California Encephalitis
Although relatively rare, California encephalitis (CE) can be a highly lethal disease that is caused by the Balamuthia mandrillaris ameba. In fact, of the 10 cases of CE reported to the California Encephalitis Project during the period from 1999 through 2007, all but one patient died. Today, though, the majority of victims of CE survive the condition, but a significant percentage (about 20%) experience long-term complications as a result. To determine the facts about this potentially deadly human pathogen, this paper reviews the literature to provide the history of CE including its first outbreak, how the disease is transmitted, and the epidemiology of CE. In addition, a discussion concerning the search for a vaccine for CE is followed by description of the treatments and public health considerations of CE. Finally, an examination of the concern CE has for public health is followed by a summary of the research and important findings concerning this disease in the conclusion.
History of California encephalitis
First isolated in 1943 from mosquitoes in Kern County in the Central Valley of California, the arbovirus California encephalitis virus was caused the first recorded deaths of three humans in 1945, and all three deaths were located in Kern County (Eldridge, Glaser, Pedrin & Chiles, 2001). California encephalitis belongs to the California serogroup of viruses but a number of the other viruses that belong to this serogroup are not found in California (California serogroup - pathogen safety data sheet, 2015) but are found throughout other parts of North America, including Wisconsin and Illinois (Vanderhoof-Forschner, 2003). In fact, there were 13 confirmed cases of CE in Illinois in 1996 alone (Racki, 1997).
Many victims of CE, especially adults, frequently fail to demonstrate any symptoms until the condition is well progressed (California serogroup viruses, 2015). For instance, according to the Wisconsin Department of Health Services, "People infected with California serogroup viruses may have no apparent symptoms. Some people have symptoms of illness that may range from mild fever to encephalitis or mengioencephelitis" (California serogroup viruses, 2015, para. 2). Although precise numbers are unavailable and the potential for misdiagnosis is high in CE cases, clinicians and researchers have reported about 150 cases of balamuthiasis worldwide since 1990 (Balamuthia Amebic Encephalitis -- California, 1999 -- 2007, 2015).
How CE is transmitted
The ameba that is responsible for CE in humans is ubiquitous in the soil and like yellow and dengue fever, can be directly transmitted through breaks in the skin, through direct contact with skin lesions (Mahy, 1998) or through airborne inhalation (Balamuthia Amebic Encephalitis -- California, 1999 -- 2007, 2015). According to Massey (2015), the ameba responsible for CE is carried by intermediate vectors such as mosquitoes and ticks. In this regard, Massey advises that, "Mosquito-borne illnesses include viruses that can cause life-threatening encephalopathy and meningitis [including] the Lacrosse virus resulting in California encephalitis" (p. 3). Symptom severity in CE cases varies widely, and adults may be completely asymptomatic; however, infants and children typically experience more severe symptoms (California encephalitis, 2015). Human-to-human transmission of CE is not possible since humans are the dead end hosts for the pathogen (California serogroup - pathogen safety data sheet, 2015).
Epidemiology of CE
Despite ongoing and extensive research, the epidemiology of all types of encephalitis in the United States remains characterized by a majority of cases that have unknown origins (Trevejo, 2004). The research to date, though, implicates exposure to mosquitoes as being the most probable route of infection for many victims in the Central Valley of California (Eldridge et al., 2001). In this regard, Eldridge and his associates report that, "Further studies are needed to assess the risk for human infection by California encephalitis in coastal California and the role of various mosquito species in transmission" (2001, p. 452). In addition, ticks are also known disease transmission vectors (Vanderhoof-Forschner, 2003) and chipmunks, squirrels and other small mammals such as are known intermediary hosts (California serogroup - pathogen safety data sheet, 2015; Romanucci-Ross & Moerman, 1997).
Although many of the viruses that belong to the California serogroup are not found in California, they occur worldwide in a broad range of climates, including: tropical, coastal temperate marshland, lowland river valleys, alpine valleys, high lands, deserts, and arctic regions (California serogroup - pathogen safety data sheet, 2015). The group of viruses that belong to the California serogroup that are currently found in North America include CE, La Crosse, Snowshoe hare, Jamestown Canyon, and Trivittatus viruses (California serogroup - pathogen safety data sheet, 2015).
Moreover, the pathogen that causes CE can survive the winter months in an intermediary host, and the potential for infection increases as the weather warms (Anderson & Schneider, 2005). In this regard Vanderhoof-Forschner advises that, "The seasonality of arboviral transmission is variable and depends on the geographic location...
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