1
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Maramattom BV, Philips G. Acute Parkinsonism with West Nile Virus Infection. Ann Indian Acad Neurol 2023; 26:801-803. [PMID: 38022432 PMCID: PMC10666871 DOI: 10.4103/aian.aian_539_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
| | - Geetha Philips
- Department of Internal Medicine, Aster Neurosciences, Kochi, Kerala, India
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2
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Moreno-Reina C, Martínez-Moya M, Piñero-González de la Peña P, Caro-Domínguez P. Neuroinvasive disease due to West Nile virus: Clinical and imaging findings associated with a re-emerging pathogen. RADIOLOGIA 2022; 64:473-483. [PMID: 36243447 DOI: 10.1016/j.rxeng.2021.06.007] [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: 12/12/2020] [Accepted: 06/21/2021] [Indexed: 06/16/2023]
Abstract
The West Nile virus (WNV) is an arbovirus than can infect human beings and cause severe neuroinvasive disease. Taking the outbreak that occurred in Spain in 2020 as a reference, this article reviews the clinical and imaging findings for neuroinvasive disease due to WNV. We collected demographic, clinical, laboratory, and imaging (CT and MRI) variables for 30 patients with WNV infection diagnosed at our center. The main clinical findings were fever, headache, and altered levels of consciousness. Neuroimaging studies, especially MRI, are very useful in the diagnosis and follow-up of these patients. The most common imaging findings were foci of increased signal intensity in the thalamus and brainstem in T2-weighted sequences; we illustrate these findings in cases from our hospital.
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Affiliation(s)
- C Moreno-Reina
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - M Martínez-Moya
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - P Caro-Domínguez
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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3
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Myelitis with flaccid paralysis due to Japanese encephalitis: case report and review of the literature. Infection 2022; 50:1597-1603. [PMID: 35396695 PMCID: PMC8993587 DOI: 10.1007/s15010-022-01815-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/23/2022] [Indexed: 11/05/2022]
Abstract
Background Japanese encephalitis is an arthropod-borne zoonotic flavivirus infection endemic to tropical and subtropical Asia. A minority of infections leads to a symptomatic course, but affected patients often develop life-threatening encephalitis with severe sequelae. Literature review Myelitis with flaccid paralysis is a rare complication of Japanese Encephalitis, which—according to our literature search—was reported in 27 cases, some of which were published as case reports and others as case series. Overall, there is a broad clinical spectrum with typically asymmetric manifestation and partly severe motor sequelae and partly mild courses. Lower limb paralysis appears to be more frequent than upper limb paralysis. An encephalitic component is not apparent in all cases Case presentation We herein add the case of a 29 year-old female who developed encephalitis and myelitis with flaccid paralysis during a long-time stay in Indonesia. Diagnostic workup in Indonesia did not clearly reveal an underlying cause. Upon clinical stabilization, the patient was evacuated to her home country Germany, where further diagnostics confirmed Japanese encephalitis virus as the causative agent. The patient has partly recovered, but still suffers from residual paralysis of the upper limb. Conclusion Flaccid paralysis is a rare, and likely underdiagnosed complication of Japanese encephalitis, which, to the best of our knowledge, has never been diagnosed outside endemic areas before.
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4
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Manusov EG, Campuzano AM, Ahmed O, Macias S, Gomez de Ziegler C, Munoz Monaco G. Case Report: Neurologic Presentation of West Nile Virus: Difficult Diagnosis. Front Public Health 2021; 9:628799. [PMID: 34956995 PMCID: PMC8702647 DOI: 10.3389/fpubh.2021.628799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 10/25/2021] [Indexed: 11/21/2022] Open
Abstract
West Nile virus infections have surged across the globe. South Texas, located on the path of bird migration, with Culex quinquefasciatus and other Culex species, and biotic primers that predispose the area to epidemics (floods, amplifying hosts, and lack of mosquito control and prevention) remains a highly endemic area for arbovirus spread. West Nile virus infection ranges from mild febrile illness to severe central nervous system involvement. The purpose of this report is to highlight complex presentations of WNV and how confounding presenting symptoms delay diagnosis. The secondary goal is to describe how pandemics, such as SARS-CoV-2, can overwhelm the system and result in medical decision bias errors.
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Affiliation(s)
- Eron G Manusov
- Department of Human Genetics, University of Texas Rio Grande Valley School of Medicine, Mercedes, TX, United States
| | - Amalia Mora Campuzano
- Knapp Family Medicine Residency, University of Texas Rio Grande Valley, Mercedes, TX, United States
| | - Omar Ahmed
- Knapp Family Medicine Residency, University of Texas Rio Grande Valley, Mercedes, TX, United States
| | - Samantha Macias
- Knapp Family Medicine Residency, University of Texas Rio Grande Valley, Mercedes, TX, United States
| | | | - Gerardo Munoz Monaco
- Knapp Family Medicine Residency, University of Texas Rio Grande Valley, Mercedes, TX, United States
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5
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Moreno-Reina C, Martínez-Moya M, Piñero-González de la Peña P, Caro-Domínguez P. Neuroinvasive disease due to West Nile virus: clinical and imaging findings associated with a re-emerging pathogen. RADIOLOGIA 2021; 64:S0033-8338(21)00114-4. [PMID: 34325916 DOI: 10.1016/j.rx.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 05/10/2021] [Accepted: 06/21/2021] [Indexed: 10/20/2022]
Abstract
The West Nile virus (WNV) is an arbovirus than can infect human beings and cause severe neuroinvasive disease. Taking the outbreak that occurred in Spain in 2020 as a reference, this article reviews the clinical and imaging findings for neuroinvasive disease due to WNV. We collected demographic, clinical, laboratory, and imaging (CT and MRI) variables for 30 patients with WNV infection diagnosed at our center. The main clinical findings were fever, headache, and altered levels of consciousness. Neuroimaging studies, especially MRI, are very useful in the diagnosis and follow-up of these patients. The most common imaging findings were foci of increased signal intensity in the thalamus and brainstem in T2-weighted sequences; we illustrate these findings in cases from our hospital.
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Affiliation(s)
- C Moreno-Reina
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España.
| | - M Martínez-Moya
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
| | | | - P Caro-Domínguez
- Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocío, Sevilla, España
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6
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Chowdhury P, Khan SA. Global emergence of West Nile virus: Threat & preparedness in special perspective to India. Indian J Med Res 2021; 154:36-50. [PMID: 34782529 PMCID: PMC8715705 DOI: 10.4103/ijmr.ijmr_642_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Indexed: 11/18/2022] Open
Abstract
West Nile virus (WNV) is a mosquito-borne single-stranded RNA neurotropic virus within the family Flaviviridae. The virus was first reported in the West Nile province of Uganda in 1937. Since then, sporadic cases have been reported until the last two decades when it has emerged as a threat to public health. The emergence of WNV with more severity in recent times is intriguing. Considering this phenomenon, the WNV-affected areas of the world were distinguished as old versus new in a depicted world map. The present review showcases the historical and epidemiological perspectives of the virus, genetic diversity of prevailing lineages and clinical spectrum associated with its infection. Emergence of the virus has been discussed in special context to India because of co-circulation of different WNV lineages/strains along with other flaviviruses. Recent laboratory diagnostics, vaccine development and clinical management associated with WNV infection have also been discussed. Further, the research gaps, especially in context to India have been highlighted that may have a pivotal role in combating the spread of WNV.
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Affiliation(s)
- Pritom Chowdhury
- Department of Biotechnology, Tocklai Tea Research Institute, Tea Research Association, Jorhat, Assam, India
| | - Siraj Ahmed Khan
- Division of Medical Entomology, Arbovirology & Rickettsial Diseases, ICMR-Regional Medical Research Centre, Northeast Region, Dibrugarh, Assam, India
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7
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Server Alonso A, Sakinis T, Pfeiffer HCV, Sandvig I, Barlinn J, Marthinsen PB. Understanding Pediatric Neuroimmune Disorder Conflicts: A Neuroradiologic Approach in the Molecular Era. Radiographics 2020; 40:1395-1411. [PMID: 32735475 DOI: 10.1148/rg.2020200032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neuroimmune disorders in children are a complex group of inflammatory conditions of the central nervous system with diverse pathophysiologic mechanisms and clinical manifestations. Improvements in antibody analysis, genetics, neuroradiology, and different clinical phenotyping have expanded knowledge of the different neuroimmune disorders. The authors focus on pediatric-onset myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease, which is a new entity in the spectrum of inflammatory demyelinating diseases, distinct from both multiple sclerosis (MS) and anti-aquaporin-4 (AQP4) antibody neuromyelitis optica spectrum disorders (NMOSDs). The authors review the importance of an optimized antibody-detection assay, the frequency of MOG antibodies in children with acquired demyelinating syndrome (ADS), the disease course, the clinical spectrum, proposed diagnostic criteria, and neuroimaging of MOG antibody-associated disease. Also, they outline differential diagnosis from other neuroimmune disorders in children according to the putative primary immune mechanism. Finally, they recommend a diagnostic algorithm for the first manifestation of ADS or relapsing ADS that leads to four demyelinating syndromes: MOG antibody-associated disease, AQP4 antibody NMOSDs, MS, and seronegative relapsing ADS. This diagnostic approach provides a framework for the strategic role of neuroradiology in diagnosis of ADS and decision making, to optimize patient care and treatment outcome in concert with clinicians. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Andres Server Alonso
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Tomas Sakinis
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Helle Cecilie V Pfeiffer
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Inger Sandvig
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Jon Barlinn
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Pål B Marthinsen
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
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8
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Clinical Features of Four West Nile Virus Cases and Its Molecular Characterization from a South Indian Tertiary Care Hospital. Case Rep Infect Dis 2020; 2020:1315041. [PMID: 32724683 PMCID: PMC7381993 DOI: 10.1155/2020/1315041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 01/24/2020] [Indexed: 12/04/2022] Open
Abstract
West Nile virus (WNV) is currently a significant reemerging virus of the 21st century. It belongs to the family Flaviviridae and genus Flavivirus. Although it is primarily transmitted by the Culex spp of mosquitoes, other routes of transmission are also well defined. Of eight lineages described, Lineage 1a has been reported from many parts of South India and is known to cause neuroinvasive illness. Many tests and serological techniques have been described to diagnose WNV infection such as complement fixation, neutralization, heamagglutination inhibition, ELISA, and PCR for molecular confirmation. The latter far outweighs the limitations inherent in the other tests. WNV infection is being reported from Vellore for the first time after 1968. This paper aims to describe four cases of WNV infection causing central nervous system manifestations with its molecular characterization. West Nile virus infection was diagnosed with the available molecular techniques such as PCR and sequencing, which emphasizes the need for considering West Nile virus in the differential diagnosis of acute meningoencephalitis and the wider availability of molecular diagnostic tests.
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9
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Kalita J, Vibhute A, Kumar M, Misra UK. Myelopathy in West Nile virus encephalitis: Report of a case and review of literature. J Spinal Cord Med 2020; 43:444-448. [PMID: 30124385 PMCID: PMC7480635 DOI: 10.1080/10790268.2018.1507804] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Context: In West Nile virus (WNV) encephalitis, polio-like illness has been reported but there is no report on acute transverse myelopathy. Design, Setting and Participants: We report a patient with WNV myelopathy admitted in a tertiary care teaching hospital, India along with review of the literature. Findings: A 34 year-old lady presented with fever, headache, diarrhea, seizure, bulbar weakness and quadriplegia for 20 days. Her encephalopathy, bulbar and upper limb weakness improved within few days but flaccid areflexic paraplegia persisted till 6 months with a horizontal sensory level at D3. Electromyography was suggestive of anterior horn cell involvement and somatosensory evoked potential was unrecordable. MRI revealed middle cerebellar peduncle, pons and whole of spinal cord involvement. We could get 11 articles with spinal cord involvement in WNV infection in the medical literature through PubMed search. Their clinical, MRI and electro-diagnostic findings and outcome have been discussed. Conclusion/Clinical Relevance: Acute transverse myelitis may occur in WNV encephalitis and EMG may be helpful in confirming anterior horn cell involvement and predicting outcome.
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Affiliation(s)
- Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India,Correspondence to: Jayantee Kalita, Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareily Road, Lucknow226014, India; Ph: +91 522 2494177.
| | - Amar Vibhute
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Mritunjai Kumar
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Usha K. Misra
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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10
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Dubey D, Pittock SJ, Krecke KN, Morris PP, Sechi E, Zalewski NL, Weinshenker BG, Shosha E, Lucchinetti CF, Fryer JP, Lopez-Chiriboga AS, Chen JC, Jitprapaikulsan J, McKeon A, Gadoth A, Keegan BM, Tillema JM, Naddaf E, Patterson MC, Messacar K, Tyler KL, Flanagan EP. Clinical, Radiologic, and Prognostic Features of Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Autoantibody. JAMA Neurol 2020; 76:301-309. [PMID: 30575890 DOI: 10.1001/jamaneurol.2018.4053] [Citation(s) in RCA: 210] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Recognizing the characteristics of myelin oligodendrocyte glycoprotein autoantibody (MOG-IgG) myelitis is essential for early accurate diagnosis and treatment. Objective To evaluate the clinical, radiologic, and prognostic features of MOG-IgG myelitis and compare with myelitis with aquaporin-4-IgG (AQP4-IgG) and multiple sclerosis (MS). Design, Setting, and Participants We retrospectively identified 199 MOG-IgG-positive Mayo Clinic patients from January 1, 2000, through December 31, 2017, through our neuroimmunology laboratory. Fifty-four patients met inclusion criteria of (1) clinical myelitis; (2) MOG-IgG positivity; and (3) medical records available. We excluded 145 patients without documented myelitis. Myelitis of AQP4-IgG (n = 46) and MS (n = 26) were used for comparison. Main Outcomes and Measures Outcome variables included modified Rankin score and need for gait aid. A neuroradiologist analyzed spine magnetic resonance imaging of patients with MOG-IgG and control patients blinded to diagnosis. Results Of 54 included patients with MOG-IgG myelitis, the median age was 25 years (range, 3-73 years) and 24 were women (44%). Isolated transverse myelitis was the initial manifestation in 29 patients (54%), and 10 (19%) were initially diagnosed as having viral/postviral acute flaccid myelitis. Cerebrospinal fluid-elevated oligoclonal bands occurred in 1 of 38 (3%). At final follow-up (median, 24 months; range, 2-120 months), 32 patients (59%) had developed 1 or more relapses of optic neuritis (n = 31); transverse myelitis (n = 7); or acute disseminated encephalomyelitis (n = 1). Clinical features favoring MOG-IgG myelitis vs AQP4-IgG or MS myelitis included prodromal symptoms and concurrent acute disseminated encephalomyelitis. Magnetic resonance imaging features favoring MOG-IgG over AQP4-IgG or MS myelitis were T2-signal abnormality confined to gray matter (sagittal line and axial H sign) and lack of enhancement. Longitudinally extensive T2 lesions were of similar frequency in MOG-IgG and AQP4-IgG myelitis (37 of 47 [79%] vs 28 of 34 [82%]; P = .52) but not found in MS. Multiple spinal cord lesions and conus involvement were more frequent with MOG-IgG than AQP4-IgG but not different from MS. Wheelchair dependence at myelitis nadir occurred in one-third of patients with MOG-IgG and AQP4-IgG but never with MS, although patients with MOG-IgG myelitis recovered better than those with AQP4-IgG. Conclusions and Relevance Myelitis is an early manifestation of MOG-IgG-related disease and may have a clinical phenotype of acute flaccid myelitis. We identified a variety of clinical and magnetic resonance imaging features that may help clinicians identify those at risk in whom MOG-IgG should be tested.
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Affiliation(s)
- Divyanshu Dubey
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Karl N Krecke
- Department of Radiology (Division of Neuroradiology), Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Padraig P Morris
- Department of Radiology (Division of Neuroradiology), Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Elia Sechi
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Nicholas L Zalewski
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Brian G Weinshenker
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Eslam Shosha
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - James P Fryer
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - A Sebastian Lopez-Chiriboga
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - John C Chen
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.,Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jiraporn Jitprapaikulsan
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Avi Gadoth
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - B Mark Keegan
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jan-Mendelt Tillema
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Elie Naddaf
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Marc C Patterson
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Kevin Messacar
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Kenneth L Tyler
- Department of Neurology, University of Colorado School of Medicine, Aurora
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota
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11
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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: 21] [Impact Index Per Article: 4.2] [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.
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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
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12
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Kirolos A, Mark K, Shetty J, Chinchankar N, Mcdougall C, Eunson P, Stevenson J, Templeton K. Outcome of paediatric acute flaccid myelitis associated with enterovirus D68: a case series. Dev Med Child Neurol 2019; 61:376-380. [PMID: 30417347 DOI: 10.1111/dmcn.14096] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2018] [Indexed: 01/13/2023]
Abstract
Enterovirus D68 (EV-D68) is an emerging infection associated with acute flaccid myelitis (AFM). Cases of AFM associated with EV-D68 infection have increased in recent years and the evidence for a causal link is growing. However, our understanding of the epidemiology, clinical features, prognosis, and neurological sequelae of EV-D68 requires ongoing surveillance and investigation. We report five cases of AFM in previously typically developing children (2-6y) from South East Scotland during September and October 2016 after infection with EV-D68 (all detected in the nasopharyngeal aspirates). All cases presented with significant neurological symptoms, which were severe in two cases requiring intensive care support because of respiratory paralysis. At 18-month follow-up, two cases remain ventilator-dependent with other cases requiring ongoing community rehabilitation. These cases represent one of the largest reported paediatric cluster of AFM associated with EV-D68 in Europe. The epidemiology and clinical information add to the knowledge base and the 18-month outcome will help clinicians to counsel families. WHAT THIS PAPER ADDS: Nasopharyngeal aspirate is more sensitive for viral isolation and isolated in all cases. Clinical outcome at 18 months after enterovirus D68 with acute flaccid myelitis provides information on extent of recovery and level of disability.
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Affiliation(s)
- Amir Kirolos
- Directorate of Public Health and Health Policy, National Health Service, Lothian, Edinburgh, UK
| | - Kate Mark
- Directorate of Public Health and Health Policy, National Health Service, Lothian, Edinburgh, UK
| | - Jay Shetty
- National Health Service, Lothian, The Royal Hospital for Sick Children, Edinburgh, UK.,Department of Child Life and Health, University of Edinburgh, Edinburgh, UK
| | - Nandita Chinchankar
- National Health Service, Lothian, The Royal Hospital for Sick Children, Edinburgh, UK
| | - Catherine Mcdougall
- National Health Service, Lothian, The Royal Hospital for Sick Children, Edinburgh, UK
| | - Paul Eunson
- National Health Service, Lothian, The Royal Hospital for Sick Children, Edinburgh, UK
| | - Janet Stevenson
- Directorate of Public Health and Health Policy, National Health Service, Lothian, Edinburgh, UK
| | - Kate Templeton
- Department of Child Life and Health, University of Edinburgh, Edinburgh, UK.,Department of Virology, National Health Service, Lothian, Royal Infirmary Edinburgh, Edinburgh, UK
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13
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Acosta-Ampudia Y, Monsalve DM, Castillo-Medina LF, Rodríguez Y, Pacheco Y, Halstead S, Willison HJ, Anaya JM, Ramírez-Santana C. Autoimmune Neurological Conditions Associated With Zika Virus Infection. Front Mol Neurosci 2018; 11:116. [PMID: 29695953 PMCID: PMC5904274 DOI: 10.3389/fnmol.2018.00116] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/26/2018] [Indexed: 12/20/2022] Open
Abstract
Zika virus (ZIKV) is an emerging flavivirus rapidly spreading throughout the tropical Americas. Aedes mosquitoes is the principal way of transmission of the virus to humans. ZIKV can be spread by transplacental, perinatal, and body fluids. ZIKV infection is often asymptomatic and those with symptoms present minor illness after 3 to 12 days of incubation, characterized by a mild and self-limiting disease with low-grade fever, conjunctivitis, widespread pruritic maculopapular rash, arthralgia and myalgia. ZIKV has been linked to a number of central and peripheral nervous system injuries such as Guillain-Barré syndrome (GBS), transverse myelitis (TM), meningoencephalitis, ophthalmological manifestations, and other neurological complications. Nevertheless, mechanisms of host-pathogen neuro-immune interactions remain incompletely elucidated. This review provides a critical discussion about the possible mechanisms underlying the development of autoimmune neurological conditions associated with Zika virus infection.
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Affiliation(s)
- Yeny Acosta-Ampudia
- Center for Autoimmune Diseases Research, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Diana M Monsalve
- Center for Autoimmune Diseases Research, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Luis F Castillo-Medina
- Center for Autoimmune Diseases Research, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Yhojan Rodríguez
- Center for Autoimmune Diseases Research, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Yovana Pacheco
- Center for Autoimmune Diseases Research, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Susan Halstead
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Hugh J Willison
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
| | - Carolina Ramírez-Santana
- Center for Autoimmune Diseases Research, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, Colombia
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14
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Abstract
West Nile virus (WNV) is a mosquito-borne flavivirus that can cause mild-to-severe disease in humans and horses. WNV was first documented in Uganda in 1937 and passed through the majority of Africa, West Asia, and Europe before arriving in the USA (with infections in New York City in 1999). After the spread of the virus on the US east coast, it traveled westward, northward, and southward through the USA and into Central and South America. WNV can cause fever, rashes, nausea, vomiting, and potentially neuroinvasive disease or death. The virus is sustained through a mosquito-bird-mosquito cycle and there are many species that are competent vectors. Unfortunately, there are no vaccines and the only treatment is supportive care. This chapter highlights the epidemiology and transmission of WNV and provides insight into some of the challenges of controlling WNV disease.
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Affiliation(s)
- Andrea Troupin
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, 6439 Garners Ferry Rd., Bldg 2, Room B4, Columbia, SC, 29209, USA
| | - Tonya M Colpitts
- Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, 6439 Garners Ferry Rd., Bldg 2, Room B4, Columbia, SC, 29209, USA.
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15
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Kalaiyarasu S, Mishra N, Khetan RK, Singh VP. Serological evidence of widespread West Nile virus and Japanese encephalitis virus infection in native domestic ducks (Anas platyrhynchos var domesticus) in Kuttanad region, Kerala, India. Comp Immunol Microbiol Infect Dis 2016; 48:61-8. [PMID: 27638121 DOI: 10.1016/j.cimid.2016.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/03/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022]
Abstract
Birds can act as reservoirs of West Nile virus (WNV) with a key role in its epidemiology. WNV lineage 1 associated fatal cases of human encephalitis in 2011 and acute flaccid paralysis in 2013 were reported in Alappuzha district, Kerala, India. But no information is available on WNV circulation in domestic ducks, which are abundant, cohabit with humans and occupy wetlands and water bodies in the region. To determine the extent of WNV infection, we investigated 209 sera, 250 oral and 350 cloacal swab samples from local Chara and Chemballi domestic ducks (Anas platyrhynchos var domesticus) in the districts of Alappuzha, Kottayam, Kollam and Pathanamthitta collected during January and March 2015. The serum samples were tested for WNV antibodies first by a competition ELISA and then by a micro virus neutralization test (micro-VNT), while oral and cloacal swabs were subjected to WNV real-time RT-PCR. Ninety five ducks showed evidence of flavivirus antibodies by ELISA. End point neutralizing antibody titre against WNV and Japanese encephalitis virus (JEV) revealed WNV specific antibodies in 24 (11.5%) ducks in 3 districts, JEV specific antibodies in 21 (10%) ducks in 2 districts and flavivirus specific antibodies in 19 (9%) ducks. However, no WNV genomic RNA could be detected. The results of this study demonstrate evidence of widespread WNV and JEV infection in domestic ducks in Kuttanad region, Kerala with a higher seroprevalence to WNV than JEV. Additionally, it highlights the utility of domestic ducks as a surveillance tool to detect WNV/JEV circulation in a region.
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Affiliation(s)
- Semmannan Kalaiyarasu
- ICAR-National Institute of High Security Animal Diseases, Anand Nagar, Bhopal, Madhya Pradesh 462 022, India
| | - Niranjan Mishra
- ICAR-National Institute of High Security Animal Diseases, Anand Nagar, Bhopal, Madhya Pradesh 462 022, India.
| | - Rohit Kumar Khetan
- ICAR-National Institute of High Security Animal Diseases, Anand Nagar, Bhopal, Madhya Pradesh 462 022, India
| | - Vijendra Pal Singh
- ICAR-National Institute of High Security Animal Diseases, Anand Nagar, Bhopal, Madhya Pradesh 462 022, India
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16
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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.
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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
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17
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Abstract
A 43-year-old woman presented to George Washington emergency department with 48 h of new-onset inguinal pain. Physical examination revealed a diffuse maculopapular rash involving the palms and soles, as well as inguinal lymphadenopathy. The patient denied recent travel outside of Washington, DC, and had no known sick contacts. She was admitted to the hospital for observation. Within 24 h of admission she developed left lower extremity flaccid paralysis, with loss of left patellar and Achilles reflexes. cerebrospinal fluid was positive for West Nile virus IgG and IgM antibodies, so methylprednisone 125 mg intravenously two times per day was started. On day 7, the patient recovered reflexes and continued to regain strength in the left lower extremity. She was discharged on day 9 on prednisone taper, with outpatient follow-up.
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Affiliation(s)
- Ashely Alker
- Department of Medicine, George Washington University, Washington, DC, USA
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