1
|
Nikolić N, Poluga J, Milošević I, Todorović N, Filipović A, Jegorović B, Mitrović N, Karić U, Gmizić I, Stevanović G, Milošević B. Neurological and neuromuscular manifestations in patients with West Nile neuroinvasive disease, Belgrade area, Serbia, season 2022. Neurol Sci 2024; 45:719-726. [PMID: 37606743 DOI: 10.1007/s10072-023-07025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION We aimed to describe neurological manifestations and functional outcome at discharge in patients with West Nile neuroinvasive disease. METHODS This retrospective study enrolled inpatients treated in the University Clinic for Infectious and Tropical Diseases in Belgrade, Serbia, from 1 June until 31 October 2022. Functional outcome at discharge was assessed using modified Rankin scale. RESULTS Among the 135 analyzed patients, encephalitis, meningitis and acute flaccid paralysis (AFP) were present in 114 (84.6%), 20 (14.8%), and 21 (15.6%), respectively. Quadriparesis/quadriplegia and monoparesis were the most frequent forms of AFP, present in 9 (6.7%) and 6 (4.4%) patients, respectively. Fourty-five (33.3%) patients had cerebellitis, 80 (59.3%) had rhombencephalitis, and 5 (3.7%) exhibited Parkinsonism. Ataxia and wide-based gait were present in 79 (58.5%) patients each. Fifty-one (37.8%) patients had tremor (41 (30.3%) had postural and/or kinetic tremor, 10 (7.4%) had resting tremor). Glasgow coma score (GCS) ≤ 8 and respiratory failure requiring mechanical ventilation developed in 39 (28.9%), and 33 (24.4%) patients, respectively. Quadriparesis was a risk factor for prolonged ventilator support (29.5 ± 16.8 vs. 12.4 ± 8.7 days, p = 0.001). At discharge, one patient with monoparesis recovered full muscle strength, whereas 8 patients with AFP were functionally dependent. Twenty-nine (21.5%) patients died. All of the succumbed had encephalitis, and 7 had quadriparesis. Ataxia, tremor and cognitive deficit persisted in 18 (16.9%), 15 (14.2%), and 22 (16.3%) patients at discharge, respectively. Age, malignancy, coronary disease, quadriparesis, mechanical ventilation, GCS ≤ 8 and healthcare-associated infections were risk factors for death (p = 0.001; p = 0.019; p = 0.004; p = 0.001; p < 0.001; p < 0.001, and p < 0.001, respectively).
Collapse
Affiliation(s)
- Nataša Nikolić
- University Clinic for Infectious and Tropical Diseases of the University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jasmina Poluga
- University Clinic for Infectious and Tropical Diseases of the University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Milošević
- University Clinic for Infectious and Tropical Diseases of the University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nevena Todorović
- University Clinic for Infectious and Tropical Diseases of the University Clinical Centre of Serbia, Belgrade, Serbia
| | - Ana Filipović
- University Clinic for Infectious and Tropical Diseases of the University Clinical Centre of Serbia, Belgrade, Serbia
| | - Boris Jegorović
- University Clinic for Infectious and Tropical Diseases of the University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Mitrović
- University Clinic for Infectious and Tropical Diseases of the University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Uroš Karić
- University Clinic for Infectious and Tropical Diseases of the University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Gmizić
- University Clinic for Infectious and Tropical Diseases of the University Clinical Centre of Serbia, Belgrade, Serbia
| | - Goran Stevanović
- University Clinic for Infectious and Tropical Diseases of the University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Branko Milošević
- University Clinic for Infectious and Tropical Diseases of the University Clinical Centre of Serbia, Belgrade, Serbia.
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
| |
Collapse
|
2
|
Rosenheck MS, Higham C, Sanzone K, Caprio C. New-onset Bell's palsy after neuroinvasive West Nile virus. BMJ Case Rep 2022; 15:e249770. [PMID: 35835481 PMCID: PMC9289023 DOI: 10.1136/bcr-2022-249770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In this case report, a patient was diagnosed with new-onset Bell's palsy 3 weeks after the onset of neuroinvasive West Nile virus. This was the second case report of West Nile virus-associated Bell's palsy, highlighting the need to monitor these patients for peripheral neuropathies. This case report is also intended to raise awareness about the prevalence of West Nile virus in the USA.
Collapse
Affiliation(s)
| | | | - Kaitlin Sanzone
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Colleen Caprio
- Internal Medicine, Cooper University Health Care, Camden, New Jersey, USA
| |
Collapse
|
3
|
Bougossa R, Chelli J, Arfa S, Machraoui R, Berriche O, Larbi F. Association des manifestations neurologiques rares à West Nile virus chez un patient immunocompétent. Rev Med Interne 2022; 43:381-384. [DOI: 10.1016/j.revmed.2022.03.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 11/29/2022]
|
4
|
Onisiforou A, Spyrou GM. Identification of viral-mediated pathogenic mechanisms in neurodegenerative diseases using network-based approaches. Brief Bioinform 2021; 22:bbab141. [PMID: 34237135 PMCID: PMC8574625 DOI: 10.1093/bib/bbab141] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/01/2021] [Accepted: 03/23/2021] [Indexed: 12/18/2022] Open
Abstract
During the course of a viral infection, virus-host protein-protein interactions (PPIs) play a critical role in allowing viruses to replicate and survive within the host. These interspecies molecular interactions can lead to viral-mediated perturbations of the human interactome causing the generation of various complex diseases. Evidences suggest that viral-mediated perturbations are a possible pathogenic etiology in several neurodegenerative diseases (NDs). These diseases are characterized by chronic progressive degeneration of neurons, and current therapeutic approaches provide only mild symptomatic relief; therefore, there is unmet need for the discovery of novel therapeutic interventions. In this paper, we initially review databases and tools that can be utilized to investigate viral-mediated perturbations in complex NDs using network-based analysis by examining the interaction between the ND-related PPI disease networks and the virus-host PPI network. Afterwards, we present our theoretical-driven integrative network-based bioinformatics approach that accounts for pathogen-genes-disease-related PPIs with the aim to identify viral-mediated pathogenic mechanisms focusing in multiple sclerosis (MS) disease. We identified seven high centrality nodes that can act as disease communicator nodes and exert systemic effects in the MS-enriched Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways network. In addition, we identified 12 KEGG pathways, 5 Reactome pathways and 52 Gene Ontology Immune System Processes by which 80 viral proteins from eight viral species might exert viral-mediated pathogenic mechanisms in MS. Finally, our analysis highlighted the Th17 differentiation pathway, a disease communicator node and part of the 12 underlined KEGG pathways, as a key viral-mediated pathogenic mechanism and a possible therapeutic target for MS disease.
Collapse
Affiliation(s)
- Anna Onisiforou
- Department of Bioinformatics, Cyprus Institute of Neurology & Genetics, and the Cyprus School of Molecular Medicine, Cyprus
| | - George M Spyrou
- Department of Bioinformatics, Cyprus Institute of Neurology & Genetics, and professor at the Cyprus School of Molecular Medicine, Cyprus
| |
Collapse
|
5
|
Lenka A, Kamat A, Mittal SO. Spectrum of Movement Disorders in Patients With Neuroinvasive West Nile Virus Infection. Mov Disord Clin Pract 2019; 6:426-433. [PMID: 31392241 DOI: 10.1002/mdc3.12806] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/28/2019] [Accepted: 06/05/2019] [Indexed: 11/05/2022] Open
Abstract
Background West Nile virus (WNV) is a flavivirus that is recognized as one of the common causes of arboviral neurological disease in the world. WNV infections usually manifest with constitutional symptoms such as fever, fatigue, myalgia, rash, arthralgia, and headache. Neuroinvasive WNV infections are characterized by signs and symptoms suggestive of meningitis, encephalitis, meningoencephalitis, and acute flaccid paralysis. In addition, many patients with neuroinvasive WNV infection develop a wide range of movement disorders. This article aims to comprehensively review the spectrum and natural course of the movement disorders observed in patients with neuroinvasive WNV infections. Methods A literature search was performed in March 2019 (in PubMed and EMBASE) to identify articles for this review. Results Movement disorders observed in the context of WNV infections include tremor, opsoclonus-myoclonus, parkinsonism, myoclonus, ataxia, and chorea. Most often, these movement disorders resolve within a few weeks to months with an indolent course. The commonly observed tremor phenotypes include action tremor of the upper extremities (bilateral > unilateral). Tremor in patients with West Nile meningitis subsides earlier than that in patients with West Nile encephalitis/acute flaccid paralysis. Opsoclonus-myoclonus in WNV infections responds well to intravenous immunoglobulins/plasmapheresis/corticosteroids. Parkinsonism has been reported to be mild in nature and usually lasts for a few weeks to months in the majority of the patients. Conclusion A wide spectrum of movement disorders is observed in neuroinvasive WNV infections. Longitudinal studies are warranted to obtain better insights into the natural course of these movement disorders.
Collapse
Affiliation(s)
- Abhishek Lenka
- Department of Neurology MedStar Georgetown University Hospital Washington DC USA
| | - Anuja Kamat
- Department of Internal Medicine Texas Tech University Health Sciences Center Amarillo TX USA
| | - Shivam Om Mittal
- Department of Neurology Cleveland Clinic Abu Dhabi United Arab Emirates
| |
Collapse
|
6
|
Radu RA, Terecoasă EO, Ene A, Băjenaru OA, Tiu C. Opsoclonus-Myoclonus Syndrome Associated With West-Nile Virus Infection: Case Report and Review of the Literature. Front Neurol 2018; 9:864. [PMID: 30386288 PMCID: PMC6198716 DOI: 10.3389/fneur.2018.00864] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/25/2018] [Indexed: 12/29/2022] Open
Abstract
Opsoclonus-myoclonus syndrome (OMS) is a very rare condition with different autoimmune, infectious and paraneoplastic aetiologies or in most cases idiopathic. We report the case of a 75-year-old woman who was admitted in our department in early fall for altered mental status, opsoclonus, multifocal myoclonus, truncal titubation and generalized tremor, preceded by a 5 day prodrome consisting of malaise, nausea, fever and vomiting. Brain computed tomography and MRI scans showed no significant abnormalities and cerebrospinal fluid changes consisted of mildly increased protein content and number of white cells. Work-up for paraneoplastic and autoimmune causes of OMS was negative but serologic tests identified positive IgM and IgG antibodies against West Nile virus (WNV). The patient was treated with Dexamethasone and Clonazepam with progressive improvement of mental status, myoclonus, opsoclonus and associated neurologic signs. Six months after the acute illness she had complete recovery. To our knowledge this is the 14th case of WNV associated OMS reported in the literature so far. We briefly describe the clinical course of the other reported cases together with the different treatment strategies that have been employed.
Collapse
Affiliation(s)
- Răzvan Alexandru Radu
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania.,Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Elena Oana Terecoasă
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania.,Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Amalia Ene
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania
| | - Ovidiu Alexandru Băjenaru
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania.,Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Cristina Tiu
- Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania.,Department of Clinical Neurosciences, University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| |
Collapse
|
7
|
Abstract
Although long recognized as a human pathogen, West Nile virus (WNV) emerged as a significant public health problem following its introduction and spread across North America. Subsequent years have seen a greater understanding of all aspects of this viral infection. The North American epidemic resulted in a further understanding of the virology, pathogenesis, clinical features, and epidemiology of WNV infection. Approximately 80% of human WNV infections are asymptomatic. Most symptomatic people experience an acute systemic febrile illness; less than 1% of infected people develop neuroinvasive disease, which typically manifests as meningitis, encephalitis, or anterior myelitis resulting in acute flaccid paralysis. Older age is associated with more severe illness and higher mortality; other risk factors for poor outcome have been challenging to identify. In addition to natural infection through mosquito bites, transfusion- and organ transplant-associated infections have occurred. Since there is no definitive treatment for WNV infection, protection from mosquito bites and other preventative measures are critical. WNV has reached an endemic pattern in North America, but the future epidemiologic pattern is uncertain.
Collapse
|
8
|
David S, Abraham AM. Epidemiological and clinical aspects on West Nile virus, a globally emerging pathogen. Infect Dis (Lond) 2016; 48:571-86. [PMID: 27207312 DOI: 10.3109/23744235.2016.1164890] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Since the isolation of West Nile virus (WNV) in 1937, in Uganda, it has spread globally, causing significant morbidity and mortality. While birds serve as amplifier hosts, mosquitoes of the Culex genus function as vectors. Humans and horses are dead end hosts. The clinical manifestations of West Nile infection in humans range from asymptomatic illness to West Nile encephalitis. METHODS The laboratory offers an array of tests, the preferred method being detection of RNA and serum IgM for WNV, which, if detected, confirms the clinical diagnosis. Although no definitive antiviral therapy and vaccine are available for humans, many approaches are being studied. STUDY This article will review the current literature of the natural cycle, geographical distribution, virology, replication cycle, molecular epidemiology, pathogenesis, laboratory diagnosis, clinical manifestations, blood donor screening for WNV, treatment, prevention and vaccines.
Collapse
Affiliation(s)
- Shoba David
- a Department of Clinical Virology , Christian Medical College , Vellore , Tamil Nadu , India
| | - Asha Mary Abraham
- a Department of Clinical Virology , Christian Medical College , Vellore , Tamil Nadu , India
| |
Collapse
|
9
|
Blázquez AB, Martín-Acebes MA, Saiz JC. Inhibition of West Nile Virus Multiplication in Cell Culture by Anti-Parkinsonian Drugs. Front Microbiol 2016; 7:296. [PMID: 27014219 PMCID: PMC4779909 DOI: 10.3389/fmicb.2016.00296] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/23/2016] [Indexed: 12/14/2022] Open
Abstract
West Nile virus (WNV) is a mosquito-borne flavivirus maintained in a transmission cycle between mosquitoes and birds, but it can also infect other vertebrates, including humans, in which it can cause neuroinvasive diseases. To date, no licensed vaccine or therapy for human use against this pathogen is yet available. A recent approach to search for new antiviral agent candidates is the assessment of long-used drugs commonly administered by clinicians to treat human disorders in drug antiviral development. In this regard, as patients with West Nile encephalitis frequently develop symptoms and features of parkinsonism, and cellular factors altered in parkinsonism, such as alpha-synuclein, have been shown to play a role on WNV infection, we have assessed the effect of four drugs (L-dopa, Selegiline, Isatin, and Amantadine), that are used as therapy for Parkinson's disease in the inhibition of WNV multiplication. L-dopa, Isatin, and Amantadine treatments significantly reduced the production of infectious virus in all cell types tested, but only Amantadine reduced viral RNA levels. These results point to antiparkinsonian drugs as possible therapeutic candidates for the development of antiviral strategies against WNV infection.
Collapse
Affiliation(s)
- Ana B Blázquez
- Department of Biotechnology, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria Madrid, Spain
| | - Miguel A Martín-Acebes
- Department of Biotechnology, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria Madrid, Spain
| | - Juan-Carlos Saiz
- Department of Biotechnology, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria Madrid, Spain
| |
Collapse
|
10
|
Mora A, Arroyo M, Gummelt KL, Colbert G, Ursales AL, Van Vrancken MJ, Snipes GJ, Guileyardo JM, Columbus C. West Nile virus and the 2012 outbreak: The Baylor University Medical Center experience. Proc (Bayl Univ Med Cent) 2015; 28:291-5. [PMID: 26130870 DOI: 10.1080/08998280.2015.11929253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
West Nile virus (WNV) has been responsible for multiple outbreaks and has shown evolution in its clinical manifestation. The Centers for Disease Control and Prevention has provided diagnostic criteria in classifying the variety of WNV infection; however, application of these criteria can prove challenging during outbreaks, and understanding the array of presentations and patient population is clinically important. In this article, we present the challenges encountered during the 2012 outbreak at one institution.
Collapse
Affiliation(s)
- Adan Mora
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - Mariangeli Arroyo
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - Kyle L Gummelt
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - Gates Colbert
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - Anna L Ursales
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - Michael J Van Vrancken
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - George J Snipes
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - Joseph M Guileyardo
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| | - Cristie Columbus
- Division of Pulmonary Disease (Mora), Department of Internal Medicine (Arroyo, Gummelt, Colbert, Ursales), Department of Pathology (Van Vrancken, Snipes, Guileyardo), and Division of Infectious Diseases (Columbus), Baylor University Medical Center at Dallas
| |
Collapse
|
11
|
Sejvar JJ. Clinical manifestations and outcomes of West Nile virus infection. Viruses 2014; 6:606-23. [PMID: 24509812 PMCID: PMC3939474 DOI: 10.3390/v6020606] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/20/2014] [Accepted: 01/21/2014] [Indexed: 12/12/2022] Open
Abstract
Since the emergence of West Nile virus (WNV) in North America in 1999, understanding of the clinical features, spectrum of illness and eventual functional outcomes of human illness has increased tremendously. Most human infections with WNV remain clinically silent. Among those persons developing symptomatic illness, most develop a self-limited febrile illness. More severe illness with WNV (West Nile neuroinvasive disease, WNND) is manifested as meningitis, encephalitis or an acute anterior (polio) myelitis. These manifestations are generally more prevalent in older persons or those with immunosuppression. In the future, a more thorough understanding of the long-term physical, cognitive and functional outcomes of persons recovering from WNV illness will be important in understanding the overall illness burden.
Collapse
Affiliation(s)
- James J Sejvar
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| |
Collapse
|
12
|
|
13
|
Abstract
IMPORTANCE Since its introduction in North America in 1999, West Nile virus has produced the 3 largest arboviral neuroinvasive disease outbreaks ever recorded in the United States. OBJECTIVE To review the ecology, virology, epidemiology, clinical characteristics, diagnosis, prevention, and control of West Nile virus, with an emphasis on North America. EVIDENCE REVIEW PubMed electronic database was searched through February 5, 2013. United States national surveillance data were gathered from the Centers for Disease Control and Prevention. FINDINGS West Nile virus is now endemic throughout the contiguous United States, with 16,196 human neuroinvasive disease cases and 1549 deaths reported since 1999. More than 780,000 illnesses have likely occurred. To date, incidence is highest in the Midwest from mid-July to early September. West Nile fever develops in approximately 25% of those infected, varies greatly in clinical severity, and symptoms may be prolonged. Neuroinvasive disease (meningitis, encephalitis, acute flaccid paralysis) develops in less than 1% but carries a fatality rate of approximately 10%. Encephalitis has a highly variable clinical course but often is associated with considerable long-term morbidity. Approximately two-thirds of those with paralysis remain with significant weakness in affected limbs. Diagnosis usually rests on detection of IgM antibody in serum or cerebrospinal fluid. Treatment is supportive; no licensed human vaccine exists. Prevention uses an integrated pest management approach, which focuses on surveillance, elimination of mosquito breeding sites, and larval and adult mosquito management using pesticides to keep mosquito populations low. During outbreaks or impending outbreaks, emphasis shifts to aggressive adult mosquito control to reduce the abundance of infected, biting mosquitoes. Pesticide exposure and adverse human health events following adult mosquito control operations for West Nile virus appear negligible. CONCLUSIONS AND RELEVANCE In North America, West Nile virus has and will remain a formidable clinical and public health problem for years to come.
Collapse
Affiliation(s)
- Lyle R Petersen
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, US Public Health Service, Department of Health and Human Services, Fort Collins, Colorado 80521, USA.
| | | | | |
Collapse
|
14
|
Abstract
Since its introduction to North America in 1999, West Nile virus, an arthropod-borne flavivirus, has become the most significant cause of epidemic encephalitis in the western hemisphere. While most human infections with the virus are asymptomatic and the majority of symptomatic persons experience febrile illness, severe neurologic manifestations, including meningitis, encephalitis, and poliomyelitis may be seen. This review summarizes the virology, epidemiology and pathogenesis of human infection with West Nile virus, and details recent advances in our understanding of the pathophysiology and various clinical manifestations of infection.
Collapse
Affiliation(s)
- James J Sejvar
- Division of Vector-Borne Infectious Diseases and Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases (NCID), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA.
| | | |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW This article reviews recent developments in West Nile encephalitis. Because of the large number of individuals infected in the United States, an expanded spectrum of the disease has been recognized. Flaccid paralysis presenting as poliomyelitis-like syndrome is being increasingly recognized. RECENT FINDINGS Since 1999, West Nile encephalitis in the United States has involved thousands of patients providing an opportunity to observe the protean manifestations of the virus. Recently, ophthalmological manifestations have been described that appear to be common and specific for the virus. Clinicians in endemic areas should be careful to distinguish between West Nile encephalitis and its mimics. The virus may occur in patients with underlying disorders that have encephalopathy as a clinical feature, and clinicians should test for the virus during the mosquito season, even in patients that appear to have an explanation for their encephalopathy. West Nile encephalitis may present as viral aseptic meningitis, meningoencephalitis, or encephalitis. Muscle weakness may or may not accompany any of these clinical variants. This virus may be transmitted via blood transfusion. SUMMARY Clinical manifestations of West Nile encephalitis continue to expand following each year's outbreaks. New neurologic and ophthalmologic manifestations continue to be described. Because of the protean manifestations, testing should be carried out during mosquito season, even in patients that have another explanation for their encephalopathy. There is no effective therapy. Flaccid paralysis may be prolonged/permanent. Prognosis may be related to the degree of relative lymphopenia on presentation, the degree of elevation of serum ferritin levels and advanced age. The course of West Nile encephalitis and its clinical manifestations are the same in normal and compromised hosts.
Collapse
Affiliation(s)
- Burke A Cunha
- Infectious Disease Division, Winthrop-University Hospital, Mineola, New York 11501, USA
| |
Collapse
|
16
|
|