Is West Nile virus a potential cause of central nervous system infection in Brazil?

Two case reports of neuroinvasive West Nile virus infection in the Almaty region, Kazakhstan

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Population screening has confirmed circulation of West Nile virus in the southern region of Kazakhstan (Almaty region).

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We report two cases of meningoencephalitis of unknown etiology occurred in the rural area near Tekeli city, Kazakhstan, in August 2019.

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Retrospective analysis showed high titers of anti-WNV IgG in both patients’ serum specimens obtained on day 9 after the onset of symptoms.

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These are the first reports of West Nile virus infection in Kazakhstan.

Background

West Nile virus (WNV) is a member of the genus Flavivirus, which transmitted to humans mainly by mosquitoes. Recent pilot serosurveillance data from the Almaty region, Kazakhstan, suggest widespread WNV circulation in this area. This report includes two cases of neuroinvasive WNV infection in the same family living in a rural area near Tekeli city, Eskeldinsky district, Almaty region, Kazakhstan. Occurring concurrently and manifesting as WNV infection with febrile illness and symptoms of meningoencephalitis.

Methods

The study performed retrospective analysis of clinical histories and achieved serum samples obtained from patients with febrile and meningoencephalitic syndromes of unknown origin in the Almaty region spanning from April 1 to October 31, 2019. All sera samples obtained from patients with clinically suspected cases of acute WNV infection were retrospectively tested for WNV and tick-borne encephalitis virus by commercial immunoassays. Two cases were selected.

Cases presentation

We report two cases that occurred in August 2019 in a rural area near Tekeli city. Previously healthy 28- and 19-year-old husband and wife with febrile illness and neurological manifestations were hospitalized with the diagnosis of meningoencephalitis of unknown etiology and treated empirically. Retrospective serological analysis showed the presence of high titers of IgG against WNV on day 9 after onset of symptoms in cases.

Conclusions

This is the first report of aseptic meningitis with WNV infection in the background in Kazakhstan. The obtained data suggest circulation of WNV in the Almaty region and emphasize importance of laboratory testing for WNV in suspicious cases occurring in the region.

Emergent Arboviruses and Renal Transplantation: A Global Challenge

In recent years, Zika, Chikungunya, Dengue, West Nile Fever, and Yellow Fever epidemics have generated some concerns. Besides difficulties related to vector control, there are challenges related to behavior of pathologies not yet fully understood. The transplanted population requires additional care due to immunosuppressive drugs. Furthermore, the potential risk of transmission during donation is another source of uncertainty and generates debate among nephrologists in transplant centers. Do the clinical outcomes and prognoses of these infections tend to be more aggressive in this population? Is there a risk of viral transmission via kidney donation? In this review article, we address these issues and discuss the relationship between arbovirus and renal transplantation.

West Nile Virus Encephalitis: The First Human Case Recorded in Brazil

A Brazilian ranch worker with encephalitis and flaccid paralysis was evaluated in the regional Acute Encephalitis Syndromic Surveillance Program. This was the first Brazilian patient who met the Centers for Disease Control and Prevention (CDC) confirmation criteria for West Nile virus disease. Owing to the overlapping of neurological manifestations attributable to several viral infections of the central nervous system, this report exemplifies the importance of human acute encephalitis surveillance. The syndromic approach to human encephalitis cases may enable early detection of the introduction of unusual virus or endemic occurrence of potentially alarming diseases within a region.

The global ecology and epidemiology of West Nile virus

Since its initial isolation in Uganda in 1937 through the present, West Nile virus (WNV) has become an important cause of human and animal disease worldwide. WNV, an enveloped virus of the genus Flavivirus, is naturally maintained in an enzootic cycle between birds and mosquitoes, with occasional epizootic spillover causing disease in humans and horses. The mosquito vectors for WNV are widely distributed worldwide, and the known geographic range of WNV transmission and disease has continued to increase over the past 77 years. While most human infections with WNV are asymptomatic, severe neurological disease may develop resulting in long-term sequelae or death. Surveillance and preventive measures are an ongoing need to reduce the public health impact of WNV in areas with the potential for transmission.

West nile virus and its theories, a big puzzle in Mexico and latin america

It has been 13 years since the first outbreak of West Nile Virus (WNV) occurred in the Americas. Since then, thousands of human cases have been reported in the United States. In contrast, there has not yet been an outbreak of WNV in any Latin American countries, including Mexico where <20 cases have been reported. We aimed to review publications to gather the main theories related to the fact that not all the countries of the continent reported human cases or that they have reported few cases since the introduction of WNV in the Western Hemisphere. We identified relevant publications using the PubMed database. Furthermore, we present on-line published information from Mexico. We found that researchers have tried to explain this phenomenon using several theories, like pre-existing antibodies against a heterotypical virus that have conferred cross protection in the population. Another explanation is that the strains circulating in Latin America are attenuated or that they came from a different origin of introduction in the continent. Another theory is that a conclusive diagnostic in regions where more than one Flavivirus is circulating results in cross-reaction in serological tests. Probably the sum of factors described by researchers in these theories in order to explain the behavior of the virus has resulted in the low number of reported cases in Latin America.

Serological detection of West Nile virus in horses and chicken from Pantanal, Brazil

In an effort to detect West Nile virus (WNV) in Brazil, we sampled serum from horses and chickens from the Pantanal region of the state of Mato Grosso and tested for flavivirus-reactive antibodies by blocking ELISA. The positive samples were further confirmed for serological evidence of WNV infection in three (8%) of the 38 horses and one (3.2%) of the 31 chickens using an 80% plaque-reduction neutralisation test (PRNT80). These results provide evidence of the circulation of WNV in chickens and horses in Pantanal.