Widespread Availability of Artemisinin Monotherapy in the United States

horses and 1 from Cx. tarsalis mosquitoes. Notably, our sequence is distantly related to GQ287646, which was isolated from Culex spp. mosquitoes in Chaco, Argentina. The nucleotide sequence of the positive control VEEV-Tc83 is correctly placed in the VEEV clade. Clinical and laboratory fi ndings showed that the illness described here was compatible with viral encephalitis. Using a generic RT-PCR assay on an early CSF sample, we amplifi ed a partial sequence (NSP4 gene) of an alphavirus. Phylogenetic analyses showed that the patient’s sequence grouped with sequences from WEEV, with high statistical support. A second RT-PCR assay on the NSP1 gene enabled us to obtain an amplifi cation of 208 bp, which is consistent with the expected size for WEEV. Therefore, we concluded that the fatal disease was likely caused by WEEV. Since the 1970s, to our knowledge, the presence of WEEV (or other alphaviruses) in Uruguay has not been documented. Moreover, no recent reports have been made of genome detection of WEEV in encephalitis cases in the region. Although the case described here may be rare, the etiology of many viral encephalitides in Uruguay remains unknown. Serologic studies in horses and studies to detect arboviruses in mosquito populations are being conducted to investigate the status of arbovirus infections in Uruguay.