title: An unexpected outbreak of Japanese encephalitis in the Chugoku district of Japan, 2002.
abstract: Six patients unexpectedly presented with Japanese encephalitis (JE) from early August to mid-September 2002 in the Chugoku district of Japan. The mean age was 67.5 years (range 42 - 89 years); the onset period in two patients shifted to the middle of September. The JE virus was isolated from the cerebrospinal fluid samples from two patients, and the strain isolated in the one was identified as genotype III. Neurologically, consciousness impairment, meningeal signs, rigidity, hemiparesis, tetraparesis, and convulsive seizures were commonly observed. Magnetic resonance imaging uniformly revealed high signal intensities in the bilateral thalami, brainstem (substantia nigra), hippocampi, and brain cortices. In all patients, acyclovir was used, due to the unexpected outbreak of JE. Five patients, except for one without sequelae, had a severe outcome, including one death. This report indicates that JE in Japan is still a threat to adults and the elderly with decreased or absent immunity to the JE virus.
authors.affiliation: The First Department (Neurology) of Internal Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan.
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Ayukawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fujimoto
authors.forename: Mitsuyoshi
authors.initials: M
authors.lastname: Ayabe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shoji
authors.forename: Ryukichi
authors.initials: R
authors.lastname: Matsui
authors.forename: Yuko
authors.initials: Y
authors.lastname: Iwata
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fukuda
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Ochi
authors.forename: Koichi
authors.initials: K
authors.lastname: Noda
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Ono
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sakai
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takehisa
authors.forename: Kotaro
authors.initials: K
authors.lastname: Yasui
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D002555:Cerebrospinal Fluid / Q000821:virology; D004196:Disease Outbreaks; D004664:Encephalitis Virus, Japanese / Q000302:isolation & purification; D004672:Encephalitis, Japanese / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed