Venezuelan Equine Encephalitis Treatment & Management

  • Author: Robert W Derlet, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jul 18, 2011
 

Approach Considerations

No specific treatment other than supportive care is available. Venezuelan equine encephalitis virus is an RNA virus; therefore, antivirals that have been successful against deoxyribonucleic acid (DNA) viruses are ineffective. Treatment of Venezuelan equine encephalitis is symptomatic and in the ED most likely involves correcting fluid deficiencies.

Patients with neurologic manifestations of Venezuelan equine encephalitis should be transferred to a facility that can provide intensive care treatment, if necessary.

Supportive care in nonneurologic Venezuelan equine encephalitis

Patients with nonneurologic Venezuelan equine encephalitis virus infection generally require only supportive care, including fluid management for dehydration and electrolyte derangement caused by fever and vomiting.

Supportive care in Venezuelan equine encephalitis with neurologic manifestations

Patients with neurologic manifestations of Venezuelan equine encephalitis require prompt supportive care to reduce the risk of mortality.

Appropriate measures include standard anticonvulsant therapy as treatment for seizures; fluid management for dehydration and electrolyte imbalance produced by fever, vomiting, decreased oral intake, and inappropriate ADH secretion; and proper airway and respiratory management in those progressing to coma.

Neurosurgical evaluation and monitoring for increased intracranial pressure are beneficial. Prevention and treatment of secondary bacterial infection significantly improve the patient's prognosis.

Consultations

Contact an infectious disease specialist if Venezuelan equine encephalitis is suspected. In addition, involve the county and/or state health department. Neurosurgical evaluation and monitoring for increased intracranial pressure, when possible, is beneficial.

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Vaccine Development

Trials are currently underway to develop a vaccine for Venezuelan equine encephalitis. C-84 is a formalin-inactivated vaccine. V3526 is a newer live attenuated vaccine. TC-83 also is a live-attenuated vaccine. Studies have shown that the V3526 vaccine has been safe and efficacious in the treatment of horses. Vaccination with V3526 results in a lack of detectable viremia. However, further research is needed to determine whether this vaccine will safely confer immunity in humans.[8]

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Deterrence and Prevention

Protection from mosquito bites in endemic areas is important. Visitors to endemic areas should take appropriate precautions to avoid mosquito bites, including proper clothing, insect repellant, and mosquito nets. Large-scale aerial insecticide applications may decrease the number of disease-carrying mosquitoes.

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Contributor Information and Disclosures
Author

Robert W Derlet, MD  Professor of Emergency Medicine, University of California at Davis School of Medicine; Chief Emeritus, Emergency Department, University of California at Davis Health System

Robert W Derlet, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Association for the Advancement of Science, Infectious Diseases Society of America, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Iris Reyes, MD  Associate Professor of Clinical Emergency Medicine, Advisory Dean, Office of Student Affairs, University of Pennsylvania School of Medicine

Iris Reyes, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Sarah M Perman, MD  Resident, Department of Emergency Medicine, University of Pennsylvania Health Systems

Sarah M Perman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John R Richards, MD, FAAEM  Professor of Emergency Medicine, University of California at Davis School of Medicine

John R Richards, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM  Associate Professor, Education Officer, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

William H Shoff, MD, DTM&H  Director, PENN Travel Medicine, Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania

William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Glaxo Smith Kline None None; Glaxo Smith Kline Honoraria Speaking and teaching

Specialty Editor Board

Jerry L Mothershead, MD  Medical Readiness Consultant, Medical Readiness and Response Group, Battelle Memorial Institute; Advisor, Technical Advisory Committee, Emergency Management Strategic Healthcare Group, Veteran's Health Administration; Adjunct Associate Professor, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences

Jerry L Mothershead, MD is a member of the following medical societies: American College of Emergency Physicians and National Association of EMS Physicians

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

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.

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

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, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Weaver SC, Reisen WK. Present and future arboviral threats. Antiviral Res. Feb 2010;85(2):328-45. [Medline]. [Full Text].

  2. Figueiredo LT. Emergent arboviruses in Brazil. Rev Soc Bras Med Trop. Mar-Apr 2007;40(2):224-9. [Medline].

  3. Carrara AS, Coffey LL, Aguilar PV, et al. Venezuelan equine encephalitis virus infection of cotton rats. Emerg Infect Dis. Aug 2007;13(8):1158-65. [Medline]. [Full Text].

  4. Estrada-Franco JG, Navarro-Lopez R, Freier JE, et al. Venezuelan equine encephalitis virus, southern Mexico. Emerg Infect Dis. Dec 2004;10(12):2113-21. [Medline].

  5. Jackson AC, Rossiter JP. Apoptotic cell death is an important cause of neuronal injury in experimental Venezuelan equine encephalitis virus infection of mice. Acta Neuropathol. Apr 1997;93(4):349-53. [Medline].

  6. CDC. Venezuelan equine encephalitis--Colombia, 1995. MMWR Morb Mortal Wkly Rep. Oct 6 1995;44(39):721-4. [Medline].

  7. Morrison AC, Forshey BM, Notyce D, et al. Venezuelan equine encephalitis virus in Iquitos, Peru: urban transmission of a sylvatic strain. PLoS Negl Trop Dis. 2008;2(12):e349. [Medline]. [Full Text].

  8. Fine DL, Roberts BA, Teehee ML, et al. Venezuelan equine encephalitis virus vaccine candidate (V3526) safety, immunogenicity and efficacy in horses. Vaccine. Feb 26 2007;25(10):1868-76. [Medline].

 
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