Abstract Details

Title Neuroinvasive Powassan Virus Infection: A Case Series Highlighting Diagnostic and Clinical Challenges

Topic Infectious Disease

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 3-006

Objective To characterize the clinical presentations, diagnostic findings, management approach and outcomes of neuroinvasive Powassan virus (POWV) infection especially in adults residing in endemic regions, and to highlight the diagnostic challenges and outcome associated with this emerging tick-borne encephalitis.

Background Powassan virus (POWV) is an emerging tick-borne flavivirus causing severe neuroinvasive disease, with increasing incidence in the United States especially during the summer. Clinical manifestations range from meningitis to meningoencephalitis including rhombencephalitis and movement disorders, often leading to poor outcomes and mortality.

Design/Methods We describe three cases of adults presenting with neuroinvasive POWV infection diagnosed during the summer in the Hudson Valley of New York State. All patients presented with acute or subacute encephalopathy, focal neurological deficits, and abnormal neuroimaging involving various brain regions, including the cerebellum, cortex, and subcortex. Cerebrospinal fluid (CSF) analysis consistently revealed lymphocytic pleocytosis with elevated protein and normal glucose. Diagnosis was confirmed by POWV-specific IgM in CSF or serum, with confirmatory plaque reduction neutralization testing in ambiguous cases

Results

All patients had a prolonged hospitalization and required admission to intensive care unit. Two developed severe rhombencephalitis with rapid neurological decline, one was immunocompromised. Management was supportive given the lack of effective antiviral therapy, outcomes were poor. One patient died, while the others had persistent severe neurological deficits at discharge. These findings are consistent with prior reports indicating a 10–20% case fatality rate and long-term sequelae in the majority of survivors.The role of corticosteroids remain unknown.

Conclusions POWV is a neuroinvasive disease with variable neurological manifestations and outcomes. There is no known effective antiviral therapy thus increased clinical recognition, public awareness and preventative measures are important to mitigate the impact of this emerging pathogen.

Authors/Disclosures
Ruaa Alsaeed, MBBS (Alfaisal University) PRESENTER	Dr. Alsaeed has nothing to disclose.
Nishitha Bujala, MBBS (Kamineni Institute of Medical Sciences)	Dr. Bujala has nothing to disclose.
Mehriban Sariyeva, MD	Dr. Sariyeva has nothing to disclose.
Yakira P. Mishan, MBBS	Dr. Mishan has nothing to disclose.
Seonghyun Park	Mr. Park has received personal compensation for serving as an employee of University of California.
Kushal Gautam, MD	Dr. Gautam has nothing to disclose.
Marc El Khoury, MD	Dr. El Khoury has received personal compensation in the range of $500-$4,999 for serving as a Peer reviewer for the VA with IPRO.
Carolin Dohle, MD	Dr. Dohle has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion TPharmaceuticals. Dr. Dohle has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics.

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