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Abstract Details

Powassan Encephalitis. A Rising Epidemiological Concern
Infectious Disease
Infectious Disease Posters (7:00 AM-5:00 PM)
035
N/A

Powassan virus is a rare flavivirus transmitted by tick bite and is commonly associated with progressive encephalitis. Reported cases have increased by 671% over the last 18 years. We describe a case of a patient with fever and rapid mental deterioration, found to have Powassan encephalitis.
69 years-old woman with significant past medical history of hypertension, hyperlipidemia, and diabetes mellitus type 2 admitted due to recurrent nausea, fever and progressive lethargy. Blood and urine cultures were negative. COVID-19 and respiratory viral panel were negative. Patient was started on IV vancomycin and cefepime. Over the next two days, patient developed new leukocytosis of 12.9 thou/cmm, thrombocytopenia of 62 thou/cmm, and hyponatremia of 129 mmol/L. CT Head was unrevealing. Brain MRI showed area of decreased diffusion within the central medulla and confluent T2/FLAIR signal abnormality involving the midbrain and pons. Ampicillin and acyclovir were added due to concerns for meningoencephalitis. Lumbar Puncture resulted in RBC of 5/cmm, WBC 34/cmm (62% lymphocytes), glucose 90 mg/dL, protein 122 mg/dL. CSF culture and meningitis/encephalitis panel including Listeria monocytogenes were negative. Further history revealed that she was at high risk for tick exposure. Lyme, Ehrlichia and Anaplasma were negative. Powassan antibody testing was sent out to CDC. Antibiotics were discontinued. EEG revealed no seizure activity. A week later, repeated Brain MRI showed new areas of T2/FLAIR increased signal. In the interim, patient became obtunded and required intubation. Patient was started on 5 days course of high dose IV steroids. Powassan antibody testing in CSF and serum was positive. Eventually, she was successfully extubated, and mentation improved.
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Despite the current low public health burden of Powassan infections; the considerable increase in case diagnosis, high fatality ratio and short- or long-term sequelae in affected patients, justify implementation of more research efforts to better understand this disease.
Authors/Disclosures
Ramiro G. Castro Apolo, MD (Lehigh Valley Health Network)
PRESENTER 		Dr. Castro Apolo has nothing to disclose.
Jaspreet Johal, MD Dr. Johal has nothing to disclose.
Negar Moheb, MD (Lehigh Valley Fleming Neuroscience Institute) Dr. Moheb has nothing to disclose.
No disclosure on file
Jay D. Varrato, DO Dr. Varrato has nothing to disclose.