title: Potential role of deer tick virus in Powassan encephalitis cases in Lyme disease-endemic areas of New York, U.S.A.
abstract: Powassan virus, a member of the tick-borne encephalitis group of flaviviruses, encompasses 2 lineages with separate enzootic cycles. The prototype lineage of Powassan virus (POWV) is principally maintained between Ixodes cookei ticks and the groundhog (Marmota momax) or striped skunk (Mephitis mephitis), whereas the deer tick virus (DTV) lineage is believed to be maintained between Ixodes scapularis ticks and the white-footed mouse (Peromyscus leucopus). We report 14 cases of Powassan encephalitis from New York during 2004-2012. Ten (72%) of the patients were residents of the Lower Hudson Valley, a Lyme disease-endemic area in which I. scapularis ticks account for most human tick bites. This finding suggests that many of these cases were caused by DTV rather than POWV. In 2 patients, DTV infection was confirmed by genetic sequencing. As molecular testing becomes increasingly available, more cases of Powassan encephalitis may be determined to be attributable to the DTV lineage.
authors.forename: Marc Y
authors.initials: MY
authors.lastname: El Khoury
authors.forename: Jose F
authors.initials: JF
authors.lastname: Camargo
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: White
authors.forename: Bryon P
authors.initials: BP
authors.lastname: Backenson
authors.forename: Alan P
authors.initials: AP
authors.lastname: Dupuis
authors.forename: Kay L
authors.initials: KL
authors.lastname: Escuyer
authors.forename: Laura
authors.initials: L
authors.lastname: Kramer
authors.forename: Kirsten
authors.initials: K
authors.lastname: St George
authors.forename: Debarati
authors.initials: D
authors.lastname: Chatterjee
authors.forename: Melissa
authors.initials: M
authors.lastname: Prusinski
authors.forename: Gary P
authors.initials: GP
authors.lastname: Wormser
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Wong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004669:Encephalitis Viruses, Tick-Borne / Q000145:classification*; D004675:Encephalitis, Tick-Borne / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D062306:Geography, Medical; D006760:Hospitalization; D006801:Humans; D008193:Lyme Disease / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents
keywords: Ixodes scapularis; Lyme disease; New York; Powassan virus; United States; deer tick virus; encephalitis; flavivirus; ticks; vector-borne infections; viruses