicking herpes simplex encephalitis.[10] Common symptoms of California encephalitis virus include:[1][11]

Physical Examination

Common physical examination findings of California encephalitis virus include:[2]

This negatively-stained transmission electron micrograph (TEM) revealed the presence of numerous California encephalitis virus virions. Contained within its enveloped capsid, the genome of this Bunyaviridae family member consists of three segments of negative-sense single-stranded RNA ((-)ssRNA). From Public Health Image Library (PHIL). [12]

Laboratory Findings

The diagnostic method of choice for California encephalitis virus is laboratory testing. Laboratory findings consistent with the diagnosis of California encephalitis virus include:[2]

EEG

On EEG, California encephalitis virus is characterized by periodic lateralizing epilepitoform discharges.[1] However, results on imaging are not sufficient evidence to warrant California encephalitis virus diagnosis.

Treatment

Medical Therapy

There is no treatment for California encephalitis virus; the mainstay of therapy is supportive care.[3]

Surgery

Surgical intervention is not recommended for the management of California encephalitis virus.[1]

Prevention

There are no available vaccines against California encephalitis virus. Primary prevention strategies include:[2]

  • Removal of standing water
  • Screens on doors and windows
  • When outdoors, wearing:
    • Insect repellent containing DEET
    • Long sleeves, pants; tucking in pants into high socks

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 M.D. JE, Dolin R, Blaser MJ. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Expert Consult Premium Edition. Saunders; 2014.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 La Crosse Encephalitis. Ohio Department of Health. http://www.odh.ohio.gov/pdf/idcm/lac.pdf Accessed on February 25, 2016.
  3. ↑ 3.0 3.1 The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America. http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Encephalitis.pdf Accessed on February 16, 2016.
  4. ↑ Eldridge BF, Glaser C, Pedrin RE, Chiles RE (2001). "The first reported case of California encephalitis in more than 50 years". Emerg Infect Dis. 7 (3): 451–2. doi:10.3201/eid0703.010316. PMC 2631795. PMID 11384526.
  5. ↑ Kennedy PG (2004). "Viral encephalitis: causes, differential diagnosis, and management". J Neurol Neurosurg Psychiatry. 75 Suppl 1: i10–5. PMC 1765650. PMID 14978145.
  6. ↑ Arboviral Infections (arthropod-borne encephalitis, eastern equine encephalitis, St. Louis encephalitis, California encephalitis, Powassan encephalitis, West Nile encephalitis). New York State Department of Health (2006). https://www.health.ny.gov/diseases/communicable/arboviral/fact_sheet.htm Accessed on February 23, 2016
  7. ↑ Eckstein C, Saidha S, Levy M (2012). "A differential diagnosis of central nervous system demyelination: beyond multiple sclerosis". J Neurol. 259 (5): 801–16. doi:10.1007/s00415-011-6240-5. PMID 21932127.
  8. ↑ De Kruijk JR, Twijnstra A, Leffers P (2001). "Diagnostic criteria and differential diagnosis of mild traumatic brain injury". Brain Inj. 15 (2): 99–106. doi:10.1080/026990501458335. PMID 11260760.
  9. ↑ Goldman L, Schafer AI. Goldman's Cecil Medicine. Elsevier Health Sciences; 2011.
  10. ↑ Sokol DK, Kleiman MB, Garg BP (2001). "LaCrosse viral encephalitis mimics herpes simplex viral encephalitis". Pediatr Neurol. 25 (5): 413–5. PMID 11744319.
  11. ↑ Richie MB, Josephson SA (2015). "A Practical Approach to Meningitis and Encephalitis". Semin Neurol. 35 (6): 611–20. doi:10.1055/s-0035-1564686. PMID 26595861.
  12. ↑ "Public Health Image Library (PHIL)".



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