No Evidence of Dengue Virus Circulation in Rural Gabon

patient subsequently reported that her stuttering had ceased. A high degree of clinical suspicion for WNV infection should be considered in patients with a recent history of mosquito bites and an acute febrile illness associated with neurologic signs and symptoms (5). Typical CSF fi ndings of infection with WNV include lymphocytic pleocytosis, elevated protein level, reference glucose and lactic acid levels, and no erythrocytes (6). The clinical presentation of WNV infection varied widely from asymptomatic seroconversion to fatal encephalitis. It is possible, but unlikely, that the stuttering in the patient was an indication of a migraine aura. Initially, the patient reported that the headache might have been a migraine, but later reported that its associated symptoms, e.g., photophobia, were not as severe and did not last as long as her usual migraines. Further argument against migraine aura is the lack of response to her migraine medication and the fact that the stuttering continued after the headache resolved. Because WNV resembles JEV, it is interesting to note that a case of stuttering in a young adult infected with JEV has been reported (7). However, the mechanism of stuttering associated with WNV is unknown. One possible explanation is myoclonic contractions of the tongue, i.e., vocal myoclonus.