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St. Louis Encephalitis Medication

  • Author: Charurut Somboonwit, MD, FACP; Chief Editor: Burke A Cunha, MD  more...
 
Updated: Apr 16, 2015
 

Medication Summary

Supportive care is the mainstay of treatment. The drugs in supportive care consist of agents capable of ameliorating neurologic complications. Antipyretics are used as needed.

A pilot study has shown that early use of interferon-alpha2b may decrease the severity of complications.[10] As previously stated, no antiviral agent is available for the treatment of St. Louis encephalitis virus (SLEV) infection, and no vaccine is available for preexposure protection.

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Anticonvulsant Agents

Class Summary

These agents prevent seizure recurrence and terminate clinical and electrical seizure activity.

Phenytoin (Dilantin, Phenytek)

 

Phenytoin may act in the motor cortex, where it may inhibit the spread of seizure activity. The activity of brain stem centers responsible for the tonic phase of grand mal seizures may also be inhibited.

Individualize the dose. Administer a larger dose before retiring if the dose cannot be divided equally. The rate of infusion must not exceed 50 mg per minute to avoid hypotension and arrhythmia.

Diazepam (Valium)

 

Diazepam depresses all levels of the CNS (eg, limbic, reticular formation), possibly by increasing the activity of gamma-aminobutyric acid (GABA). Alternatively, lorazepam can be used when indicated.

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Antipyretics

Class Summary

These agents are helpful in relieving the associated lethargy, malaise, and fever associated with the disease.

Acetaminophen (Acephen, Feverall, Tylenol)

 

Acetaminophen inhibits the action of endogenous pyrogens on heat-regulating centers. It reduces fever by a direct action on the hypothalamic heat-regulating centers, which, in turn, increases the dissipation of body heat via sweating and vasodilation.

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Contributor Information and Disclosures
Author

Charurut Somboonwit, MD, FACP Associate Professor of Internal Medicine, Division of Infectious Disease and International Medicine, University of South Florida College of Medicine; Clinical Research and Communicable Diseases Director, USF Health and Hillsborough Health Department

Charurut Somboonwit, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Fariba M Donovan, MD, PhD Intercoastal Medical Group

Fariba M Donovan, MD, PhD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Joseph T Katta, DO Fellow in Infectious Disease and International Medicine, University of South Florida College of Medicine

Joseph T Katta, DO is a member of the following medical societies: American College of Physicians, American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

John L Brusch, MD, FACP Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Eduardo Gotuzzo, MD Adjunct Professor, Department of Medicine, University of Alabama School of Medicine

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Mary D Nettleman, MD, MS, MACP Professor and Chair, Department of Medicine, Michigan State University College of Human Medicine

Mary D Nettleman, MD, MS, MACP is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical Research, Infectious Diseases Society of America, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Norvin Perez, MD Medical Director, Juneau Urgent and Family Care

Norvin Perez, MD is a member of the following medical societies: American College of Emergency Physicians and American Medical Association

Disclosure: Nothing to disclose.

Emad Soliman, MD, MSc Consulting Staff, Department of Neurology, St John's Riverside Hospital

Emad Soliman, MD, MSc is a member of the following medical societies: American Academy of Neurology and American Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
  1. Halperin JJ. Encephalitis: Diagnosis and Treatment. New York, NY: Informa Healthcare; 2008.

  2. Day JF. Predicting St. Louis encephalitis virus epidemics: lessons from recent, and not so recent, outbreaks. Annu Rev Entomol. 2001. 46:111-38. [Medline].

  3. Day JF, Stark LM. Avian serology in a St. Louis encephalitis epicenter before, during, and after a widespread epidemic in south Florida, USA. J Med Entomol. 1999 Sep. 36(5):614-24. [Medline].

  4. Day JF, Stark LM. Frequency of Saint Louis encephalitis virus in humans from Florida, USA: 1990-1999. J Med Entomol. 2000 Jul. 37(4):626-33. [Medline].

  5. Day JF, Stark LM. Transmission patterns of St. Louis encephalitis and eastern equine encephalitis viruses in Florida: 1978-1993. J Med Entomol. 1996 Jan. 33(1):132-9. [Medline].

  6. Reimann CA, Hayes EB, DiGuiseppi C, et al. Epidemiology of neuroinvasive arboviral disease in the United States, 1999-2007. Am J Trop Med Hyg. 2008 Dec. 79(6):974-9. [Medline].

  7. Day JF. Predicting St. Louis encephalitis virus epidemics: lessons from recent, and not so recent, outbreaks. Annu Rev Entomol. 2001. 46:111-38. [Medline].

  8. White MG, Carter NW, Rector FC, et al. Pathophysiology of epidemic St. Louis encephalitis. I. Inappropriate secretion of antidiuretic hormone. II. Pituitary-adrenal function. 3. Cerebral blood flow and metabolism. Ann Intern Med. 1969 Oct. 71(4):691-702. [Medline].

  9. Sejvar JJ, Bode AV, Curiel M, Marfin AA. Post-infectious encephalomyelitis associated with St. Louis encephalitis virus infection. Neurology. 2004 Nov 9. 63(9):1719-21. [Medline].

  10. Rahal JJ, Anderson J, Rosenberg C, Reagan T, Thompson LL. Effect of interferon-alpha2b therapy on St. Louis viral meningoencephalitis: clinical and laboratory results of a pilot study. J Infect Dis. 2004 Sep 15. 190(6):1084-7. [Medline].

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