title: Madariaga virus infection associated with a case of acute disseminated encephalomyelitis.
abstract: We present the first report of a pediatric case of acute disseminated encephalomyelitis (ADEM) associated with Madariaga virus infection (MADV, Alphavirus, Togaviridae; formerly known as South American variants of eastern equine encephalitis virus [EEEV]) in a patient of the 2010 alphaviral epidemic reported in Panama. The patient was admitted to the Hospital del Niño in Panama City with suspected meningitis, exhibited with decreased alertness and disorientation in space and time, hemiparesis, and left Babinski sign. The patient was transferred to the intensive care unit and treated with aciclovir and methylprednisolone. The magnetic resonance imaging (MRI) of the brain revealed multiple hyperintense lesions at T2-weighted images (T2) and fluid-attenuated inversion recovery (FLAIR) on the cortical-subcortical level. Sera samples obtained on days 6 and 12 were immunoglobulin M (IgM) positive for MADV. The findings on the clinical and cerebrospinal analyses, rapid symptom progression as well as neuroimaging, and serologic studies support our diagnosis. Our results suggest that MADV should be included in the etiologic differential diagnosis of ADEM in endemic countries.
authors: Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama.
authors: Kathia
authors: K
authors: Luciani
authors: Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama.
authors: Iván
authors: I
authors: Abadía
authors: Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama.
authors: Alex O
authors: AO
authors: Martínez-Torres
authors: Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama.
authors: Julio
authors: J
authors: Cisneros
authors: Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama.
authors: Ilka
authors: I
authors: Guerra
authors: Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama.
authors: Mariana
authors: M
authors: García
authors: Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama.
authors: Dora
authors: D
authors: Estripeaut
authors: Division of Pediatric Infection Disease and Division of Pediatric Neurology, Hospital del Niño, Panama City, Panama; Department of Research in Virology and Biotechnology, Gorgas Memorial Institute of Health Studies, Panama City, Panama; School of Medicine, Columbus University, Panama City, Panama; Department of Microbiology and Parasitology, University of Panama, Panama City, Panama jpcarrera@gorgas.gob.pa.
authors: Jean-Paul
authors: JP
authors: Carrera
mesh_terms: D000524:Alphavirus; D018354:Alphavirus Infections / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D001921:Brain / Q000473:pathology; D002648:Child; D004673:Encephalomyelitis, Acute Disseminated / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology / Q000821:virology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D010176:Panama / Q000453:epidemiology