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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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The value of West Nile virus RNA detection by real-time RT-PCR in urine samples from patients with neuroinvasive forms. Arch Microbiol 2022; 204:238. [DOI: 10.1007/s00203-022-02829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 03/08/2022] [Indexed: 11/26/2022]
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Koch M, Pozsgai É, Soós V, Nagy A, Girán J, Nyisztor N, Martyin T, Müller Z, Fehér M, Hajdú E, Varga C. Identifying risks for severity of neurological symptoms in Hungarian West Nile virus patients. BMC Infect Dis 2021; 21:65. [PMID: 33441090 PMCID: PMC7805165 DOI: 10.1186/s12879-020-05760-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/30/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND West Nile virus (WNV) infections have become increasingly prevalent in certain European countries, including Hungary. Although most human infections do not cause severe symptoms, in approximately 1% of cases WNV infections can lead to severe WNV neuroinvasive disease (WNND) and death. The goal of our study was to assess the neurological status changes of WNV -infected patients admitted to inpatient care and to identify potential risk factors as underlying reasons for severe neurological outcome. METHODS We conducted a retrospective chart review of 66 WNV-infected patients from four Hungarian medical centers. Patients' neurological status at hospital admission and at two follow-up intervals (1st follow-up, within 60-90 days and 2nd follow-up, within 150-180 days, after hospital discharge) were assessed. All of the 66 patients in the initial sample had some type of neurological symptoms and 56 patients were diagnosed with WNND. The modified Rankin Scale (mRS) and the West Nile Virus Neurological Index (WNV-N Index), a scoring system designed for the purpose of this study, were used for neurological status assessment. Patients were dichotomized into two categories, "moderately severe" and "severe" based on their neurological status. Descriptive analysis for sample description, stratified analysis for calculation of odds ratio (OR) and logistic regression for continuous input variables, were performed. RESULTS The average number of days between the onset of neurological symptoms and hospital admission (the neurological symptom interval) was 6.01 days. Complications during the hospital stay arose in almost a fifth of the patients (18.2%) and 5 patients died. Each day's increase in the neurological symptom interval significantly increased the risk for developing a severe neurological status following hospital admission (0.799-fold and 0.688-fold, based on the WNV-N Index and mRS, respectively). Patients' age, comorbidity, presence of complications and symptoms of malaise, and gait uncertainty were shown to be independent risk factors for severe neurological status. CONCLUSIONS Timely hospital admission of patients with neurological symptoms as well as risk assessment by clinicians - possibly with an optimal assessment tool for estimating neurological status- could improve the neurological outcome of WNV-infected patients.
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Affiliation(s)
- Márton Koch
- Department of Emergency Medicine, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street, 20-32, Kaposvár, 7400 Hungary
| | - Éva Pozsgai
- Department of Public Health, Medical School, University of Pécs, Szigeti Street, 12, Pécs, 7624 Hungary
- Institute of Primary Health Care, Medical School, University of Pécs, Rákóczi Street 2, Pécs, 7623 Hungary
| | - Viktor Soós
- Department of Emergency Medicine, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street, 20-32, Kaposvár, 7400 Hungary
| | - Anna Nagy
- National Reference Laboratory for Viral Zoonoses; National Public Health Center, 1097 Albert Flórián Road 2-6, Budapest, Hungary
| | - János Girán
- Department of Public Health, Medical School, University of Pécs, Szigeti Street, 12, Pécs, 7624 Hungary
| | - Norbert Nyisztor
- Department of Infectious Diseases (Hepatology and Immunology), Békés County Central Hospital, Semmelweis Street 1, Gyula, 5700 Hungary
| | - Tibor Martyin
- Department of Infectious Diseases (Hepatology and Immunology), Békés County Central Hospital, Semmelweis Street 1, Gyula, 5700 Hungary
| | - Zsófia Müller
- Department of Infectious Diseases, Fejér County St George Teaching Hospital, Seregélyesi Street 3, Székesfehérvár, 8000 Hungary
| | - Melánia Fehér
- Department of Infectious Diseases, Fejér County St George Teaching Hospital, Seregélyesi Street 3, Székesfehérvár, 8000 Hungary
| | - Edit Hajdú
- Department of Infectology, University of Szeged, Albert Szent-Györgyi Health Center, Kálvária Avenue 57, Szeged, 6725 Hungary
| | - Csaba Varga
- Department of Emergency Medicine, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street, 20-32, Kaposvár, 7400 Hungary
- Institute of Emergency Care and Pedagogy of Health, Faculty of Health Sciences, University of Pécs, Vörösmarty Mihály Street 4, Pécs, 7621 Hungary
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