Rocio viral encephalitis
Citation, DOI & article data
Rocio viral encephalitis is an endemic flavivirus encephalitis that appeared in the Ribeira Valley, located on the south coast of São Paulo, Brazil, between 1975-1976.
Rocio virus was first isolated from central nervous system tissue of a deceased 39-year-old male in the Rocio district of São Paulo, with serological prevalence in affected individuals confirming that this virus was the causative agent of the endemic encephalitis 1. The vector was later found to be a pool of Psorophora ferox mosquitoes 2.
Despite there being no further outbreaks of Rocio viral encephalitis, significant seroprevalence of the virus in numerous regions within Brazil threatens reemergence 3.
Fever, nausea, malaise, severe headache and photophobia precede features of encephalitis 3. Death may occur 5 days following onset of symptoms.
Rocio virus demonstrated a predilection for grey matter structures 4. Thalamic inflammatory necrosis was common 4. In addition, damage to the dentate nuclei, substantia inominata, brain stem, spinal cord and basal nuclei was reported 4.
The epidemic unfortunately predates the invention of MRI, which is the modality of choice for imaging encephalitis.
Treatment and prognosis
Treatment is supportive; no vaccine is available. Mortality is approximated at 13% - 900 infected individuals and 117 deaths reported following the epidemic 3. Around 20% of those who survived suffer permanent neurological deficits 3.
Cross-protective immunity to other flaviviruses, namely Ilheus virus and Saint Louis encephalitis virus, may be a protective factor against the development of Rocio viral encephalitis 5.
The Rocio viral encephalitis outbreak was unprecedented. One of the many flavivirus encephalitides would be high on the list of differentials if Rocio virus were to surface again, particularly those endemic to the Americas:
Other CNS infections are, of course, worth thinking about, for example:
- herpes simplex encephalitis
- bacteria meningitis
- fungal meningitis
- HIV CNS manifestations
- rabies encephalitis
Thorough history-taking is fundamental to establishing an appropriate list of differential diagnoses.
- 1. de Souza Lopes O, Coimbra TL, de Abreu Sacchetta L, Calisher CH. Emergence of a new arbovirus disease in Brazil. I. Isolation and characterization of the etiologic agent, Rocio virus. (1978) American journal of epidemiology. 107 (5): 444-9. doi:10.1093/oxfordjournals.aje.a112563 - Pubmed
- 2. de Souza Lopes O, de Abreu Sacchetta L, Francy DB, Jakob WL, Calisher CH. Emergence of a new arbovirus disease in Brazil. III. Isolation of Rocio virus from Psorophora Ferox (Humboldt, 1819). (1981) American journal of epidemiology. 113 (2): 122-5. doi:10.1093/oxfordjournals.aje.a113075 - Pubmed
- 3. Amarilla, Alberto A, Santos-Junior, Nilton Nascimento, Figueiredo, Mario Luis, Luiz, Joao Paulo Mesquita, Fumagalli, Marcilio Jorge, Colón, David F, Lippi, Veronica, Alfonso, Helda Liz, Lima-Junior, Djalma S, Trabuco, Amanda C, Spinieli, Richard L, Desidera, Amanda C, Leite-Panissi, Christie R A, Lauretti, Flávio, Mendoza, Silvia Elena Sánchez, Silva, Cleide Lúcia Araújo, Rego, Eduardo Magalhaes, Galvao-Lima, Leonardo J, Bassi, Gabriel S, Penharvel Martíns, Sandra L B, Manrique, Wilson Gomez, Alves-Filho, José Carlos, Cunha, Fernando Q, Peng, Nias Y G, Modhiran, Naphak, Setoh, Yin Xiang, Khromykh, Alexander A, Figueiredo, Luiz T M, Aquino , Victor H. CCR2 Plays a Protective Role in Rocio Virus–Induced Encephalitis by Promoting Macrophage Infiltration Into the Brain. (2019) The Journal of Infectious Diseases. 219 (12): 2015. doi:10.1093/infdis/jiz029
- 4. Rosemberg S. Neuropathology of S. Paulo south coast epidemic encephalitis (Rocio flavivurus). J Neurol Sci. 1980 Feb;45(1):1-12. doi:10.1016/s0022-510x(80)80001-3
- 5. Alberto A. Amarilla, Yin X. Setoh, Parthiban Periasamy, Nias Y. Peng, Gabor Pali, Luiz T. Figueiredo, Alexander A. Khromykh, Victor H. Aquino. Chimeric viruses between Rocio and West Nile: the role for Rocio prM-E proteins in virulence and inhibition of interferon-α/β signaling. Scientific Reports. 7 (1): 1. doi:10.1038/srep44642