{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T09:17:53Z","timestamp":1775035073568,"version":"3.50.1"},"reference-count":42,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,4,22]],"date-time":"2022-04-22T00:00:00Z","timestamp":1650585600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Chao Foundation","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]},{"DOI":"10.13039\/501100018905","name":"Brockman Foundation","doi-asserted-by":"publisher","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/501100018905","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Emerging vector-borne and zoonotic pathogens can cause neuroinvasive disease in children; utilization of appropriate diagnostic testing can be low, hindering diagnosis and clinical management of these cases. We must understand factors that influence healthcare providers\u2019 decisions to order diagnostic testing. We reviewed medical charts for pediatric meningitis and encephalitis patients (90 days\u201318 years) between 2010 and 2017 and analyzed variables associated with testing for known neuroinvasive zoonotic pathogens in the southern United States: West Nile virus (WNV), Bartonella spp., and Rickettsia spp. Among 620 cases of meningitis and encephalitis, ~1\/3 (n = 209, 34%) were tested for WNV. Fewer cases were tested for Bartonella (n = 77, 12%) and Rickettsia (n = 47, 8%). Among those tested, 14 (7%) WNV, 7 (9%) Bartonella, and 6 (13%) Rickettsia cases were identified. Factors predicting testing were similar between all agents: clinical presentation of encephalitis, focal neurologic symptoms, new onset seizure, and decreased Glasgow Coma Scale on admission. Cases with a history of arthropod contact were more likely to be tested; however, we did not see an increase in testing during the summer season, when vector exposure typically increases. While our test utilization was higher than that reported in other studies, improvement is needed to identify zoonotic causes of neuroinvasive diseases.<\/jats:p>","DOI":"10.3390\/pathogens11050501","type":"journal-article","created":{"date-parts":[[2022,4,24]],"date-time":"2022-04-24T00:45:21Z","timestamp":1650761121000},"page":"501","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Zoonotic Disease Testing Practices in Pediatric Patients with Meningitis and Encephalitis in a Subtropical Region"],"prefix":"10.3390","volume":"11","author":[{"given":"Timothy A.","family":"Erickson","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Section of Pediatric Tropical Medicine, Center for Human Immunobiology, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, TX 77030, USA"},{"name":"School of Public Health, University of Texas Health Science Center, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shannon E.","family":"Ronca","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Pediatric Tropical Medicine, Center for Human Immunobiology, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0648-6828","authenticated-orcid":false,"given":"Sarah M.","family":"Gunter","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Pediatric Tropical Medicine, Center for Human Immunobiology, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2659-6490","authenticated-orcid":false,"given":"Eric L.","family":"Brown","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Texas Health Science Center, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodrigo","family":"Hasbun","sequence":"additional","affiliation":[{"name":"McGovern Medical School, University of Texas, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristy O.","family":"Murray","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Pediatric Tropical Medicine, Center for Human Immunobiology, Baylor College of Medicine and Texas Children\u2019s Hospital, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1084","DOI":"10.1542\/peds.2008-3278","article-title":"West Nile virus disease in children, United States, 1999\u20132007","volume":"123","author":"Lindsey","year":"2009","journal-title":"Pediatrics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1520\/JFS15307J","article-title":"Fatal meningitis and encephalitis due to Bartonella henselae bacteria","volume":"47","author":"Gerber","year":"2002","journal-title":"J. Forensic Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2329048X19826480","DOI":"10.1177\/2329048X19826480","article-title":"A Rare Case of Bartonella Encephalitis with Hemiplegia","volume":"6","author":"Rosas","year":"2019","journal-title":"Child Neurol. Open"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"713","DOI":"10.4269\/ajtmh.2012.11-0453","article-title":"Fatal Rocky Mountain spotted fever in the United States, 1999-2007","volume":"86","author":"Dahlgren","year":"2012","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.pediatrneurol.2013.09.017","article-title":"Murine typhus as a cause of cognitive impairment: Case report and a review of the literature","volume":"50","author":"Carr","year":"2014","journal-title":"Pediatric Neurol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1089\/vbz.2007.0109","article-title":"Clinical investigation of hospitalized human cases of West Nile virus infection in Houston, Texas, 2002\u20132004","volume":"8","author":"Murray","year":"2008","journal-title":"Vector Borne Zoonotic Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"645","DOI":"10.3201\/eid2304.160958","article-title":"Typhus Group Rickettsiosis, Texas, USA, 2003\u20132013","volume":"23","author":"Murray","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.3201\/eid2210.160115","article-title":"Cat-Scratch Disease in the United States, 2005\u20132013","volume":"22","author":"Nelson","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.5194\/hess-11-1633-2007","article-title":"Updated world map of the Koppen-Geiger climate classification","volume":"11","author":"Peel","year":"2007","journal-title":"Hydrol. Earth Syst. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.1017\/S0950268811002494","article-title":"Completeness of West Nile virus testing in patients with meningitis and encephalitis during an outbreak in Arizona, USA","volume":"140","author":"Weber","year":"2012","journal-title":"Epidemiol. Infect."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1587","DOI":"10.3201\/eid2209.152050","article-title":"Use of Testing for West Nile Virus and Other Arboviruses","volume":"22","author":"Vanichanan","year":"2016","journal-title":"Emerg. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e20192543","DOI":"10.1542\/peds.2019-2543","article-title":"Infectious and Autoimmune Causes of Encephalitis in Children","volume":"145","author":"Erickson","year":"2020","journal-title":"Pediatrics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1086\/656602","article-title":"West Nile fever characteristics among viremic persons identified through blood donor screening","volume":"202","author":"Zou","year":"2010","journal-title":"J. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/S0140-6736(01)05480-0","article-title":"Epidemic West Nile encephalitis, New York, 1999: Results of a household-based seroepidemiological survey","volume":"358","author":"Mostashari","year":"2001","journal-title":"Lancet"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"325","DOI":"10.3201\/eid2502.180765","article-title":"Cumulative Incidence of West Nile Virus Infection, Continental United States, 1999\u20132016","volume":"25","author":"Ronca","year":"2019","journal-title":"Emerg. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"684","DOI":"10.3201\/eid1804.111313","article-title":"Neuroinvasive disease and West Nile virus infection, North Dakota, USA, 1999\u20132008","volume":"18","author":"Carson","year":"2012","journal-title":"Emerg. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.3201\/eid1111.040933","article-title":"West Nile virus epidemic, northeast Ohio, 2002","volume":"11","author":"Mandalakas","year":"2005","journal-title":"Emerg. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.jpeds.2006.11.023","article-title":"Clinical and laboratory features, hospital course, and outcome of Rocky Mountain spotted fever in children","volume":"150","author":"Buckingham","year":"2007","journal-title":"J. Pediatr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1001\/archpedi.1991.02160010104026","article-title":"Cat-scratch disease. Acute encephalopathy and other neurologic manifestations","volume":"145","author":"Carithers","year":"1991","journal-title":"Am. J. Dis. Child"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/0002-9343(60)90029-2","article-title":"Central nervous system syndromes of \u201cvital\u201d etiology. A study of 713 cases","volume":"29","author":"Meyer","year":"1960","journal-title":"Am. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e642","DOI":"10.1542\/peds.2014-0498","article-title":"Neuroinvasive arboviral disease in the United States: 2003 to 2012","volume":"134","author":"Gaensbauer","year":"2014","journal-title":"Pediatrics"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1086\/509330","article-title":"Beyond viruses: Clinical profiles and etiologies associated with encephalitis","volume":"43","author":"Glaser","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1001\/archpedi.155.3.396","article-title":"Clinical, laboratory, and epidemiologic features of murine typhus in 97 Texas children","volume":"155","author":"Whiteford","year":"2001","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_24","unstructured":"(2021, December 05). 2020 National Notifiable Conditions. Centers for Disease Control and Prevention, Available online: https:\/\/wwwn.cdc.gov\/nndss\/conditions\/notifiable\/2020\/."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.jcv.2017.07.016","article-title":"Aseptic meningitis in adults and children: Diagnostic and management challenges","volume":"94","author":"Shukla","year":"2017","journal-title":"J. Clin. Virol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/0002-9343(86)90023-9","article-title":"Eosinophilic meningitis caused by Rocky Mountain spotted fever","volume":"80","author":"Crennan","year":"1986","journal-title":"Am. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s004150050264","article-title":"Murine typhus presenting as subacute meningoencephalitis","volume":"245","author":"Masalha","year":"1998","journal-title":"J. Neurol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1086\/319351","article-title":"Epidemic typhus meningitis in the southwestern United States","volume":"32","author":"Massung","year":"2001","journal-title":"Clin. Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.3201\/eid2312.170631","article-title":"Newly Recognized Pediatric Cases of Typhus Group Rickettsiosis, Houston, Texas, USA","volume":"23","author":"Erickson","year":"2017","journal-title":"Emerg. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1001\/jama.1991.03470100057033","article-title":"Clinical and laboratory features of murine typhus in south Texas, 1980 through 1987","volume":"266","author":"Dumler","year":"1991","journal-title":"JAMA"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1086\/444506","article-title":"Characteristics of the rash associated with West Nile virus fever","volume":"41","author":"Ferguson","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1016\/S0190-9622(99)70337-3","article-title":"Unusual eruption as a presenting symptom of cat scratch disease","volume":"41","author":"Landau","year":"1999","journal-title":"J. Am. Acad. Derm."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/00001648-199001000-00010","article-title":"No adjustments are needed for multiple comparisons","volume":"1","author":"Rothman","year":"1990","journal-title":"Epidemiology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1093\/oxfordjournals.aje.a117737","article-title":"Multiple comparisons and related issues in the interpretation of epidemiologic data","volume":"142","author":"Savitz","year":"1995","journal-title":"Am. J. Epidemiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1060","DOI":"10.1007\/s11606-013-2755-z","article-title":"Six persistent research misconceptions","volume":"29","author":"Rothman","year":"2014","journal-title":"J. Gen. Intern. Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1007\/s00415-019-09229-9","article-title":"Lack of accuracy of the international classification of disease, ninth (ICD-9) codes in identifying patients with encephalitis","volume":"266","author":"Samannodi","year":"2019","journal-title":"J. Neurol."},{"key":"ref_37","unstructured":"(2021, October 26). Texas Children\u2019s Annual Report. Available online: https:\/\/texaschildrensannualreport.org\/numbers.html."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1093\/cid\/cit458","article-title":"Case definitions, diagnostic algorithms, and priorities in encephalitis: Consensus statement of the international encephalitis consortium","volume":"57","author":"Venkatesan","year":"2013","journal-title":"Clin. Infect. Dis."},{"key":"ref_39","unstructured":"(2018). CDC\/NHSN Surveillance Definitions for Specific Types of Infections. National Healthcare Safety Network (NHSN) Patient Safety Component Manual, Centers for Disease Control and Prevention."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1097\/INF.0000000000001954","article-title":"Murine Typhus in South Texas Children: An 18-year Review","volume":"37","author":"Howard","year":"2018","journal-title":"Pediatric Infect. Dis. J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.3201\/eid2605.191505","article-title":"Rise in Murine Typhus in Galveston County, Texas, USA, 2018","volume":"26","author":"Ruiz","year":"2020","journal-title":"Emerg. Infect. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.3201\/eid2308.161861","article-title":"Acute Febrile Illness and Complications Due to Murine Typhus, Texas, USA","volume":"23","author":"Afzal","year":"2017","journal-title":"Emerg. Infect. Dis."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/11\/5\/501\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:58:44Z","timestamp":1760137124000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/11\/5\/501"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,22]]},"references-count":42,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["pathogens11050501"],"URL":"https:\/\/doi.org\/10.3390\/pathogens11050501","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,22]]}}}