Fatal Case of Chronic Jamestown Canyon Virus Encephalitis Diagnosed by Metagenomic Sequencing in Patient Receiving Rituximab
Isaac H. Solomon, Vijay Ganesh, Guixia Yu, Xian Ding Deng, Michael R. Wilson, Steve Miller, Tracey Milligan, Shibani S. Mukerji, Abigail Mathewson, Justin Linxweiler, Darlene Morse, Jana M. Ritter, J. Erin Staples, Holly R. Hughes, Carolyn V. Gould, Pardis C. Sabeti, Charles Y. Chiu, Anne Piantadosi
Abstract
J amestown Canyon orthobunyavirus (JCV) is a neg- ative-sense RNA virus in the California serogroup. Its tripartite genome comprises small (nucleocapsid), medium (glycoprotein), and large (polymerase) segments. JCV is distributed throughout the United States and Canada and has been isolated from multiple mammals and mosquitoes (1,2). Most infections occur in adults, during the summer, and are asymptomatic, but manifestations can include fever and acute meningoencephalitis (2). Cerebrospinal fluid (CSF) typically shows a lymphocytic pleocytosis with elevated protein and normal glucose. Diagnosis is made by detection of JCV IgM in serum or CSF and confirmed by plaque-reduction neutralization testing to rule out cross-reactivity with other California serogroup viruses (3). Detection of viral RNA in human CSF has rarely been described, with viremia presumed to be of short duration, so reverse transcription PCR (RT-PCR) is not routinely used for diagnosis No specific treatments are available, although intravenous ribavirin has been reported to improve seizures (6). Because of the limited number of cases described, the full range of findings associated with JCV infection is unknown. No fatal cases were reported to the Centers for Disease Control and Prevention (CDC) before 2017, and no autopsy reports have been published (7).