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Kasule SN, Gupta S, Patron RL, Grill MF, Vikram HR. Neuroinvasive West Nile virus infection in solid organ transplant recipients. Transpl Infect Dis 2023; 25:e14004. [PMID: 36573623 DOI: 10.1111/tid.14004] [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: 08/25/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Literature on the natural course of neuroinvasive West Nile virus (WNV) infection in solid organ transplant (SOT) recipients is sparse. In the setting of a 2021 WNV outbreak in Arizona, we reviewed our institution's experience with neuroinvasive WNV infection in patients with SOT. METHODS We retrospectively identified SOT recipients treated for neuroinvasive WNV at Mayo Clinic in Arizona from 2007 through 2021. Clinical manifestations, disease course, and outcomes were analyzed. RESULTS Among 24 SOT recipients with WNV infection identified during the study period, 13 infections occurred in 2021. Most patients had gastrointestinal tract symptoms and fever at disease presentation. Five patients had cognitive impairment, and 14 initially or eventually had acute flaccid paralysis. Clinically significant deterioration occurred at a median of 4 (range, 1-11) days after hospital admission. Seventeen patients (71%) were transferred to the intensive care unit, with 15 requiring mechanical ventilation. Initial cerebrospinal fluid analysis mainly demonstrated a neutrophil-predominant pleocytosis. Almost all patients (n = 23) were treated with intravenous immunoglobulin alone or in combination with interferon alfa-2b. Sixteen patients had clinical improvement, 4 of whom recovered completely. Six patients died during hospitalization due to complications of neuroinvasive WNV infection. Two patients were discharged to hospice without clinical recovery. The overall 30-day mortality rate was 36%. CONCLUSION Despite advances in supportive care, neuroinvasive WNV infection is associated with substantial morbidity and mortality in SOT recipients. Flaccid paralysis is an indicator of poor prognosis.
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Affiliation(s)
- Sabirah N Kasule
- Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Simran Gupta
- Department of Internal Medicine, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Roberto L Patron
- Division of Infectious Diseases, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Marie F Grill
- Department of Neurology, Mayo Clinic Hospital, Phoenix, Arizona, USA
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Ashkin A, Saccone N, Valle J, Rasnake M. Symmetric Ascending Paralysis Secondary to West Nile Virus. Case Rep Neurol 2023; 15:120-125. [PMID: 37497261 PMCID: PMC10368093 DOI: 10.1159/000529120] [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: 10/24/2022] [Accepted: 01/02/2023] [Indexed: 07/28/2023] Open
Abstract
West Nile virus (WNV) is classified as a Flavivirus, belonging to a Japanese encephalitis subgroup often transmitted via mosquitoes. The classic presentation of a WNV infection usually displays high fevers, myalgias, and headache which can progress to neck stiffness, stupor, and coma (Case Rep Infect Dis. 2020;2020:6501658). Our case study presented with a rare manifestation of ascending paralysis, encompassing the feared neuroinvasive disease pattern that is seldom exhibited. This case had an unusual presentation as certain manifestations experienced by our patient closely resembled that of Guillain-Barré syndrome, although others were more indicative of poliomyelitis-like syndrome. Overall, the mainstay of therapy in both conditions is supportive care, although the prognosis varies substantially depending on the underlying diagnosis.
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Affiliation(s)
- Alex Ashkin
- NCH Graduate Medical Education, Naples, FL, USA
| | | | - Jose Valle
- Academic Pulmonologist with NCH Graduate Medical Education, Naples, FL, USA
| | - Mark Rasnake
- Academic Infectious Disease Specialist with NCH Graduate Medical Education, Naples, FL, USA
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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]
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Neuroinvasive West Nile Infection with an Unusual Clinical Presentation: A Single-Center Case Series. Trop Med Infect Dis 2020; 5:tropicalmed5030138. [PMID: 32878269 PMCID: PMC7558676 DOI: 10.3390/tropicalmed5030138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/14/2020] [Accepted: 08/25/2020] [Indexed: 12/22/2022] Open
Abstract
The 2018 West Nile Virus (WNV) season in Europe was characterized by an extremely high infection rate and an exceptionally higher burden when compared to previous seasons. Overall, there was a 10.9-fold increase in incidence in Italy, with 577 human cases, 230 WNV neuroinvasive diseases (WNNV) and 42 WNV-attributed deaths. Methods: in this paper we retrospectively reported the neurological presentation of 7 patients admitted to University Hospital of Udine with a diagnosis of WNNV, especially focusing on two patients who presented with atypical severe brain stem involvement. Conclusions: the atypical features of some of these forms highlight the necessity to stay vigilant and suspect the diagnosis when confronted with neurological symptoms. We strongly encourage clinicians to consider WNNV in patients presenting with unexplained neurological symptoms in mild climate-areas at risk.
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Talbot B, Caron-Lévesque M, Ardis M, Kryuchkov R, Kulkarni MA. Linking Bird and Mosquito Data to Assess Spatiotemporal West Nile Virus Risk in Humans. ECOHEALTH 2019; 16:70-81. [PMID: 30673905 DOI: 10.1007/s10393-019-01393-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 06/09/2023]
Abstract
West Nile virus (WNV; family Flaviviridae) causes a disease in humans that may develop into a deadly neuroinvasive disease. In North America, several peridomestic bird species can develop sufficient viremia to infect blood-feeding mosquito vectors without succumbing to the virus. Mosquito species from the genus Culex, Aedes and Ochlerotatus display variable host preferences, ranging between birds and mammals, including humans, and may bridge transmission among avian hosts and contribute to spill-over transmission to humans. In this study, we aimed to test the effect of density of three mosquito species and two avian species on WNV mosquito infection rates and investigated the link between spatiotemporal clusters of high mosquito infection rates and clusters of human WNV cases. We based our study around the city of Ottawa, Canada, between the year 2007 and 2014. We found a large effect size of density of two mosquito species on mosquito infection rates. We also found spatiotemporal overlap between a cluster of high mosquito infection rates and a cluster of human WNV cases. Our study is innovative because it suggests a role of avian and mosquito densities on mosquito infection rates and, in turn, on hotspots of human WNV cases.
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Affiliation(s)
- Benoit Talbot
- School of Epidemiology and Public Health, University of Ottawa, Room 217A, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.
| | - Merlin Caron-Lévesque
- School of Epidemiology and Public Health, University of Ottawa, Room 217A, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Mark Ardis
- GDG Environnement, Trois-Rivières, QC, Canada
| | - Roman Kryuchkov
- School of Epidemiology and Public Health, University of Ottawa, Room 217A, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
| | - Manisha A Kulkarni
- School of Epidemiology and Public Health, University of Ottawa, Room 217A, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada
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Freeman MC, Coyne CB, Green M, Williams JV, Silva LA. Emerging arboviruses and implications for pediatric transplantation: A review. Pediatr Transplant 2019; 23:e13303. [PMID: 30338634 DOI: 10.1111/petr.13303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/29/2018] [Accepted: 09/19/2018] [Indexed: 11/28/2022]
Abstract
Recent years have brought a rise in newly emergent viral infections, primarily in the form of previously known arthropod-transmitted viruses that have increased significantly in both incidence and geographical range. Of particular note are DENV, CHIKV, and ZIKV, which are transmitted mostly by Aedes species of mosquitoes that exhibit a wide and increasing global distribution. Being important pathogens for the general population, these viruses have the potential to be devastating in the international transplant community, with graft rejection and death as possible outcomes of infection. In this review, we discuss the current state of knowledge for these viruses as well as repercussions of infection in the solid organ and HSCT population, with a focus, when possible, on pediatric patients.
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Affiliation(s)
- Megan Culler Freeman
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carolyn B Coyne
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michael Green
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - John V Williams
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laurie A Silva
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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Neuroinvasive Seronegative West Nile Virus in the Setting of R-CHOP Chemotherapy for Diffuse Large B-Cell Lymphoma. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cheng VCC, Sridhar S, Wong SC, Wong SCY, Chan JFW, Yip CCY, Chau CH, Au TWK, Hwang YY, Yau CSW, Lo JYC, Lee CK, Yuen KY. Japanese Encephalitis Virus Transmitted Via Blood Transfusion, Hong Kong, China. Emerg Infect Dis 2018; 24. [PMID: 29043965 PMCID: PMC5749455 DOI: 10.3201/eid2401.171297] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Japanese encephalitis virus (JEV) is a mosquitoborne virus endemic to China and Southeast Asia that causes severe encephalitis in <1% of infected persons. Transmission of JEV via blood transfusion has not been reported. We report transmission of JEV via blood donation products from an asymptomatic viremic donor to 2 immunocompromised recipients. One recipient on high-dose immunosuppressive drugs received JEV-positive packed red blood cells after a double lung transplant; severe encephalitis and a poor clinical outcome resulted. JEV RNA was detected in serum, cerebrospinal fluid, and bronchoalveolar lavage fluid specimens. The second recipient had leukemia and received platelets after undergoing chemotherapy. This patient was asymptomatic; JEV infection was confirmed in this person by IgM seroconversion. This study illustrates that, consistent with other pathogenic flaviviruses, JEV can be transmitted via blood products. Targeted donor screening and pathogen reduction technologies could be used to prevent transfusion-transmitted JEV infection in highly JEV-endemic areas.
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Abstract
This chapter provides an overview of infectious syndromes, pathogens, and diagnostic testing modalities for central nervous system infections in the immunocompromised host.
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Hoffman KW, Sachs D, Bardina SV, Michlmayr D, Rodriguez CA, Sum J, Foster GA, Krysztof D, Stramer SL, Lim JK. Differences in Early Cytokine Production Are Associated With Development of a Greater Number of Symptoms Following West Nile Virus Infection. J Infect Dis 2016; 214:634-43. [PMID: 27142077 DOI: 10.1093/infdis/jiw179] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/27/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND West Nile virus (WNV) is an emerging cause of meningitis and encephalitis in the United States. Although severe neuroinvasive disease and death can occur in rare instances, the majority of infected individuals remain asymptomatic or present with a range of clinical manifestations associated with West Nile fever. METHODS To better understand the interindividual variability associated with the majority of WNV infections, we evaluated the association of cytokine/chemokine production and outcome of infection among 115 WNV-positive US blood donors identified in 2008-2011. All subjects self-reported symptoms as having occurred during the 2 weeks following blood donation, using a standardized questionnaire. RESULTS We discovered that, prior to seroconversion, an early potent, largely type I interferon-mediated response correlated with development of a greater number of symptoms in WNV-infected individuals. Interestingly, individuals who developed fewer symptoms had not only a more modest type I interferon response initially, but also a protracted cytokine response after seroconversion, marked by the production of monocyte and T-cell-associated chemokines. CONCLUSIONS Collectively, our data suggest that, although an early type I interferon response appears to be crucial to control WNV infection, successful immunity may require a modest early response that is maintained during the course of infection.
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Affiliation(s)
| | - David Sachs
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York
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Fatal West Nile Virus Encephalitis in a Heart Transplant Recipient. J Clin Microbiol 2015; 53:2749-52. [PMID: 25994169 DOI: 10.1128/jcm.00834-15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/11/2015] [Indexed: 11/20/2022] Open
Abstract
The diagnosis of encephalitis is particularly challenging in immunocompromised patients. We report here a case of fatal West Nile virus encephalitis confounded by the presence of budding yeast in the cerebrospinal fluid (CSF) from a patient who had undergone heart transplantation for dilated cardiomyopathy 11 months prior to presentation of neurologic symptoms.
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West Nile virus seroprevalence and behavioral risks in HIV-1 infected individuals, Northern Greece, 2011. Int J Infect Dis 2014; 30:64-6. [PMID: 25448330 DOI: 10.1016/j.ijid.2014.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 09/23/2014] [Accepted: 10/25/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study sought to assess the West Nile Virus (WNV) seroprevalence and behavioral risk factors for WNV infection in HIV-1 infected individuals in Northern Greece in 2011. METHODS We prospectively enrolled 91 HIV-1 consecutive patients followed up in the HIV clinic of the AHEPA University Hospital in the period from November to December 2011. Serum samples were tested for the presence of WNV IgG antibodies. All subjects were administered a standardized questionnaire to evaluate for risk factors for WNV infection. RESULTS WNV IgG antibodies were detected in three subjects (3.3%, 95% CI 0.7-9.3%), two of whom were of African origin. The prevalence of WNV antibodies in HIV patients of Greek origin was 1.2% (95% CI: 0.03% - 6.3%). In the sample surveyed, 53.6% (95% CI: 42.4% to 64.5%) were aware of WNV prevention measures; 2.2% reported no implementation of prevention measures, whereas 46.1% implemented at least three measures. Approximately one half of the patients reported outdoor activities for more than two hours from dusk to dawn. None of the IgG-positive patients reported any symptoms compatible with WNV disease during the season at risk. CONCLUSIONS Among native Greek HIV patients, the WNV seroprevalence is 1.2%. A considerable proportion of patients was aware of WNV prevention measures and implemented some of these. HIV patients and other categories of immunocompromised patients are at increased risk of neuroinvasive disease, and widespread implementation of prevention measures should be strongly encouraged in this patient population.
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Abstract
PURPOSE OF REVIEW West Nile virus (WNV) is the most important cause of epidemic encephalitis in the United States. We review articles published in the last 18 months related to the epidemiology, immunology, clinical features, and treatment of this disease. RECENT FINDINGS There was a resurgence in WNV disease in the United States in 2012. The WNV strain now predominant in the United States (NA/WN02) differs from the initial emergent isolate in 1999 (NY99). However, differences in the genetics of currently circulating United States WNV strains do not explain variations in epidemic magnitude or disease severity. Innate and acquired immunity are critical in control of WNV, and in some cases pathways are central nervous system specific. The clinical features of infection are now well understood, although nonconfirmed observations of chronic viral excretion in urine remain controversial. There is no specific antiviral therapy for WNV, but studies of antivirals specific for other flaviviruses may identify agents with promise against WNV. Phase I and II human WNV vaccine clinical trials have established that well tolerated and immunogenic WNV vaccines can be developed. SUMMARY WNV remains an important public health problem. Although recent studies have significantly increased our understanding of host immune and genetic factors involved in control of WNV infection, no specific therapy is yet available. Development of a well tolerated, immunogenic, and effective vaccine against WNV is almost certainly feasible, but economic factors and the lack of predictability of the magnitude and location of outbreaks are problematic for designing phase III trials and ultimate licensure.
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Affiliation(s)
- Kenneth L. Tyler
- Department of Neurology, University of Colorado School of Medicine, Aurora
- Denver Veterans Affairs Medical Center, Eastern Colorado Healthcare System, Denver, Colorado, USA
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