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Roberts JA, Kim CY, Dean A, Kulas KE, St. George K, Hoang HE, Thakur KT. Clinical and Diagnostic Features of West Nile Virus Neuroinvasive Disease in New York City. Pathogens 2024; 13:382. [PMID: 38787234 PMCID: PMC11123700 DOI: 10.3390/pathogens13050382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
West Nile virus (WNV) neuroinvasive disease (WNND) occurs in approximately 1 percent of WNV-infected patients and typically presents as encephalitis, meningitis, or acute flaccid paralysis (AFP). WNND remains a difficult inpatient diagnosis, creating significant challenges for prognostication and therapy selection. We characterized the clinical and diagnostic features of WNND cases at two major academic medical centers in New York City in routine clinical practice. We retrospectively reviewed the charts of thirty-six patients with WNND, including twenty-six encephalitis, four meningitis, and six AFP cases. The most common presenting symptoms were fever (86.1%) and gastrointestinal symptoms (38.9%) in addition to altered mental status (72.2%), lethargy (63.9%), gait disturbances (46.2%), and headache (44.4%). Fourteen (48.3%) patients displayed acute magnetic resonance imaging (MRI) findings, particularly T2 hyperintensities in the bilateral thalami, brainstem, and deep white matter. New York State Department of Health WNV CSF IgM testing was utilized for diagnosis in 58.3% of patients; however, just 38.1% had the result by discharge, compared to 85.6% of those who underwent serum IgM testing. The median length of stay was 13.5 days, 38.9% were intubated, and three patients (8.9%) died during acute hospitalization. Our findings underscore the morbidity, mortality, and diagnostic challenges of WNND, suggesting the potential utility of serum IgM testing in combination with confirmatory CSF testing to expedite diagnosis in the acute setting.
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Affiliation(s)
- Jackson A. Roberts
- Program in Neuroinfectious Diseases, Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Carla Y. Kim
- Program in Neuroinfectious Diseases, Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Amy Dean
- Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, Albany, NY 12237, USA
| | - Karen E. Kulas
- Diagnostic Immunology, Wadsworth Center, New York State Department of Health, Albany, NY 12237, USA
| | - Kirsten St. George
- Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, Albany, NY 12237, USA
- Department of Biomedical Science, University at Albany, SUNY, Albany, NY 12222, USA
| | - Hai E. Hoang
- Department of Neurology, Weill Cornell Medical Center, New York, NY 10065, USA
| | - Kiran T. Thakur
- Program in Neuroinfectious Diseases, Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA
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Schwarz ER, Long MT. Comparison of West Nile Virus Disease in Humans and Horses: Exploiting Similarities for Enhancing Syndromic Surveillance. Viruses 2023; 15:1230. [PMID: 37376530 DOI: 10.3390/v15061230] [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: 04/18/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
West Nile virus (WNV) neuroinvasive disease threatens the health and well-being of horses and humans worldwide. Disease in horses and humans is remarkably similar. The occurrence of WNV disease in these mammalian hosts has geographic overlap with shared macroscale and microscale drivers of risk. Importantly, intrahost virus dynamics, the evolution of the antibody response, and clinicopathology are similar. The goal of this review is to provide a comparison of WNV infection in humans and horses and to identify similarities that can be exploited to enhance surveillance methods for the early detection of WNV neuroinvasive disease.
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Affiliation(s)
- Erika R Schwarz
- Montana Veterinary Diagnostic Laboratory, MT Department of Livestock, Bozeman, MT 59718, USA
| | - Maureen T Long
- Department of Comparative, Diagnostic, & Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610, USA
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Snyder RE, Feiszli T, Foss L, Messenger S, Fang Y, Barker CM, Reisen WK, Vugia DJ, Padgett KA, Kramer VL. West Nile virus in California, 2003-2018: A persistent threat. PLoS Negl Trop Dis 2020; 14:e0008841. [PMID: 33206634 PMCID: PMC7710070 DOI: 10.1371/journal.pntd.0008841] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 12/02/2020] [Accepted: 09/24/2020] [Indexed: 02/06/2023] Open
Abstract
The California Arbovirus Surveillance Program was initiated over 50 years ago to track endemic encephalitides and was enhanced in 2000 to include West Nile virus (WNV) infections in humans, mosquitoes, sentinel chickens, dead birds and horses. This comprehensive statewide program is a function of strong partnerships among the California Department of Public Health (CDPH), the University of California, and local vector control and public health agencies. This manuscript summarizes WNV surveillance data in California since WNV was first detected in 2003 in southern California. From 2003 through 2018, 6,909 human cases of WNV disease, inclusive of 326 deaths, were reported to CDPH, as well as 730 asymptomatic WNV infections identified during screening of blood and organ donors. Of these, 4,073 (59.0%) were reported as West Nile neuroinvasive disease. California's WNV disease burden comprised 15% of all cases that were reported to the U.S. Centers for Disease Control and Prevention during this time, more than any other state. Additionally, 1,299 equine WNV cases were identified, along with detections of WNV in 23,322 dead birds, 31,695 mosquito pools, and 7,340 sentinel chickens. Annual enzootic detection of WNV typically preceded detection in humans and prompted enhanced intervention to reduce the risk of WNV transmission. Peak WNV activity occurred from July through October in the Central Valley and southern California. Less than five percent of WNV activity occurred in other regions of the state or outside of this time. WNV continues to be a major threat to public and wild avian health in California, particularly in southern California and the Central Valley during summer and early fall months. Local and state public health partners must continue statewide human and mosquito surveillance and facilitate effective mosquito control and bite prevention measures.
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Affiliation(s)
- Robert E. Snyder
- California Department of Public Health, Vector-Borne Disease Section, Richmond and Sacramento, California, United States of America
| | - Tina Feiszli
- California Department of Public Health, Vector-Borne Disease Section, Richmond and Sacramento, California, United States of America
| | - Leslie Foss
- California Department of Public Health, Vector-Borne Disease Section, Richmond and Sacramento, California, United States of America
| | - Sharon Messenger
- California Department of Public Health, Division of Communicable Disease Control, Richmond, California, United States of America
| | - Ying Fang
- Department of Pathology, Microbiology & Immunology, School of Veterinary Medicine, University of California, Davis, California, United States of America
| | - Christopher M. Barker
- Department of Pathology, Microbiology & Immunology, School of Veterinary Medicine, University of California, Davis, California, United States of America
| | - William K. Reisen
- Department of Pathology, Microbiology & Immunology, School of Veterinary Medicine, University of California, Davis, California, United States of America
| | - Duc J. Vugia
- California Department of Public Health, Division of Communicable Disease Control, Richmond, California, United States of America
| | - Kerry A. Padgett
- California Department of Public Health, Vector-Borne Disease Section, Richmond and Sacramento, California, United States of America
| | - Vicki L. Kramer
- California Department of Public Health, Vector-Borne Disease Section, Richmond and Sacramento, California, United States of America
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West Nile Virus: An Update on Pathobiology, Epidemiology, Diagnostics, Control and "One Health" Implications. Pathogens 2020; 9:pathogens9070589. [PMID: 32707644 PMCID: PMC7400489 DOI: 10.3390/pathogens9070589] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
West Nile virus (WNV) is an important zoonotic flavivirus responsible for mild fever to severe, lethal neuroinvasive disease in humans, horses, birds, and other wildlife species. Since its discovery, WNV has caused multiple human and animal disease outbreaks in all continents, except Antarctica. Infections are associated with economic losses, mainly due to the cost of treatment of infected patients, control programmes, and loss of animals and animal products. The pathogenesis of WNV has been extensively investigated in natural hosts as well as in several animal models, including rodents, lagomorphs, birds, and reptiles. However, most of the proposed pathogenesis hypotheses remain contentious, and much remains to be elucidated. At the same time, the unavailability of specific antiviral treatment or effective and safe vaccines contribute to the perpetuation of the disease and regular occurrence of outbreaks in both endemic and non-endemic areas. Moreover, globalisation and climate change are also important drivers of the emergence and re-emergence of the virus and disease. Here, we give an update of the pathobiology, epidemiology, diagnostics, control, and “One Health” implications of WNV infection and disease.
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Ziyaeyan M, Behzadi MA, Leyva-Grado VH, Azizi K, Pouladfar G, Dorzaban H, Ziyaeyan A, Salek S, Jaber Hashemi A, Jamalidoust M. Widespread circulation of West Nile virus, but not Zika virus in southern Iran. PLoS Negl Trop Dis 2018; 12:e0007022. [PMID: 30557321 PMCID: PMC6312345 DOI: 10.1371/journal.pntd.0007022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 12/31/2018] [Accepted: 11/26/2018] [Indexed: 12/20/2022] Open
Abstract
West Nile virus (WNV) and Zika virus (ZIKV) are mosquito-borne viral infections. Over the past few decades, WNV has been associated with several outbreaks involving high numbers of neuroinvasive diseases among humans. The recent re-emergence of ZIKV has been associated with congenital malformation and also with Guillain-Barre syndrome in adults. The geographic range of arthropod-borne viruses has been rapidly increasing in recent years. The objectives of this study were to determine the presence of IgG specific antibodies and the genome of WNV and ZIKV in human samples, as well as WNV and ZIKV genomes in wild-caught mosquitoes in urban and rural areas of the Hormozgan province, in southern Iran. A total of 494 serum samples were tested for the presence of WNV and ZIKV IgG antibodies using ELISA assays. One hundred and two (20.6%) samples were reactive for WNV IgG antibodies. All serum samples were negative for ZIKV IgG antibodies. Using the multivariable logistic analysis, age (45+ vs. 1-25; OR = 3.4, 95% C.I.: 1.8-6.3), occupation (mostly outdoor vs. mostly indoor; OR = 2.4, 95% C.I.: 1.1-5.2), and skin type(type I/II vs. type III/IV and type V/VI; OR = 4.3, 95% C.I.: 1.7-10.8 and OR = 2.7, 95% C.I.: 1.3-5.5 respectively, skin types based on Fitzpatrick scale) showed significant association with WNV seroreactivity. We collected 2,015 mosquitoes in 136 pools belonging to 5 genera and 14 species. Three pools of Culex pipiens complex were positive for WNV RNA using real-time reverse transcription polymerase chain reaction (rtRT-PCR). ZIKV RNA was not detected in any of the pools. All WNV ELISA reactive serum samples were negative for WNV RNA. In conclusion, we provided evidence of the establishment of WNV in southern Iran and no proof of ZIKV in serum samples or in mosquito vectors. The establishment of an organized arbovirus surveillance system and active case finding strategies seems to be necessary.
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Affiliation(s)
- Mazyar Ziyaeyan
- Department of Clinical Virology, Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Namazi Hospital, Shiraz, Iran
| | - Mohammad Amin Behzadi
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Victor Hugo Leyva-Grado
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Kourosh Azizi
- Department of Medical Entomology and Vector Control, Research Center for Health Sciences, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamreza Pouladfar
- Department of Infectious Diseases, Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Namazi Hospital, Shiraz, Iran
| | - Hedayat Dorzaban
- Department of Medical Entomology and Vector Control, Research Center for Health Sciences, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Sanaz Salek
- Department of Clinical Virology, Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Namazi Hospital, Shiraz, Iran
| | - Aghyl Jaber Hashemi
- Department of Medical Entomology and Vector Control, Research Center for Health Sciences, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Jamalidoust
- Department of Clinical Virology, Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Namazi Hospital, Shiraz, Iran
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Abstract
West Nile virus (WNV), a mosquito-borne flavivirus, has been a significant public health concern in the United States for nearly two decades. The virus has been linked to acute viral encephalitis, neurological sequelae, and chronic kidney diseases. Neither antiviral drugs nor vaccines are currently available for humans. In vitro cell culture and experimental animal models have been used to study WNV infection in humans. In this review, we will focus on recent findings and provide new insights into WNV host immunity and viral pathogenesis.
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Affiliation(s)
- Huanle Luo
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, USA
| | - Tian Wang
- Department of Microbiology & Immunology, University of Texas Medical Branch, Galveston, USA.,Department of Pathology, University of Texas Medical Branch, Galveston, USA.,Institute for Human Infections & Immunity, University of Texas Medical Branch, Galveston, USA
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