• West Nile virus infection and variable physical, functional, or cognitive disability, which may persist for months or years or be permanent.

Limited or Suggestive Evidence of an Association

The evidence from available studies suggests an association between exposure to a specific agent and a specific health outcome in human studies, but the body of evidence is limited by the inability to rule out chance and bias, including confounding, with confidence. For example, at least one high-quality study reports an association that is sufficiently free of bias, including adequate control for confounding. Other corroborating studies provide support for the association, but they were not sufficiently free of bias, including confounding. Alternatively, several studies of less quality show consistent associations, and the results are probably not due to bias, including confounding.

The committee concludes that there is limited or suggestive evidence of an association between

  • Brucellosis and

    • Myelitis-radiculoneuritis, demyelinating meningovascular syndromes, deafness, sensorineural hearing loss, and GBS.

    • Papilledema, optic neuritis, episcleritis, nummular keratitis, and multifocal choroiditis.

    • Fatigue, inattention, amnesia, and depression.

  • Campylobacter jejuni infection and development of uveitis if uveitis is manifest within 1 month of infection.

  • Coxiella burnetii infection and post-Q-fever chronic fatigue syndrome years after the primary infection.

  • Plasmodium falciparum infection and neurologic disease, neuropsychiatric disease, or both months to years after the acute infection.

  • Plasmodium vivax and Plasmodium falciparum infections and demyelinating polyneuropathy and GBS.

Inadequate or Insufficient Evidence to Determine Whether an Association Exists

The evidence from available studies is of insufficient quantity, quality, or consistency to permit a conclusion regarding the existence of an association between exposure to a specific agent and a specific health outcome in humans.

For some potential long-term adverse health outcomes of the nine identified diseases, the evidence of an association is inadequate, insufficient, or both. The committee presents these potential long-term adverse health outcomes and their characteristics in tabular form in the body of the report.



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