Prolonged Detection of Japanese Encephalitis Virus in Urine and Whole Blood in a Returned Short-term Traveler

Huang, G Khai Lin; Tio, Shio Yen; Caly, Leon; Nicholson, Suellen; Thevarajan, Irani; Papadakis, Georgina; Catton, Mike; Tong, Steven Y C; Druce, Julian

A previously well 69-year-old Australian man traveled to Thailand in early May 2017. The planned duration of travel was 12 days, and he did not attend a travel clinic prior to departure. The patient did not take malaria chemoprophylaxis, nor did he have a prior history of Japanese encephalitis virus (JEV) vaccination. He flew to Phuket, before traveling north to the popular tourist destination of Khao Lak, where he stayed in a beachside holiday resort. Heavy rainfall occurred during the trip, which limited holiday activities. He did not travel to rural or remote areas, but did receive numerous mosquito bites. On the eighth day of travel, he became unwell with lethargy and generalized muscle aches. He flew to Bangkok on the ninth day of the trip, and over the following 3 days his symptoms included ongoing lethargy, poor appetite, and drenching sweats, but no headache, meningism, or confusion. He returned to Australia on day 12 of travel and was admitted to a regional hospital the following day, now the fifth day after symptoms commenced ( Figure 1 ).