Clinical Signs and Symptoms

The disease presents as an acute encephalitis with symptoms of fever, headache, and giddiness followed by coma. Distinctive clinical features include segmental myoclonus, areflexia and hypotonia, hypertension, and tachycardia. Neurologic relapse occurred in a few patients after initial mild disease. Several of the survivors had relapsed or late-onset encephalitis. In the Singapore outbreak, 3 patients presented with atypical pneumonia, one later developed hallucinations and evidence of encephalitis. Cerebrospinal fluid was abnormal in 75% at presentation. Magnetic resonance imaging shows the presence of discrete high-signal-intensity lesions disseminated throughout the brain. The main histopathologic findings include a systemic vasculitis with extensive thrombosis and parenchymal necrosis, especially in the central nervous system (40-44).

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