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The peripheral white blood cell count is variable Cerebrospinal fluid protein is elevated; cerebrospinal fluid glucose is normal; there is usually a lymphocytic pleocytosis; and polymorphonuclear cells may predominate early The diagnosis of arboviral encephalitides including West Nile fever depends on serologic tests For West Nile virus, an IgM capture ELISA can be done on either serum or cerebrospinal fluid and is almost always positive by the time the disease is clinically evident The virus is also detectable in urine and blood using PCR but only during limited intervals, thus limiting PCR as a diagnostic assay There is cross-reaction among the different flaviviruses, so a plaque reduction assay may be needed to definitively distinguish between West Nile fever and St Louis encephalitis Serum IgM may be positive for many months after acute infection, so an increase in antibody titer between acute and convalescent samples is necessary to confirm acute infection when cerebrospinal fluid samples are unavailable CT scans of the brain usually show no acute disease, but MRI may reveal leptomeningeal, basal ganglia, thalamic, or periventricular enhancement

Mild forms of encephalitis must be differentiated from aseptic meningitis, lymphocytic choriomeningitis, and nonparalytic poliomyelitis Severe forms of arbovirus encephalitides (Table 32 2) are to be differentiated from other causes of viral encephalitis (HSV, mumps virus, poliovirus or other enteroviruses, HIV), encephalitis accompanying exanthematous diseases of childhood (measles, varicella, infectious mononucleosis, rubella), encephalitis following vaccination (a demyelinating type following rabies, measles, pertussis), toxic encephalitis (from drugs, poisons, or bacterial toxins such as Shigella dysenteriae

At the first level of design, you ll think about how these objects interact and what their state, capabilities, and responsibilities are: State A programmer refers to the current conditions and values of an object as that object s state For example, you might have an object representing a customer..

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The symptoms of arboviral encephalitis include fever, malaise, sore throat, headache, gastrointestinal upset, lethargy, and stupor progressing to coma Stiff neck and mental status changes are the most common neurologic signs Seizures are present in 5% of patients and flaccid paralysis is seen in 10% Other signs include tremors, convulsions, cranial nerve palsies, paralysis of extremities, and pathologic reflexes About

Centers for Disease Control and Prevention (CDC) West Nile virus activity United States, January 1 November 7, 2006 MMWR Morb Mortal Wkly Rep 2006 Nov 10;55(44):1204 5 [PMID: 17093387] Gea-Banacloche J et al West Nile virus: pathogenesis and therapeutic options Ann Intern Med 2004 Apr 6;140(7): 545 53 [PMID: 15068983] Hayes EB et al Epidemiology and ecology of West Nile virus Emerg Infect Dis 2005 Aug;11(8):1167 73 [PMID: 16102302] Hayes EB et al Virology, pathology, and clinical manifestations of West Nile virus disease Emerg Infect Dis 2005 Aug;11(8): 1174 9 [PMID: 16102303]

type 1), Reye s syndrome, and severe forms of stroke, brain tumors, brain abscess, autoimmune processes such as lupus cerebritis, and intoxications In the California Encephalitis Project, the cause for most cases of encephalitis was not identified

The customer s state includes the customer s address, phone number, and email, as well as the customer s credit rating, recent purchase history, and so forth. A different customer would have different state. Capabilities The customer has many capabilities, but a developer cares about modeling only those that are relevant to the problem domain. Thus, a customer object might be able to make a deposit, transfer funds, withdraw cash, and so forth. Responsibilities Along with capabilities come responsibilities. The customer object is responsible for managing its own address. In a well-designed program, no other object needs to know the details of the customer s address. The address might be stored as data within the customer object, or it might be stored in a database, but it is up to the customer object to know how to retrieve and update her own address. (The monthly-statement object should not know the customer s address, though it might ask the customer object for the customer address. This way, when the customer moves, the responsibility for knowing the new address is located in a single object: the customer.) This ability for an object to own responsibility for its own internal state and actions is known as encapsulation. Of course, all of the objects in your program are just metaphors for the objects in your problem domain.

Bronchial pneumonia, urinary retention and infection, prolonged weakness, and decubitus ulcers may occur Late sequelae are fatigue, extremity weakness, mental deterioration, parkinsonism, and epilepsy in both mild and severe disease

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