1
|
Naveed A, Eertink LG, Wang D, Li F. Lessons Learned from West Nile Virus Infection:Vaccinations in Equines and Their Implications for One Health Approaches. Viruses 2024; 16:781. [PMID: 38793662 PMCID: PMC11125849 DOI: 10.3390/v16050781] [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: 03/11/2024] [Revised: 05/03/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024] Open
Abstract
Humans and equines are two dead-end hosts of the mosquito-borne West Nile virus (WNV) with similar susceptibility and pathogenesis. Since the introduction of WNV vaccines into equine populations of the United States of America (USA) in late 2002, there have been only sporadic cases of WNV infection in equines. These cases are generally attributed to unvaccinated and under-vaccinated equines. In contrast, due to the lack of a human WNV vaccine, WNV cases in humans have remained steadily high. An average of 115 deaths have been reported per year in the USA since the first reported case in 1999. Therefore, the characterization of protective immune responses to WNV and the identification of immune correlates of protection in vaccinated equines will provide new fundamental information about the successful development and evaluation of WNV vaccines in humans. This review discusses the comparative epidemiology, transmission, susceptibility to infection and disease, clinical manifestation and pathogenesis, and immune responses of WNV in humans and equines. Furthermore, prophylactic and therapeutic strategies that are currently available and under development are described. In addition, the successful vaccination of equines against WNV and the potential lessons for human vaccine development are discussed.
Collapse
Affiliation(s)
| | | | | | - Feng Li
- Maxwell H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, KY 40546, USA; (A.N.); (L.G.E.); (D.W.)
| |
Collapse
|
2
|
Tariq Bhatti M, Long JR, Carey AR. Denial. Surv Ophthalmol 2024:S0039-6257(24)00050-X. [PMID: 38750826 DOI: 10.1016/j.survophthal.2024.05.003] [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: 03/18/2024] [Revised: 04/30/2024] [Accepted: 05/09/2024] [Indexed: 06/06/2024]
Abstract
A 51-year-old man presented with decreased vision, fever, confusion, headaches, agitation, nausea, vomiting and diarrhea. Magnetic resonance imaging of the brain demonstrated bilateral T2 hyperintense lesions in the region of the mesial temporal lobe and optic radiations. There was a predominantly polymorphonuclear leukocyte pleocytosis in the cerebrospinal fluid (CSF) with hyperproteinorachia. A meningoencephalitis was diagnosed. Intravenous fluorescein angiography (IVFA) demonstrated a multifocal chorioretinitis that was in a linear pattern in the left eye. CSF enzyme-linked immunosorbent assay was positive for West Nile virus (WNV) IgM. We review the clinical manifestations of WNV disease and highlight the value of IVFA in determining the diagnosis.
Collapse
Affiliation(s)
- M Tariq Bhatti
- The Permanente Medical Group, Department of Ophthalmology, Kaiser Permanente-Northern California, Roseville, CA, USA.
| | - Jennifer R Long
- The Permanente Medical Group, Department of Ophthalmology, Kaiser Permanente-Northern California, Roseville, CA, USA
| | - Andrew R Carey
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Mbonde AA, Gritsch D, Harahsheh EY, Kasule SN, Hasan S, Parsons AM, Zhang N, Butterfield R, Shiue H, Norville KA, Reynolds JL, Vikram HR, Chong B, Grill MF. Neuroinvasive West Nile Virus Infection in Immunosuppressed and Immunocompetent Adults. JAMA Netw Open 2024; 7:e244294. [PMID: 38546642 PMCID: PMC10979308 DOI: 10.1001/jamanetworkopen.2024.4294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/02/2024] [Indexed: 04/01/2024] Open
Abstract
Importance West Nile virus (WNV) is the leading cause of human arboviral disease in the US, peaking during summer. The incidence of WNV, including its neuroinvasive form (NWNV), is increasing, largely due to the expanding distribution of its vector, the Culex mosquito, and climatic changes causing heavy monsoon rains. However, the distinct characteristics and outcomes of NWNV in individuals who are immunosuppressed (IS) and individuals who are not IS remain underexplored. Objective To describe and compare clinical and radiographic features, treatment responses, and outcomes of NWNV infection in individuals who are IS and those who are not IS. Design, Setting, and Participants This retrospective cohort study used data from the Mayo Clinic Hospital system collected from July 2006 to December 2021. Participants were adult patients (age ≥18 years) with established diagnosis of NWNV infection. Data were analyzed from May 12, 2020, to July 20, 2023. Exposure Immunosuppresion. Main Outcomes and Measures Outcomes of interest were clinical and radiographic features and 90-day mortality among patients with and without IS. Results Of 115 participants with NWNV infection (mean [SD] age, 64 [16] years; 75 [66%] male) enrolled, 72 (63%) were not IS and 43 (37%) were IS. Neurologic manifestations were meningoencephalitis (98 patients [85%]), encephalitis (10 patients [9%]), and myeloradiculitis (7 patients [6%]). Patients without IS, compared with those with IS, more frequently reported headache (45 patients [63%] vs 18 patients [42%]) and myalgias (32 patients [44%] vs 9 patients [21%]). In contrast, patients with IS, compared with those without, had higher rates of altered mental status (33 patients [77%] vs 41 patients [57%]) and myoclonus (8 patients [19%] vs 8 patients [4%]). Magnetic resonance imaging revealed more frequent thalamic T2 fluid-attenuated inversion recovery hyperintensities in individuals with IS than those without (4 patients [11%] vs 0 patients). Individuals with IS had more severe disease requiring higher rates of intensive care unit admission (26 patients [61%] vs 24 patients [33%]) and mechanical ventilation (24 patients [56%] vs 22 patients [31%]). The 90-day all-cause mortality rate was higher in the patients with IS compared with patients without IS (12 patients [28%] vs 5 patients [7%]), and this difference in mortality persisted after adjusting for Glasgow Coma Scale score (adjusted hazard ratio, 2.22; 95% CI, 1.07-4.27; P = .03). Individuals with IS were more likely to receive intravenous immunoglobulin than individuals without IS (12 individuals [17%] vs 24 individuals [56%]), but its use was not associated with survival (hazard ratio, 1.24; 95% CI, 0.50-3.09; P = .64). Conclusions and Relevance In this cohort study of individuals with NWNV infection, individuals with IS had a higher risk of disease complications and poor outcomes than individuals without IS, highlighting the need for innovative and effective therapies to improve outcomes in this high-risk population.
Collapse
Affiliation(s)
- Amir A. Mbonde
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - David Gritsch
- Department of Neurology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Ehab Y. Harahsheh
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Sabirah N. Kasule
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Shemonti Hasan
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | | | - Nan Zhang
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Phoenix, Arizona
| | - Richard Butterfield
- Department of Quantitative Health Sciences, Division of Clinical Trials and Biostatistics, Mayo Clinic, Phoenix, Arizona
| | - Harn Shiue
- Department of Pharmacy, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Kathryn A. Norville
- Department of Pharmacy, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Jenna L. Reynolds
- Department of Pharmacy, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Holenarasipur R. Vikram
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Brian Chong
- Department of Neuroradiology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| | - Marie F. Grill
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, Arizona
| |
Collapse
|
5
|
Chandwani MN, Kamte YS, Singh VR, Hemerson ME, Michaels AC, Leak RK, O'Donnell LA. The anti-viral immune response of the adult host robustly modulates neural stem cell activity in spatial, temporal, and sex-specific manners. Brain Behav Immun 2023; 114:61-77. [PMID: 37516388 DOI: 10.1016/j.bbi.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/20/2023] [Accepted: 07/14/2023] [Indexed: 07/31/2023] Open
Abstract
Viruses induce a wide range of neurological sequelae through the dysfunction and death of infected cells and persistent inflammation in the brain. Neural stem cells (NSCs) are often disturbed during viral infections. Although some viruses directly infect and kill NSCs, the antiviral immune response may also indirectly affect NSCs. To better understand how NSCs are influenced by a productive immune response, where the virus is successfully resolved and the host survives, we used the CD46+ mouse model of neuron-restricted measles virus (MeV) infection. As NSCs are spared from direct infection in this model, they serve as bystanders to the antiviral immune response initiated by selective infection of mature neurons. MeV-infected mice showed distinct regional and temporal changes in NSCs in the primary neurogenic niches of the brain, the hippocampus and subventricular zone (SVZ). Hippocampal NSCs increased throughout the infection (7 and 60 days post-infection; dpi), while mature neurons transiently declined at 7 dpi and then rebounded to basal levels by 60 dpi. In the SVZ, NSC numbers were unchanged, but mature neurons declined even after the infection was controlled at 60 dpi. Further analyses demonstrated sex, temporal, and region-specific changes in NSC proliferation and neurogenesis throughout the infection. A relatively long-term increase in NSC proliferation and neurogenesis was observed in the hippocampus; however, neurogenesis was reduced in the SVZ. This decline in SVZ neurogenesis was associated with increased immature neurons in the olfactory bulb in female, but not male mice, suggesting potential migration of newly-made neurons out of the female SVZ. These sex differences in SVZ neurogenesis were accompanied by higher infiltration of B cells and greater expression of interferon-gamma and interleukin-6 in female mice. Learning, memory, and olfaction tests revealed no overt behavioral changes after the acute infection subsided. These results indicate that antiviral immunity modulates NSC activity in adult mice without inducing gross behavioral deficits among those tested, suggestive of mechanisms to restore neurons and maintain adaptive behavior, but also revealing the potential for robust NSC disruption in subclinical infections.
Collapse
Affiliation(s)
- Manisha N Chandwani
- Duquesne University School of Pharmacy, Graduate School of Pharmaceutical Sciences, Pittsburgh, PA, USA
| | - Yashika S Kamte
- Duquesne University School of Pharmacy, Graduate School of Pharmaceutical Sciences, Pittsburgh, PA, USA
| | - Vivek R Singh
- Duquesne University School of Pharmacy, Graduate School of Pharmaceutical Sciences, Pittsburgh, PA, USA
| | - Marlo E Hemerson
- Duquesne University School of Pharmacy, Graduate School of Pharmaceutical Sciences, Pittsburgh, PA, USA
| | - Alexa C Michaels
- Duquesne University School of Pharmacy, Graduate School of Pharmaceutical Sciences, Pittsburgh, PA, USA
| | - Rehana K Leak
- Duquesne University School of Pharmacy, Graduate School of Pharmaceutical Sciences, Pittsburgh, PA, USA
| | - Lauren A O'Donnell
- Duquesne University School of Pharmacy, Graduate School of Pharmaceutical Sciences, Pittsburgh, PA, USA.
| |
Collapse
|
6
|
Telford SR, Piantadosi AL. Powassan virus persistence after acute infection. mBio 2023; 14:e0071223. [PMID: 37338444 PMCID: PMC10470498 DOI: 10.1128/mbio.00712-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 06/21/2023] Open
Abstract
Survivors of Powassan encephalitis often have persistent neurological disease. A new mouse model replicates some elements of the human disease and demonstrates the presence of viral RNA in the brain as well as myelitis more than 2 mo after the acute infection. The related tick-borne encephalitis and West Nile Neuroinvasive Disease (WNND) also have common neurological sequelae, and models for these better-studied diseases provide evidence for prolonged virus, RNA, and inflammation in some cases, in addition to damage from the acute encephalitic disease. A better understanding of the biological basis for persistent signs and symptoms after Powassan encephalitis, currently a rare disease, could benefit from further studies of the more prevalent flaviviral encephalitides.
Collapse
Affiliation(s)
- Sam R. Telford
- Department of Infectious Disease and Global Health; Tufts Lyme Disease Initiative, Tufts University, North Grafton, Massachusetts, USA
| | - Anne L. Piantadosi
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
7
|
Pati I, Cruciani M, Candura F, Massari MS, Piccinini V, Masiello F, Profili S, De Fulvio L, Pupella S, De Angelis V. Hyperimmune Globulins for the Management of Infectious Diseases. Viruses 2023; 15:1543. [PMID: 37515229 PMCID: PMC10385259 DOI: 10.3390/v15071543] [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: 06/14/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
This review is focused on the use of hyperimmune globulin therapy to treat some infectious diseases of viral or bacterial origin. Despite the introduction of antibiotics and vaccines, plasma immunoglobulin therapy from whole blood donation can still play a key role. These treatments provide passive transfer of high-titer antibodies that either reduces the risk or the severity of the infection and offer immediate but short-term protection against specific diseases. Antibody preparations derived from immunized human donors are commonly used for the prophylaxis and treatment of rabies, hepatitis A and B viruses, varicella-zoster virus, and pneumonia caused by respiratory syncytial virus, Clostridium tetani, Clostridium botulinum. The use of hyperimmune globulin therapy is a promising challenge, especially for the treatment of emerging viral infections for which there are no specific therapies or licensed vaccines.
Collapse
Affiliation(s)
- Ilaria Pati
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | - Mario Cruciani
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | - Fabio Candura
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | | | - Vanessa Piccinini
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | - Francesca Masiello
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | - Samantha Profili
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | - Lucia De Fulvio
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | - Simonetta Pupella
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| | - Vincenzo De Angelis
- National Blood Centre, Italian National Institute of Health, 00161 Rome, Italy
| |
Collapse
|
8
|
Immune Functions of Astrocytes in Viral Neuroinfections. Int J Mol Sci 2023; 24:ijms24043514. [PMID: 36834929 PMCID: PMC9960577 DOI: 10.3390/ijms24043514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
Neuroinfections of the central nervous system (CNS) can be triggered by various pathogens. Viruses are the most widespread and have the potential to induce long-term neurologic symptoms with potentially lethal outcomes. In addition to directly affecting their host cells and inducing immediate changes in a plethora of cellular processes, viral infections of the CNS also trigger an intense immune response. Regulation of the innate immune response in the CNS depends not only on microglia, which are fundamental immune cells of the CNS, but also on astrocytes. These cells align blood vessels and ventricle cavities, and consequently, they are one of the first cell types to become infected after the virus breaches the CNS. Moreover, astrocytes are increasingly recognized as a potential viral reservoir in the CNS; therefore, the immune response initiated by the presence of intracellular virus particles may have a profound effect on cellular and tissue physiology and morphology. These changes should be addressed in terms of persisting infections because they may contribute to recurring neurologic sequelae. To date, infections of astrocytes with different viruses originating from genetically distinct families, including Flaviviridae, Coronaviridae, Retroviridae, Togaviridae, Paramyxoviridae, Picomaviridae, Rhabdoviridae, and Herpesviridae, have been confirmed. Astrocytes express a plethora of receptors that detect viral particles and trigger signaling cascades, leading to an innate immune response. In this review, we summarize the current knowledge on virus receptors that initiate the release of inflammatory cytokines from astrocytes and depict the involvement of astrocytes in immune functions of the CNS.
Collapse
|
9
|
Diagnostic value of urine qRT-PCR for the diagnosis of West Nile virus neuroinvasive disease. Diagn Microbiol Infect Dis 2023. [PMID: 37390574 DOI: 10.1016/j.diagmicrobio.2023.115920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Short and low-level viremia and virorachia, antibody cross-reactivity, IgM persistence, and inaccessibility of neutralization test, make laboratory diagnosis of West Nile virus (WNV) infection difficult. Recent investigations imply that WNV is excreted in urine longer and at higher concentrations compared to blood. The detection of WNV nucleic acid in cerebrospinal fluid (CSF), serum, and urine samples collected from 41 patients with suspected WNV neuroinvasive disease, was done by real-time RT-PCR assay. CSF and serum samples were also serologically tested using anti-WNV IgM/IgG ELISA kits. WNV infection was confirmed in 46.3% of patients by positive WNV RNA results in serum and/or CSF samples. The WNV RNA testing of urine allowed confirmation of 31.7% more cases. No association between WNV RNA urine positivity and age, gender, or the day of sample collection was found. The urine qRT-PCR can be a valuable diagnostic test for confirmation of probable cases of WNV neuroinvasive disease.
Collapse
|
10
|
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.
Collapse
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
| | | |
Collapse
|
11
|
Sun H, Acharya D, Paul AM, Lai H, He J, Bai F, Chen Q. Antibody-Dependent Enhancement Activity of a Plant-Made Vaccine against West Nile Virus. Vaccines (Basel) 2023; 11:197. [PMID: 36851075 PMCID: PMC9966755 DOI: 10.3390/vaccines11020197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/07/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
West Nile virus (WNV) causes annual outbreaks globally and is the leading cause of mosquito-borne disease in Unite States. In the absence of licensed therapeutics, there is an urgent need to develop effective and safe human vaccines against WNV. One of the major safety concerns for WNV vaccine development is the risk of increasing infection by related flaviviruses in vaccinated subjects via antibody-dependent enhancement of infection (ADE). Herein, we report the development of a plant-based vaccine candidate that provides protective immunity against a lethal WNV challenge mice, while minimizes the risk of ADE for infection by Zika (ZIKV) and dengue (DENV) virus. Specifically, a plant-produced virus-like particle (VLP) that displays the WNV Envelope protein domain III (wDIII) elicited both high neutralizing antibody titers and antigen-specific cellular immune responses in mice. Passive transfer of serum from VLP-vaccinated mice protected recipient mice from a lethal challenge of WNV infection. Notably, VLP-induced antibodies did not enhance the infection of Fc gamma receptor-expressing K562 cells by ZIKV or DENV through ADE. Thus, a plant-made wDIII-displaying VLP presents a promising WNV vaccine candidate that induces protective immunity and minimizes the concern of inducing ADE-prone antibodies to predispose vaccinees to severe infection by DENV or ZIKV.
Collapse
Affiliation(s)
- Haiyan Sun
- The Biodesign Institute and School of Life Sciences, Arizona State University, Tempe, AZ 85287, USA
| | - Dhiraj Acharya
- Department of Cell and Molecular Biology, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Amber M. Paul
- Department of Cell and Molecular Biology, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Huafang Lai
- The Biodesign Institute and School of Life Sciences, Arizona State University, Tempe, AZ 85287, USA
| | - Junyun He
- The Biodesign Institute and School of Life Sciences, Arizona State University, Tempe, AZ 85287, USA
| | - Fengwei Bai
- Department of Cell and Molecular Biology, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Qiang Chen
- The Biodesign Institute and School of Life Sciences, Arizona State University, Tempe, AZ 85287, USA
| |
Collapse
|
12
|
Giakountis A, Stylianidou Z, Zaka A, Pappa S, Papa A, Hadjichristodoulou C, Mathiopoulos KD. Development of Toehold Switches as a Novel Ribodiagnostic Method for West Nile Virus. Genes (Basel) 2023; 14:237. [PMID: 36672977 PMCID: PMC9859090 DOI: 10.3390/genes14010237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
West Nile virus (WNV) is an emerging neurotropic RNA virus and a member of the genus Flavivirus. Naturally, the virus is maintained in an enzootic cycle involving mosquitoes as vectors and birds that are the principal amplifying virus hosts. In humans, the incubation period for WNV disease ranges from 3 to 14 days, with an estimated 80% of infected persons being asymptomatic, around 19% developing a mild febrile infection and less than 1% developing neuroinvasive disease. Laboratory diagnosis of WNV infection is generally accomplished by cross-reacting serological methods or highly sensitive yet expensive molecular approaches. Therefore, current diagnostic tools hinder widespread surveillance of WNV in birds and mosquitoes that serve as viral reservoirs for infecting secondary hosts, such as humans and equines. We have developed a synthetic biology-based method for sensitive and low-cost detection of WNV. This method relies on toehold riboswitches designed to detect WNV genomic RNA as transcriptional input and process it to GFP fluorescence as translational output. Our methodology offers a non-invasive tool with reduced operating cost and high diagnostic value that can be used for field surveillance of WNV in humans as well as in bird and mosquito populations.
Collapse
Affiliation(s)
- Antonis Giakountis
- Department of Biochemistry and Biotechnology, University of Thessaly, Biopolis-Mezourlo, 41500 Larissa, Greece
| | - Zoe Stylianidou
- Department of Biochemistry and Biotechnology, University of Thessaly, Biopolis-Mezourlo, 41500 Larissa, Greece
| | - Anxhela Zaka
- Department of Biochemistry and Biotechnology, University of Thessaly, Biopolis-Mezourlo, 41500 Larissa, Greece
| | - Styliani Pappa
- Department of Microbiology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Anna Papa
- Department of Microbiology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | | | - Kostas D. Mathiopoulos
- Department of Biochemistry and Biotechnology, University of Thessaly, Biopolis-Mezourlo, 41500 Larissa, Greece
| |
Collapse
|
13
|
Reviewing the Potential Links between Viral Infections and TDP-43 Proteinopathies. Int J Mol Sci 2023; 24:ijms24021581. [PMID: 36675095 PMCID: PMC9867397 DOI: 10.3390/ijms24021581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
Transactive response DNA binding protein 43 kDa (TDP-43) was discovered in 2001 as a cellular factor capable to inhibit HIV-1 gene expression. Successively, it was brought to new life as the most prevalent RNA-binding protein involved in several neurological disorders, such as amyotrophic lateral sclerosis (ALS) and frontotemporal lobar degeneration (FTLD). Despite the fact that these two research areas could be considered very distant from each other, in recent years an increasing number of publications pointed out the existence of a potentially important connection. Indeed, the ability of TDP-43 to act as an important regulator of all aspects of RNA metabolism makes this protein also a critical factor during expression of viral RNAs. Here, we summarize all recent observations regarding the involvement of TDP-43 in viral entry, replication and latency in several viruses that include enteroviruses (EVs), Theiler's murine encephalomyelitis virus (TMEV), human immunodeficiency virus (HIV), human endogenous retroviruses (HERVs), hepatitis B virus (HBV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), West Nile virus (WNV), and herpes simplex virus-2 (HSV). In particular, in this work, we aimed to highlight the presence of similarities with the most commonly studied TDP-43 related neuronal dysfunctions.
Collapse
|
14
|
Qian XJ, Zhou HY, Liu Y, Dong JX, Tang WD, Zhao P, Tang HL, Jin YS. Synthesis of baicalein derivatives and evaluation of their antiviral activity against arboviruses. Bioorg Med Chem Lett 2022; 72:128863. [PMID: 35738350 DOI: 10.1016/j.bmcl.2022.128863] [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: 02/18/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/19/2022]
Abstract
Natural plant-derived baicalein which is extracted from Chinese herb Scutellaria baicalensis Georgi belongs to the flavonoid compounds and possesses multiple pharmacological activities. In this study, we designed and synthesized new series of derivatives of baicalein (BE) through catalytic coupling reactions, and screened for their antiviral activity against arboviruses including Chikungunya virus (CHIKV), West Nile virus (WNV) or Zika virus (ZIKV). Our results revealed for the first time that BE and its derivatives had potent anti-CHIKV, anti-WNV and anti-ZIKV effects. And modification of 8 or 4' position could lead to obtain potent antiviral compounds against CHIKV, WNV and ZIKV with lower cytotoxicity. Among the baicalein derivatives, C3 and F3 showed the most potent antiviral activities against CHIKV, WNV and ZIKV, which were 5-10 times more potent than baicalein. Our findings will provide research basis for the development of baicalein derivatives as effective antiviral agents.
Collapse
Affiliation(s)
- Xi-Jing Qian
- Department of Microbiology, Faculty of Naval Medicine, Naval Medical University, Shanghai 200433, China
| | - He-Yang Zhou
- Department of Organic Chemistry, School of Pharmacy, Naval Medical University, Shanghai 200433, China
| | - Yan Liu
- Department of Microbiology, Faculty of Naval Medicine, Naval Medical University, Shanghai 200433, China
| | - Jia-Xiao Dong
- Department of Organic Chemistry, School of Pharmacy, Naval Medical University, Shanghai 200433, China
| | - Wan-Da Tang
- Department of Microbiology, Faculty of Naval Medicine, Naval Medical University, Shanghai 200433, China
| | - Ping Zhao
- Department of Microbiology, Faculty of Naval Medicine, Naval Medical University, Shanghai 200433, China
| | - Hai-Lin Tang
- Department of Microbiology, Faculty of Naval Medicine, Naval Medical University, Shanghai 200433, China.
| | - Yong-Sheng Jin
- Department of Organic Chemistry, School of Pharmacy, Naval Medical University, Shanghai 200433, China.
| |
Collapse
|
15
|
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]
|
16
|
Schneider J, Bachmann F, Choi M, Kurvits L, Luisa Schmidt M, Bergfeld L, Meier I, Zuchowski M, Werber D, Hofmann J, Ruprecht K, Eckardt KU, Carleton Jones T, Drosten C, Max Corman V. Autochthonous West Nile virus infection in Germany: Increasing numbers and a rare encephalitis case in a kidney transplant recipient. Transbound Emerg Dis 2022; 69:221-226. [PMID: 34850584 PMCID: PMC8969181 DOI: 10.1111/tbed.14406] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/07/2021] [Accepted: 11/17/2021] [Indexed: 12/15/2022]
Abstract
West Nile Virus (WNV) infections are increasingly detected in birds and horses in central Europe, with the first mosquito-borne autochthonous human infection detected in Germany in 2019. Human infections are typically asymptomatic, with occasional severe neurological disease. Because of a low number of cases in central Europe, awareness regarding potential cases is low and WNV diagnostic testing is not routine. We tested cerebrospinal fluid (CSF) samples from unsolved encephalitis and meningitis cases from Berlin from 2019 to 2020, and describe a WNV-encephalitis case in a 33-year-old kidney transplant recipient. The infectious course was resolved by serology, RT-PCR and sequencing of stored samples. Phylogenetic sequence analysis revealed a close relationship of the patient's WNV strain to German sequences from 2019 and 2020. A lack of travel history and patient self-isolation during the SARS-CoV-2 pandemic suggest the infection was acquired in the patient's home or garden. Serological tests of four people sharing the living space were negative. Retrospective RT-PCR and WNV-IgM testing of 671 CSF samples from unsolved encephalitis and meningitis cases from Berlin detected no additional infections. The recent increase of WNV cases illustrates the importance of considering WNV in cases of meningoencephalitis, especially in immunocompromised patients, as described here. Proper education and communication and a revised diagnostic strategy will help to raise awareness and to detect future WNV infections.
Collapse
Affiliation(s)
- Julia Schneider
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,German Centre for Infection Research (DZIF), partner site Charité, Berlin, Germany
| | - Friederike Bachmann
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mira Choi
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Lille Kurvits
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marie Luisa Schmidt
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Leon Bergfeld
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Iris Meier
- State Office for Health and Social Affairs, Berlin, Germany
| | | | - Dirk Werber
- State Office for Health and Social Affairs, Berlin, Germany
| | - Jörg Hofmann
- Labor Berlin-Charité Vivantes GmbH, Berlin, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Terry Carleton Jones
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,German Centre for Infection Research (DZIF), partner site Charité, Berlin, Germany,Centre for Pathogen Evolution, Department of Zoology, University of Cambridge, Cambridge, U.K
| | - Christian Drosten
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,German Centre for Infection Research (DZIF), partner site Charité, Berlin, Germany
| | - Victor Max Corman
- Institute of Virology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany,German Centre for Infection Research (DZIF), partner site Charité, Berlin, Germany
| |
Collapse
|
17
|
Bhattacharyya S, Bradshaw MJ. Infections of the Spine and Spinal Cord. Continuum (Minneap Minn) 2021; 27:887-920. [PMID: 34623097 DOI: 10.1212/con.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Infections of the spine and spinal cord are associated with a high risk of morbidity and mortality and, therefore, require prompt clinical recognition, efficient diagnostic evaluation, and interdisciplinary treatment. This article reviews the pathophysiology, epidemiology, clinical manifestations, diagnosis, and treatment of infections of the spine and spinal cord to help practicing clinicians recognize, evaluate, and manage patients with such infections. RECENT FINDINGS Aging of the population, increasing use of immunosuppressive medications, and other factors have contributed to increasing rates of spinal infections. Although the most common agents responsible for spinal infections remain bacteria and viruses, fungal infections occur in individuals who are immunocompromised, and parasitic infections are common in endemic regions, but patterns are in evolution with migration and climate change. Recent outbreaks of acute flaccid myelitis in children have been associated with enteroviruses A71 and D68. SUMMARY Infections of the spine and spinal cord can be challenging to diagnose, requiring a thorough history and neurologic examination, laboratory studies of serum and CSF, neuroimaging (particularly MRI), and, in some instances, biopsy, to establish a diagnosis and treatment regimen. Interdisciplinary management including collaboration with experts in internal medicine, infectious disease, and neurosurgery is important to improve clinical outcomes.
Collapse
|
18
|
Lewis R, Khan N, Lynn W, Sandhu G, Papineni P. Neuroinvasive West Nile virus in a traveller from the United States to England. J Travel Med 2021; 28:6094889. [PMID: 33442720 DOI: 10.1093/jtm/taab001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/13/2020] [Accepted: 12/15/2020] [Indexed: 11/14/2022]
Abstract
Infections with West Nile virus (WNV) are emerging as a significant risk in North America and Europe; however, imported cases to the UK are still rarely seen. We report a case of neuroinvasive WNV in a traveller from the USA to the UK.
Collapse
|
19
|
Saiz JC, Martín-Acebes MA, Blázquez AB, Escribano-Romero E, Poderoso T, Jiménez de Oya N. Pathogenicity and virulence of West Nile virus revisited eight decades after its first isolation. Virulence 2021; 12:1145-1173. [PMID: 33843445 PMCID: PMC8043182 DOI: 10.1080/21505594.2021.1908740] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
West Nile virus (WNV) is a flavivirus which transmission cycle is maintained between mosquitoes and birds, although it occasionally causes sporadic outbreaks in horses and humans that can result in serious diseases and even death. Since its first isolation in Africa in 1937, WNV had been considered a neglected pathogen until its recent spread throughout Europe and the colonization of America, regions where it continues to cause outbreaks with severe neurological consequences in humans and horses. Although our knowledge about the characteristics and consequences of the virus has increased enormously lately, many questions remain to be resolved. Here, we thoroughly update our knowledge of different aspects of the WNV life cycle: virology and molecular classification, host cell interactions, transmission dynamics, host range, epidemiology and surveillance, immune response, clinical presentations, pathogenesis, diagnosis, prophylaxis (antivirals and vaccines), and prevention, and we highlight those aspects that are still unknown and that undoubtedly require further investigation.
Collapse
Affiliation(s)
- Juan-Carlos Saiz
- Department of Biotechnology, National Institute for Agricultural and Food Research and Technology (INIA), Madrid, Spain
| | - Miguel A Martín-Acebes
- Department of Biotechnology, National Institute for Agricultural and Food Research and Technology (INIA), Madrid, Spain
| | - Ana B Blázquez
- Department of Biotechnology, National Institute for Agricultural and Food Research and Technology (INIA), Madrid, Spain
| | - Estela Escribano-Romero
- Department of Biotechnology, National Institute for Agricultural and Food Research and Technology (INIA), Madrid, Spain
| | - Teresa Poderoso
- Molecular Virology Group, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Nereida Jiménez de Oya
- Department of Biotechnology, National Institute for Agricultural and Food Research and Technology (INIA), Madrid, Spain
| |
Collapse
|
20
|
Dumic I, Glomski B, Patel J, Nordin T, Nordstrom CW, Sprecher LJ, Niendorf E, Singh A, Simeunovic K, Subramanian A, Igandan O, Vitorovic D. "Double Trouble": Severe Meningoencephalitis Due to Borrelia burgdorferi and Powassan Virus Co-Infection Successfully Treated with Intravenous Immunoglobulin. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929952. [PMID: 33758161 PMCID: PMC8008974 DOI: 10.12659/ajcr.929952] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Powassan virus (POWV) is an emerging tick-borne flavivirus transmitted to humans by ticks. While infection is asymptomatic in some people, others develop life-threatening encephalitis with high mortality rates. Co-infection between POWV and Borrelia burgdorferi is rare despite the fact that both pathogens can be transmitted through the same tick vector, Ixodes scapularis. It is unclear if co-infection leads to more severe clinical presentation and worse outcome. CASE REPORT A 76-year-old Wisconsin man was admitted for meningoencephalitis complicated by hypoxemic and hypercapnic respiratory failure requiring endotracheal intubation. The patient had no known tick bites but lived in a heavily wooded area. Extensive work-up for infectious, autoimmune, and paraneoplastic causes was positive for Borrelia burgdorferi and Powassan virus infection (POWV). Following treatment with ceftriaxone for neuroborreliosis and supportive care for POWV infection, the patient failed to improve. Intravenous immunoglobulins (IVIG) were started empirically, and the patient attained gradual neurological improvement and was successfully extubated. CONCLUSIONS Treatment for POWV infection is supportive, and at this time there are no approved targeted antivirals for this disease. At this time, it remains unclear if co-infection with 2 pathogens leads to a more severe clinical presentation and higher mortality. In the absence of contraindications, IVIG might be beneficial to patients with POWV infection who are not improving with supportive care.
Collapse
Affiliation(s)
- Igor Dumic
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.,Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Bridget Glomski
- Mayo Clinic Family Medicine Residency Program, Eau Claire, WI, USA
| | - Janki Patel
- Department of Infectious Disease, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Terri Nordin
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA.,Mayo Clinic Family Medicine Residency Program, Eau Claire, WI, USA
| | - Charles W Nordstrom
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.,Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Lawrence J Sprecher
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.,Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Eric Niendorf
- Department of Radiology, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Amteshwar Singh
- Department of Hospital Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kosana Simeunovic
- Department of Hospital Medicine, Merit Health Wesley, Hattiesburg, MS, USA
| | - Anand Subramanian
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.,Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Oladapo Igandan
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.,Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | - Danilo Vitorovic
- Department of Neurology, University of Vermont, Burlington, VT, USA
| |
Collapse
|
21
|
Maximova OA, Sturdevant DE, Kash JC, Kanakabandi K, Xiao Y, Minai M, Moore IN, Taubenberger J, Martens C, Cohen JI, Pletnev AG. Virus infection of the CNS disrupts the immune-neural-synaptic axis via induction of pleiotropic gene regulation of host responses. eLife 2021; 10:e62273. [PMID: 33599611 PMCID: PMC7891934 DOI: 10.7554/elife.62273] [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: 08/19/2020] [Accepted: 01/15/2021] [Indexed: 12/19/2022] Open
Abstract
Treatment for many viral infections of the central nervous system (CNS) remains only supportive. Here we address a remaining gap in our knowledge regarding how the CNS and immune systems interact during viral infection. By examining the regulation of the immune and nervous system processes in a nonhuman primate model of West Nile virus neurological disease, we show that virus infection disrupts the homeostasis of the immune-neural-synaptic axis via induction of pleiotropic genes with distinct functions in each component of the axis. This pleiotropic gene regulation suggests an unintended off-target negative impact of virus-induced host immune responses on the neurotransmission, which may be a common feature of various viral infections of the CNS.
Collapse
Affiliation(s)
- Olga A Maximova
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
| | - Daniel E Sturdevant
- Research Technologies Branch, Genomics Unit, National Institute of Allergy and Infectious Diseases, National Institutes of HealthHamiltonUnited States
| | - John C Kash
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
| | - Kishore Kanakabandi
- Research Technologies Branch, Genomics Unit, National Institute of Allergy and Infectious Diseases, National Institutes of HealthHamiltonUnited States
| | - Yongli Xiao
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
| | - Mahnaz Minai
- Infectious Disease Pathogenesis Section, Comparative Medicine Branch, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
| | - Ian N Moore
- Infectious Disease Pathogenesis Section, Comparative Medicine Branch, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
| | - Jeff Taubenberger
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
| | - Craig Martens
- Research Technologies Branch, Genomics Unit, National Institute of Allergy and Infectious Diseases, National Institutes of HealthHamiltonUnited States
| | - Jeffrey I Cohen
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
| | - Alexander G Pletnev
- Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of HealthBethesdaUnited States
| |
Collapse
|
22
|
Chhatbar C, Prinz M. The roles of microglia in viral encephalitis: from sensome to therapeutic targeting. Cell Mol Immunol 2021; 18:250-258. [PMID: 33437050 PMCID: PMC7802409 DOI: 10.1038/s41423-020-00620-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/08/2020] [Indexed: 01/31/2023] Open
Abstract
Viral encephalitis is a devastating disease with high mortality, and survivors often suffer from severe neurological complications. Microglia are innate immune cells of the central nervous system (CNS) parenchyma whose turnover is reliant on local proliferation. Microglia express a diverse range of proteins, which allows them to continuously sense the environment and quickly react to changes. Under inflammatory conditions such as CNS viral infection, microglia promote innate and adaptive immune responses to protect the host. However, during viral infection, a dysregulated microglia-T-cell interplay may result in altered phagocytosis of neuronal synapses by microglia that causes neurocognitive impairment. In this review, we summarize the current knowledge on the role of microglia in viral encephalitis, propose questions to be answered in the future and suggest possible therapeutic targets.
Collapse
Affiliation(s)
- Chintan Chhatbar
- grid.5963.9Institute of Neuropathology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Marco Prinz
- grid.5963.9Institute of Neuropathology, Medical Faculty, University of Freiburg, Freiburg, Germany ,grid.5963.9Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany ,grid.5963.9Signalling Research Centres BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| |
Collapse
|
23
|
He J, Lai H, Esqueda A, Chen Q. Plant-Produced Antigen Displaying Virus-Like Particles Evokes Potent Antibody Responses against West Nile Virus in Mice. Vaccines (Basel) 2021; 9:60. [PMID: 33477363 PMCID: PMC7830312 DOI: 10.3390/vaccines9010060] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/09/2021] [Accepted: 01/15/2021] [Indexed: 01/11/2023] Open
Abstract
In this study, we developed a hepatitis B core antigen (HBcAg)-based virus-like particle (VLP) that displays the West Nile virus (WNV) Envelope protein domain III (wDIII) as a vaccine candidate for WNV. The HBcAg-wDIII fusion protein was quickly produced in Nicotiana benthamiana plants and reached a high expression level of approximately 1.2 mg of fusion protein per gram of leaf fresh weight within six days post gene infiltration. Electron microscopy and gradient centrifugation analysis indicated that the introduction of wDIII did not interfere with VLP formation and HBcAg-wDIII successfully assembled into VLPs. HBcAg-wDIII VLPs can be easily purified in large quantities from Nicotiana benthamiana leaves to >95% homogeneity. Further analysis revealed that the wDIII was displayed properly and demonstrated specific binding to an anti-wDIII monoclonal antibody that recognizes a conformational epitope of wDIII. Notably, HBcAg-wDIII VLPs were shown to be highly immunogenic and elicited potent humoral responses in mice with antigen-specific IgG titers equivalent to that of protective wDIII antigens in previous studies. Thus, our wDIII-based VLP vaccine offers an attractive option for developing effective, safe, and low-cost vaccines against WNV.
Collapse
Affiliation(s)
- Junyun He
- The Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (J.H.); (H.L.); (A.E.)
| | - Huafang Lai
- The Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (J.H.); (H.L.); (A.E.)
| | - Adrian Esqueda
- The Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (J.H.); (H.L.); (A.E.)
- School of Life Sciences, Arizona State University, Tempe, AZ 85287, USA
| | - Qiang Chen
- The Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; (J.H.); (H.L.); (A.E.)
- School of Life Sciences, Arizona State University, Tempe, AZ 85287, USA
| |
Collapse
|
24
|
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.
Collapse
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
| |
Collapse
|
25
|
Arboviruses in the Astrakhan region of Russia for 2018 season: The development of multiplex PCR assays and analysis of mosquitoes, ticks, and human blood sera. INFECTION GENETICS AND EVOLUTION 2021; 88:104711. [PMID: 33421655 DOI: 10.1016/j.meegid.2021.104711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 11/23/2022]
Abstract
The Astrakhan region of Russia is endemic for the number of arboviruses. In this paper, we describe the results of the detection of the list of neglected arboviruses in the Astrakhan region for the 2018 season. For the purpose of the study in-house PCR assays for detection of 18 arboviruses have been developed and validated using arboviruses obtained from Russian State Collection of Viruses. Pools of ticks (n = 463) and mosquitoes (n = 312) as well as 420 samples of human patients sera have been collected and analyzed. Using developed multiplex real-time PCR assays we were able to detect RNA of eight arboviruses (Crimean-Congo hemorrhagic fever virus, Dhori (Batken strain) virus, Batai virus, Tahyna virus, Uukuniemi virus, Inkoo virus, Sindbis virus and West Nile fever virus). All discovered viruses are capable of infecting humans causing fever and in some cases severe forms with hemorrhagic or neurologic symptoms. From PCR-positive samples, we were able to recover one isolate each of Dhori (Batken strain) virus and Crimean-Congo hemorrhagic fever virus which were further characterized by next-generation sequencing. The genomic sequences of identified Dhori (Batken strain) virus strain represent the most complete genome of Batken virus strain among previously reported.
Collapse
|
26
|
Mrzljak A, Dinjar-Kujundzic P, Santini M, Barbic L, Kosuta I, Savic V, Tabain I, Vilibic-Cavlek T. West Nile Virus: An Emerging Threat in Transplant Population. Vector Borne Zoonotic Dis 2020; 20:613-618. [PMID: 32228360 DOI: 10.1089/vbz.2019.2608] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
West Nile virus (WNV) has become one of the new challenges for transplant programs. In addition to transmission by mosquito bite, interhuman transmission is possible through blood products or organ transplantation. Majority of WNV infections present as asymptomatic or mild febrile illness, with less than 1% of infected developing neuroinvasive disease. Many studies report naturally acquired or donor-derived WNV infections in solid-organ transplant recipients, mainly kidney, but also liver, heart, lungs and pancreas. Given the much higher risk of neuroinvasive disease (40% and even higher) based on serologic and clinical studies and increased mortality in transplant population, WNV infection should be considered in all patients presented with fever and neurological symptoms after transplantation, especially during the arbovirus transmission season.
Collapse
Affiliation(s)
- Anna Mrzljak
- Department of Medicine, Merkur University Hospital, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Marija Santini
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Neuroinfections and Intensive Care Medicine, University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb, Croatia
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Iva Kosuta
- Department of Medicine, Merkur University Hospital, Zagreb, Croatia
| | - Vladimir Savic
- Poultry Center, Croatian Veterinary Institute, Zagreb, Croatia
| | - Irena Tabain
- Department of Virology, Croatian Institute of Public Health, Zagreb, Croatia
| | - Tatjana Vilibic-Cavlek
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Virology, Croatian Institute of Public Health, Zagreb, Croatia
| |
Collapse
|
27
|
Long-term, West Nile virus-induced neurological changes: A comparison of patients and rodent models. Brain Behav Immun Health 2020; 7:100105. [PMID: 34589866 PMCID: PMC8474605 DOI: 10.1016/j.bbih.2020.100105] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/07/2020] [Accepted: 07/12/2020] [Indexed: 02/06/2023] Open
Abstract
West Nile virus (WNV) is a mosquito-borne virus that can cause severe neurological disease in those infected. Those surviving infection often present with long-lasting neurological changes that can severely impede their lives. The most common reported symptoms are depression, memory loss, and motor dysfunction. These sequelae can persist for the rest of the patients’ lives. The pathogenesis behind these changes is still being determined. Here, we summarize current findings in human cases and rodent models, and discuss how these findings indicate that WNV induces a state in the brain similar neurodegenerative diseases. Rodent models have shown that infection leads to persistent virus and inflammation. Initial infection in the hippocampus leads to neuronal dysfunction, synapse elimination, and astrocytosis, all of which contribute to memory loss, mimicking findings in neurodegenerative diseases such as Alzheimer’s disease (AD) and Parkinson’s disease (PD). WNV infection acts on pathways, such as ubiquitin-signaled protein degradation, and induces the production of molecules, including IL-1β, IFN-γ, and α-synuclein, that are associated with neurodegenerative diseases. These findings indicate that WNV induces neurological damage through similar mechanisms as neurodegenerative diseases, and that pursuing research into the similarities will help advance our understanding of the pathogenesis of WNV-induced neurological sequelae. In patients with and without diagnosed WNND, there are long-lasting neurological sequelae that can mimic neurodegenerative diseases. Some rodent models of WNV reproduce some of these changes with mechanisms similar to neurodegenerative diseases. There is significant overlap between WNV and ND pathogenesis and this has been understudied. Further research needs to be done to determine accuracy of animal models compared to human patients.
Collapse
|
28
|
Aziz F, Saddler C, Jorgenson M, Smith J, Mandelbrot D. Epidemiology, management, and graft outcomes after West Nile virus encephalitis in kidney transplant recipients. Transpl Infect Dis 2020; 22:e13317. [DOI: 10.1111/tid.13317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/25/2020] [Accepted: 05/02/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Fahad Aziz
- Division of Nephrology Department of Medicine University of Wisconsin–Madison School of Medicine and Public Health University of Wisconsin Hospital and Clinics Madison WI USA
| | - Christopher Saddler
- Division of infectious disease Department of Medicine University of Wisconsin–Madison School of Medicine and Public Health University of Wisconsin Hospital and Clinics Madison WI USA
| | - Margaret Jorgenson
- Department of Pharmacology University of Wisconsin–Madison School of Medicine and Public Health University of Wisconsin Hospital and Clinics Madison WI USA
| | - Jeannina Smith
- Division of infectious disease Department of Medicine University of Wisconsin–Madison School of Medicine and Public Health University of Wisconsin Hospital and Clinics Madison WI USA
| | - Didier Mandelbrot
- Division of Nephrology Department of Medicine University of Wisconsin–Madison School of Medicine and Public Health University of Wisconsin Hospital and Clinics Madison WI USA
| |
Collapse
|
29
|
Gnann JW, Agrawal A, Hart J, Buitrago M, Carson P, Hanfelt-Goade D, Tyler K, Spotkov J, Freifeld A, Moore T, Reyno J, Masur H, Jester P, Dale I, Li Y, Aban I, Lakeman FD, Whitley RJ. Lack of Efficacy of High-Titered Immunoglobulin in Patients with West Nile Virus Central Nervous System Disease. Emerg Infect Dis 2020; 25:2064-2073. [PMID: 31625835 PMCID: PMC6810207 DOI: 10.3201/eid2511.190537] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Immunoglobulin administered to adults with neuroinvasive disease appeared to be safe but was not demonstrated to improve clinical outcomes. West Nile Virus (WNV) can result in clinically severe neurologic disease. There is no treatment for WNV infection, but administration of anti-WNV polyclonal human antibody has demonstrated efficacy in animal models. We compared Omr-IgG-am, an immunoglobulin product with high titers of anti-WNV antibody, with intravenous immunoglobulin (IVIG) and normal saline to assess safety and efficacy in patients with WNV neuroinvasive disease as part of a phase I/II, randomized, double-blind, multicenter study in North America. During 2003–2006, a total of 62 hospitalized patients were randomized to receive Omr-IgG-am, standard IVIG, or normal saline (3:1:1). The primary endpoint was medication safety. Secondary endpoints were morbidity and mortality, measured using 4 standardized assessments of cognitive and functional status. The death rate in the study population was 12.9%. No significant differences were found between groups receiving Omr-IgG-am compared with IVIG or saline for either the safety or efficacy endpoints.
Collapse
|
30
|
Vittor AY, Long M, Chakrabarty P, Aycock L, Kollu V, DeKosky ST. West Nile Virus-Induced Neurologic Sequelae-Relationship to Neurodegenerative Cascades and Dementias. CURRENT TROPICAL MEDICINE REPORTS 2020; 7:25-36. [PMID: 32775145 DOI: 10.1007/s40475-020-00200-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose of Review West Nile virus (WNV) emerged from Central Africa in the 1990s and is now endemic throughout much of the world. Twenty years after its introduction in the USA, it is becoming apparent that neurological impairments can persist for years following infection. Here, we review the epidemiological data in support of such long-term deficits and discuss possible mechanisms that drive these persistent manifestations. Recent Findings Focusing on the recently discovered antimicrobial roles of amyloid and alpha-synuclein, we connect WNV late pathology to overlapping features encountered in neurodegenerative diseases such as Alzheimer's disease and Parkinson's disease. We also summarize new research on microglial activation and engulfment of neural synapses seen in recovered WNV as well as in neurodegenerative diseases, and discuss how loss of integrity of the blood-brain barrier (BBB) may exacerbate this process. Summary Neuroinvasive viral infections such as WNV may be linked epidemiologically and mechanistically to neurodegeneration. This may open doors to therapeutic options for hitherto untreatable infectious sequelae; additionally, it may also shed light on the possible infectious etiologies of age-progressive neurodegenerative dementias.
Collapse
Affiliation(s)
- Amy Y Vittor
- Division of Infectious Disease and Global Medicine, University of Florida, Gainesville, FL, USA
| | - Maureen Long
- College of Veterinary Medicine, Department of Comparative, Diagnostic, and Population Medicine, University of Florida, Gainesville, FL, USA
| | - Paramita Chakrabarty
- Department of Neuroscience, Center for Translational Research in Neurodegenerative Diseases, and McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Lauren Aycock
- School of Medicine, University of Florida, Gainesville, FL, USA
| | - Vidya Kollu
- Division of Infectious Disease and Global Medicine, University of Florida, Gainesville, FL, USA
| | - Steven T DeKosky
- Department of Neurology and McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| |
Collapse
|
31
|
Patel A, Lynch F, Shepherd SA. Newer Immunotherapies for the Treatment of Acute Neuromuscular Disease in the Critical Care Unit. Curr Treat Options Neurol 2020; 22:7. [PMID: 32052202 DOI: 10.1007/s11940-020-0616-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OPINION STATEMENT PURPOSE OF REVIEW: In this review, we discuss current treatment options for commonly encountered neuromuscular disorders in intensive care units. We will discuss epidemiology, pathophysiology, and acute and chronic treatment options for myasthenia gravis, Guillain-Barré syndrome, West Nile virus, Botulism, and amyotrophic lateral sclerosis. RECENT FINDINGS Eculizumab is the newest immunomodulator therapy approved by the Food and Drug Administration in treatment of myasthenia gravis, shown to improve long-term functional outcomes. Edaravone is the newest therapy in management of amyotrophic lateral sclerosis, shown to slow functional deterioration. Efgartigimod showed great promise in a phase 2 safety and efficacy trial in the treatment of stable generalized myasthenia gravis. Eculizumab was found to be safe in a small phase 2 trial for use in Guillain-Barré syndrome. Currently, therapies such as plasma exchange, intravenous immunoglobulins, and steroids remain the mainstay of treatment in the ICU for many neuromuscular disorders. While there are some newer immunotherapies available, few have been studied in the acute setting. However, with the advent of new immunotherapies and biologics, changes in these approaches may be on the horizon.
Collapse
Affiliation(s)
- Alok Patel
- Department of Neurology, Rush University Medical Center, 1725 W Harrison St, Suite 1121, Chicago, IL, 60612, USA
| | - Fiona Lynch
- Department of Neurology, Rush University Medical Center, 1725 W Harrison St, Suite 1121, Chicago, IL, 60612, USA
| | - Starane A Shepherd
- Department of Neurology, Rush University Medical Center, 1725 W Harrison St, Suite 1121, Chicago, IL, 60612, USA.
| |
Collapse
|
32
|
Yu Z, Cowan JA. Design and applications of catalytic metallodrugs containing the ATCUN motif. Med Chem 2020. [DOI: 10.1016/bs.adioch.2019.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
33
|
Prediction of unfavorable outcomes in West Nile virus neuroinvasive infection - Result of a multinational ID-IRI study. J Clin Virol 2019; 122:104213. [PMID: 31778945 DOI: 10.1016/j.jcv.2019.104213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/31/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND WNV causes 1.4% of all central nervous system infections and is the most common cause of epidemic neuro-invasive disease in humans. OBJECTIVES Our main objective was to investigate retrospectively West Nile virus neuroinvasive disease (WNND) cases hospitalized during 2010-2017 and identified factors that can influence prognosis. STUDY DESIGN We documented the demographic, epidemiologic, clinical and laboratory data of WNND and identified factors that can influence prognosis. The data were recruited through Infectious Diseases International Research Initiative (ID-IRI), which serves as a network for clinical researches. RESULTS We investigated 165 patients with WNND in 10 countries from three continents. 27 patients died and the mortality rate was 16.4%. In an univariate analysis age, congestive heart failure, neoplasm and ischemic heart disease (p < 0.001), neuropsychiatric disorders (p = 0.011), chronic hepatitis (p = 0.024) and hypertension (p = 0.043) were risk factors for death. Fatal evolution was also correlated with ICU addmission, disorientation, speech disorders, change in consciousnes, coma, a low Glasgow coma score, obtundation, confusion (p < 0.001), history of syncope (p = 0.002) and history of unconsciousness (p = 0.037). In a binomial logistic regresssion analysis only age and coma remained independent prediction factors for death. We created an equation that was calculated according to age, co-morbidities and clinical manifestations that may be used to establish the prognosis of WNND patients. CONCLUSIONS WNND remain an important factor for morbidity and mortality worldwide, evolution to death or survival with sequelae are not rare. Our study creates an equation that may be used in the future to establish the prognosis of WNND patients.
Collapse
|
34
|
Abstract
BACKGROUND Data to guide neurointensivists seeing patients with West Nile Neuroinvasive disease (WNND) are lacking. We present a comparatively large series of patients with WNND admitted to the intensive care unit (ICU) and provide data on their early diagnosis, triage to the ICU and predictors of short-term outcomes. METHODS We retrospectively identified patients aged ≥ 18 years old with WNND from January 1999 to November 2016. Demographic and clinical data, the modified Rankin Scale at discharge and disposition were collected. Univariate analysis was performed to find predictors of ICU admission and to assess the impact of ICU admission on the short-term outcomes. P values < 0.05 were considered significant. RESULTS Among 26 patients, 16 were admitted to the ICU. Age < 60 years and the presentation with encephalitis and acute flaccid paralysis predicted ICU admission (P = 0.044 and 0.0007). Among patients requiring ICU admission, four died and no one was discharged home. ICU admission predicted longer hospital stay (P = 0.021), inhospital death (P = 0.034), survival with inability to walk independently (P = 0.0094), and discharge disposition other than home (P = 0.007). In the ICU group, older age was associated with longer hospital stay (P = 0.0001) and inhospital death (P = 0.035). CONCLUSION WNND requiring ICU care has a high morbidity and mortality, especially among older patients. Survivors are highly disabled at discharge, but many improve over time. Therefore, more data on the long-term prognosis of survivors are needed to guide the goals of care in the acute setting.
Collapse
Affiliation(s)
- Maximiliano A Hawkes
- Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA.
| | - Ivan D Carabenciov
- Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Eelco F M Wijdicks
- Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| | - Alejandro A Rabinstein
- Division of Critical Care Neurology, Department of Neurology, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA
| |
Collapse
|
35
|
Abstract
OBJECTIVE To assess the long-term outcomes of patients hospitalized with severe West Nile neuroinvasive disease. DESIGN Retrospective cohort. SETTING Patients admitted to a referral center (Saint Mary's Hospital, Mayo Clinic). PARTICIPANTS Twenty-six patients with West Nile neuroinvasive disease were identified by retrospective search of electronic database of Saint Mary's Hospital from January 1999 to November 2016. INTERVENTIONS Retrospective electronic medical records review and prospective telephone follow-up. MEASUREMENTS AND MAIN RESULTS Functional disability and cognitive outcomes were evaluated with the modified Rankin Scale and the Telephone Interview for Cognitive Status scores. Data on the time that the patient returned home after the hospitalization for West Nile neuroinvasive disease and the time of return to work were also collected. We identified 26 patients (81% males), 59 ± 17 years old. After a median hospital stay of 14.5 days (3-126), four patients died and 90% of survivors had a modified Rankin Scale of 3-5. Two additional patients died, and 80% of survivors had a modified Rankin Scale of 0-2 after a median follow-up of 73 months (1-144). Seven patients had cognitive impairment, which was severe in two of them. The combination of encephalitis and acute flaccid paralysis at presentation was associated with lower likelihood of returning home within 1 month after discharge (p < 0.01). Patients who required mechanical ventilation were more likely to have a modified Rankin Scale of 3-5 at last follow-up (p = 0.03), less likely to return home within 1 month of discharge (p < 0.01), less likely to return to their jobs (p < 0.01), and showed a trend toward having cognitive impairment (p = 0.05). CONCLUSIONS Despite having poor outcomes at discharge, most West Nile neuroinvasive disease survivors with severe early disability can recover functional independence in the long term, justifying aggressive support during the acute phase and extensive rehabilitation efforts.
Collapse
|
36
|
Parkash V, Woods K, Kafetzopoulou L, Osborne J, Aarons E, Cartwright K. West Nile Virus Infection in Travelers Returning to United Kingdom from South Africa. Emerg Infect Dis 2019; 25:367-369. [PMID: 30666938 PMCID: PMC6346434 DOI: 10.3201/eid2502.172101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
West Nile virus (WNV) is an arthropod-transmitted flavivirus that causes West Nile fever and may infrequently cause neuroinvasive disease in humans. We present 2 cases of confirmed WNV infection, 1 of severe encephalitis and 1 of mild febrile illness, in a couple returning to the United Kingdom from South Africa.
Collapse
|
37
|
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.
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
|
38
|
Abstract
PURPOSE Neuroinvasive West Nile virus (WNV) is rare, occurring in less than 1% of those infected, and may manifest as meningitis, encephalitis, and/or acute flaccid paralysis. Patients may present initially with nonspecific symptoms including fevers. Although rare, neuroinvasive WNV is associated with significant morbidity and mortality. The mainstay of treatment is supportive care. Electroencephalography (EEG) allows for identification of nonconvulsive status epilepticus and other epileptiform and nonepileptiform patterns suggestive of underlying cognitive dysfunction. Our aim was to describe specific EEG patterns observed in WNV neuroinvasive disease. METHODS A retrospective chart review was conducted. West Nile virus was confirmed with serum and/or cerebrospinal fluid markers. Patients with a history of abnormal EEG were excluded. Electroencephalography reports were classified into categories based on the presence of epileptiform activity, focal slowing, generalized periodic discharges with triphasic morphology, and frontally predominant generalized rhythmic delta activity. RESULTS In our cohort of 34 patients, 60% of focal EEG abnormalities were anterior-predominant, seen as epileptiform discharges, focal slowing, or frontally predominant generalized rhythmic delta activity. Nonepileptiform EEG patterns included nonspecific slowing and generalized periodic discharges with triphasic morphology. Two patients had electrographic seizures, one arising from the frontocentral head region. CONCLUSIONS EEGs are important in the evaluation of WNV infection to rule out seizures or alternative causes of encephalopathy, and because of the risk of nonconvulsive seizures or status epilepticus in encephalitis. Although an anterior predominance of EEG abnormalities was seen in our cohort, this most likely is more correlative to encephalopathy than WNV itself. Although a specific correlative EEG pattern may not accompany all cases of WNV neuroinvasive disease, WNV should be considered as a possible etiology in patients presenting with an encephalitic or meningitic syndrome in the presence of abnormal EEG findings including encephalopathic patterns, particularly those with anterior predominant EEG changes.
Collapse
|
39
|
Affiliation(s)
- David A Braun
- From the Departments of Medicine (D.A.B., P.E.S., A.L.M., J.L.) and Neurology (G.V.H.), Brigham and Women's Hospital, Boston
| | - Galen V Henderson
- From the Departments of Medicine (D.A.B., P.E.S., A.L.M., J.L.) and Neurology (G.V.H.), Brigham and Women's Hospital, Boston
| | - Paul E Sax
- From the Departments of Medicine (D.A.B., P.E.S., A.L.M., J.L.) and Neurology (G.V.H.), Brigham and Women's Hospital, Boston
| | - Amy L Miller
- From the Departments of Medicine (D.A.B., P.E.S., A.L.M., J.L.) and Neurology (G.V.H.), Brigham and Women's Hospital, Boston
| | - Joseph Loscalzo
- From the Departments of Medicine (D.A.B., P.E.S., A.L.M., J.L.) and Neurology (G.V.H.), Brigham and Women's Hospital, Boston
| |
Collapse
|
40
|
Vilibic-Cavlek T, Savic V, Sabadi D, Peric L, Barbic L, Klobucar A, Miklausic B, Tabain I, Santini M, Vucelja M, Dvorski E, Butigan T, Kolaric-Sviben G, Potocnik-Hunjadi T, Balenovic M, Bogdanic M, Andric Z, Stevanovic V, Capak K, Balicevic M, Listes E, Savini G. Prevalence and molecular epidemiology of West Nile and Usutu virus infections in Croatia in the 'One health' context, 2018. Transbound Emerg Dis 2019; 66:1946-1957. [PMID: 31067011 DOI: 10.1111/tbed.13225] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/19/2019] [Accepted: 05/03/2019] [Indexed: 12/14/2022]
Abstract
In 2018, Croatia reported the largest outbreak of West Nile virus (WNV) infections as well as the re-occurrence of human Usutu virus (USUV) infections. For the first time, fatal WNV and USUV infections were detected in wild birds. We analysed epidemiological characteristics and molecular epidemiology of WNV and USUV infections detected during 2018 transmission season. From April to November, 178 patients with neuroinvasive disease and 68 patients with febrile disease were tested for WNV and USUV. Viral RNA was detected in cerebrospinal fluid (CSF) and urine samples using a real-time RT-PCR. Positive samples were tested by nested RT-PCR and nucleotide sequencing. IgM/IgG antibodies were detected in serum/CSF samples using ELISA with confirmation of cross-reactive samples by virus neutralization test (VNT). WNV neuroinvasive disease was confirmed in 54 and WNV fever in seven patients from 10 continental Croatian counties. Areas affected in 2018 were those in which cases occurred in previous seasons, while in three areas human cases were reported for the first time. Phylogenetic analysis of six strains from patients residing in different geographic areas showed circulation of WNV lineage 2. In three patients, neuroinvasive USUV infection was confirmed by RT-PCR or VNT. Sequence analysis of one detected strain revealed USUV Europe 2 lineage. During the same period, a total of 2,574 horse and 1,069 poultry serum samples were tested for WNV antibodies using ELISA. Acute asymptomatic WNV infection (IgM antibodies) was documented in 20/0.7% horses. WNV IgG antibodies were found in 307/11.9% horses and in 125/12.7% poultry. WNV RNA was detected in two goshawks and USUV RNA was detected in one blackbird from north-western Croatia. In the Zagreb area, 3,670 female mosquitoes were collected. One Culex pipiens pool collected in July tested positive for USUV RNA. Our results highlight the importance of continuous multidisciplinary 'One health' surveillance of these emerging arboviruses.
Collapse
Affiliation(s)
- Tatjana Vilibic-Cavlek
- Croatian Institute of Public Health, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Dario Sabadi
- Clinical Hospital Center Osijek, Osijek, Croatia.,Medical Faculty, Josip Juraj Stossmayer University of Osijek, Osijek, Croatia
| | - Ljiljana Peric
- Clinical Hospital Center Osijek, Osijek, Croatia.,Medical Faculty, Josip Juraj Stossmayer University of Osijek, Osijek, Croatia
| | - Ljubo Barbic
- Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia
| | - Ana Klobucar
- Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Bozana Miklausic
- University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb, Croatia
| | - Irena Tabain
- Croatian Institute of Public Health, Zagreb, Croatia
| | - Marija Santini
- School of Medicine, University of Zagreb, Zagreb, Croatia.,University Hospital for Infectious Diseases "Dr Fran Mihaljevic", Zagreb, Croatia
| | - Marko Vucelja
- Faculty of Forestry, University of Zagreb, Zagreb, Croatia
| | | | | | | | | | | | - Maja Bogdanic
- Croatian Institute of Public Health, Zagreb, Croatia
| | | | | | | | | | - Eddy Listes
- Croatian Veterinary Institute, Regional Institute Split, Split, Croatia
| | - Giovanni Savini
- OIE Reference Center for West Nile Disease, Istituto Zooprofilattico Sperimentale "G. Caporale", Teramo, Italy
| |
Collapse
|
41
|
Anesi JA, Silveira FP. Arenaviruses and West Nile Virus in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13576. [PMID: 31022306 DOI: 10.1111/ctr.13576] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/18/2019] [Indexed: 12/01/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the epidemiology, diagnosis, prevention, and management of infection due to Arenaviruses and West Nile Virus (WNV) in the pre- and post-transplant period. Arenaviruses and WNV have been identified as causes of both donor-derived and post-transplant infection. Most data related to these infections have been published in case reports and case series. Transplant recipients may become infected with Arenaviruses if they, or their donors, are exposed to wild rodents or infected pet rodents. Lymphocytic choriomeningitis virus is the most commonly recognized Arenavirus among transplant recipients and should be considered when transplant recipients present with fever, hepatitis, meningitis/encephalitis, and/or multisystem organ failure. WNV is a mosquito-borne virus, and as such, its incidence varies yearly depending on environmental conditions. WNV in transplant recipients typically presents with fever, myalgias, and rash; approximately one in 40 develop neuroinvasive disease. Due to its morbidity, the Organ Procurement and Transplantation Network recently mandated that transplant centers screen living donors for WNV infection in endemic areas. Little is known about the optimal treatment of Arenaviruses or WNV; reduction in immunosuppression and supportive care are the mainstays of management at present.
Collapse
Affiliation(s)
- Judith A Anesi
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fernanda P Silveira
- Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania.,University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | |
Collapse
|
42
|
Leis AA, Sinclair DJ. Lazarus Effect of High Dose Corticosteroids in a Patient With West Nile Virus Encephalitis: A Coincidence or a Clue? Front Med (Lausanne) 2019; 6:81. [PMID: 31106205 PMCID: PMC6494927 DOI: 10.3389/fmed.2019.00081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/01/2019] [Indexed: 11/13/2022] Open
Abstract
West Nile virus (WNV) causes severe neuroinvasive disease in humans characterized by meningitis, encephalitis, and acute flaccid paralysis (poliomyelitis variant). In neuroinvasive disease, WNV infection of neurons resulting in neuronal loss is generally presumed to be the anatomical substrate for the high morbidity and mortality. However, on a molecular level, WNV infection also results in a significant upregulation of important proinflammatory molecules that have been reported to promote neuroinflammation and cytotoxicity. Currently, there is no specific treatment for the neurological complications of WNV infection. We present a 71-year-old woman who developed WNV infection that rapidly progressed to severe generalized weakness and encephalitis manifesting with bulbar signs (dysphagia, dysarthria) and persistent delirium and stupor. Consciousness remained impaired for 9 days and then she received a 5-day course of high-dose intravenous methylprednisolone (1,000 mg daily). After the first day, voluntary movement and spontaneous eye-opening increased and by the end of the second day, she was awake and responding to commands. Thereafter, she remained awake and responsive. Although the rapid improvement from stupor to wakefulness following treatment with an anti-inflammatory immunosuppressant could merely be coincidence, since these observations are of one patient, it may also provide a clue that in some cases of WNV neuroinvasive disease a post-infectious pro-inflammatory state, rather than neuronal loss, may also contribute to morbidity. Further clinical trials are warranted to determine if high dose corticosteroids and other drugs that can alter this neuro-inflammatory cascade may be potentially beneficial in the treatment of WNV neuroinvasive disease.
Collapse
Affiliation(s)
- A Arturo Leis
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS, United States
| | | |
Collapse
|
43
|
West Nile Virus Encephalitis in Haematological Setting: Report of Two Cases and a Brief Review of the Literature. Mediterr J Hematol Infect Dis 2019; 11:e2019033. [PMID: 31205637 PMCID: PMC6548214 DOI: 10.4084/mjhid.2019.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/03/2019] [Indexed: 01/01/2023] Open
Abstract
West Nile virus is a zoonotic agent causing life-threatening encephalitis in a proportion of infected patients. Older age, immunosuppression, and mutations in specific host genes (e.g., CCR5 delta-32 mutation) predispose to neuroinvasive infection. We report on two cases of severe West Nile encephalitis in recently-treated, different-aged, chronic lymphocytic leukemia patients. Both patients developed high-grade fever associated with severe neurological impairment. The younger one harboured germ-line CCR5 delta-32 mutation, which might have played a role in the pathogenesis of its neuroinvasive manifestations.
Collapse
|
44
|
Herring R, Desai N, Parnes M, Jarjour I. Pediatric West Nile Virus-Associated Neuroinvasive Disease: A Review of the Literature. Pediatr Neurol 2019; 92:16-25. [PMID: 30611518 DOI: 10.1016/j.pediatrneurol.2018.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 07/10/2018] [Accepted: 07/15/2018] [Indexed: 10/27/2022]
Abstract
Over the past two decades, West Nile virus has become the most common arbovirus in North America, leading to several outbreaks and infecting thousands of people. Mosquitos help transmit the virus in the majority of cases, but transmission occurs via blood transfusions, organ transplantation, and possibly pregnancy and breastfeeding. While most infected patients experience mild to no symptoms, thousands of West Nile virus-associated neuroinvasive cases have been reported in the United States, with over 700 cases occurring in children from 2003 to 2016. Neuroinvasive disease presents as meningitis, encephalitis, or acute flaccid paralysis, and carries a high likelihood of poor outcome, including severe neurological disability or death. To date, no pharmacologic treatment has proven effective. Therapeutic clinical trials have not been successfully completed due to the sporadic nature of viral outbreaks and resultant poor study enrollment. Although older age and chronic disease are risk factors for neuroinvasive West Nile virus disease in adults, the specific factors that influence the risk in pediatric populations have not been fully elucidated. This review summarizes the most recent literature regarding West Nile virus-associated neuroinvasive disease, especially as it pertains to the pediatric population. Moreover, the review describes the epidemiology, clinical, laboratory, and radiographic findings, and outlines the various therapies that have been trialed and potential future research directions.
Collapse
Affiliation(s)
- Rachelle Herring
- Section of Child Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
| | - Nilesh Desai
- Section of Neuroradiology, Department of Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Mered Parnes
- Section of Child Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Imad Jarjour
- Section of Child Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| |
Collapse
|
45
|
A case of West Nile virus encephalitis accompanied by diabetic ketoacidosis and rhabdomyolysis. IDCases 2019; 15:e00505. [PMID: 30815360 PMCID: PMC6378900 DOI: 10.1016/j.idcr.2019.e00505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 11/22/2022] Open
Abstract
Introduction We present here a case of West Nile Virus (WNV) encephalitis that initially presented with diabetic ketoacidosis and rhabdomyolysis. Case presentation A 35-year-old male with no past medical history presented to the emergency department complaining of polydipsia, generalized weakness, lightheadedness, and visual disturbances of one week duration. He was found to be in diabetic ketoacidosis. His hemoglobin A1c was 11%. The patient was appropriately treated for diabetic ketoacidosis and it resolved on hospital day 1. On hospital day 2, the patient developed a fever of 101.6 °F and his mental status became severely altered. He developed auditory and visual hallucinations. IgM and IgG antibodies to West Nile Virus were positive in the cerebral spinal fluid (CSF). The patient's creatine kinase level rose to 118,400 U/L during his hospitalization and eventually returned to baseline. The patient made a full recovery with no residual neurologic deficits after an 11 day hospital course. Discussion In this patient, neuroinvasive WNV was confirmed with positive CSF IgM. The patient's newly diagnosed diabetes likely contributed to his susceptibility to neuroinvasive disease. Furthermore, WNV encephalitis in a background of DKA has not been previously described in the literature and this case demonstrates WNV neuroinvasive disease should be in the differential diagnosis for patients presenting with unexplained neurological symptoms. Conclusion Diagnosis of neuroinvasive WNV is imperative to stop unnecessary therapies, limit further diagnostic evaluation, help predict patient outcomes, direct public health prevention measures, and further provide investigations into the clinical conditions that define the spectrum of WNV disease.
Collapse
|
46
|
Ehrlich D, Phan J, Hui G, Drakaki A. Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma. Clin Pract 2018; 8:1097. [PMID: 30613373 PMCID: PMC6291742 DOI: 10.4081/cp.2018.1097] [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: 07/27/2018] [Accepted: 11/19/2018] [Indexed: 11/23/2022] Open
Abstract
A 67-year-old male with past medical history of mantle cell lymphoma and atrial fibrillation presented with a truncal rash, bilateral lower extremity weakness, and confusion. Within three days of presentation, his condition rapidly deteriorated with the onset of diffuse flaccid paralysis, aphasia, and severe alteration in mental status. Initial results from serum studies, lumbar puncture, magnetic resonance imaging, and electroencephalogram were not diagnostic. However, on the ninth day after initial presentation, the West Nile Virus (WNV) immunoglobulin M antibody returned positive from the cerebrospinal fluid. West Nile Virus encephalitis is endemic worldwide, and is the most common viral encephalitis in the United States. WNV presents in a variety of ways, and the recognition by physicians is crucial due to the estimated 2-12% mortality rate and significant longterm morbidity of neuroinvasive disease. The initial management and long term prognosis are points of ongoing research. This case represents a particularly profound example of neuroinvasive WNV. Our patient made a significant recovery after his initial presentation with aggressive supportive care, however still suffers from bilateral lower extremity weakness more than a year later.
Collapse
Affiliation(s)
- Dean Ehrlich
- Ronald Reagan UCLA Medical Center, University of California, Los Angeles, CA, USA
| | - Jennifer Phan
- Ronald Reagan UCLA Medical Center, University of California, Los Angeles, CA, USA
| | - Gavin Hui
- Ronald Reagan UCLA Medical Center, University of California, Los Angeles, CA, USA
| | - Alexandra Drakaki
- Ronald Reagan UCLA Medical Center, University of California, Los Angeles, CA, USA
| |
Collapse
|
47
|
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
|
48
|
Albertson AJ, Dietz AR, Younce JR, Varadhachary AS. Clinical Problem-Solving: Fever and Rapidly Progressive Weakness in an Immunocompromised Patient. Neurohospitalist 2018; 8:194-198. [PMID: 30245771 DOI: 10.1177/1941874418754966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Here we report the challenging case of a 41-year-old man with HIV complicated by AIDS and a history of prior neurologic injury from progressive multifocal leukoencephalopathy who presented with headache, fevers, lower extremity weakness, hyperreflexic upper extremities, and diminished lower extremity reflexes. We review the clinical decision-making and differential diagnosis for this presentation as the physical examination evolved and diagnostic testing changed over time.
Collapse
Affiliation(s)
- Asher J Albertson
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - Alexander R Dietz
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - John R Younce
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - Arun S Varadhachary
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| |
Collapse
|
49
|
Affiliation(s)
- Kenneth L Tyler
- From the Departments of Neurology, Medicine, and Immunology-Microbiology and the Section on Neuroinfectious Disease, University of Colorado School of Medicine, Aurora
| |
Collapse
|
50
|
Kitagawa MG, Ettinger N, Breen D, Erklauer J, Chang E, Herce H, King K, Naik S. Transmission of West Nile Virus Through a Hematopoietic Stem Cell Transplant. J Pediatric Infect Dis Soc 2018; 7:e52-e54. [PMID: 29309636 DOI: 10.1093/jpids/pix100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 09/11/2017] [Indexed: 01/24/2023]
Affiliation(s)
- Melanie G Kitagawa
- Section of Pediatric Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Nick Ettinger
- Section of Pediatric Critical Care, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Day Breen
- Department of Pediatric Neurology, Baylor College of Medicine, Houston, Texas
| | - Jennifer Erklauer
- Department of Pediatric Neurology, Baylor College of Medicine, Houston, Texas
| | - Emmanuel Chang
- Retina and Vitreous of Texas, Houston, Texas.,Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Honey Herce
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | - Katherine King
- Department of Pediatric Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Swati Naik
- Section of Hematology-Oncology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| |
Collapse
|