Clinical Findings of West Nile Virus Infection in Hospitalized Patients, New York and New Jersey, 2000

Weiss, Don; Carr, Darcy B.; Kellachan, Jacqueline; Tan, Christina; Phillips, Michael; Bresnitz, Eddy A.; Layton, Marcelle

doi:10.3201/eid0704.010409

Cited by 161 publications

(161 citation statements)

References 5 publications

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“…In vitro, interferon alpha-2b and high-dose ribavirin have activity against West Nile virus (11). The clinical experience with interferon and ribiviran is limited, and these agents would have to be used with extreme care in transplant recipients (12). In our report, both patients were given acyclovir for assumed HSV encephalitis.…”

Section: Hardinger Et Almentioning

confidence: 78%

West Nile Virus-Associated Meningoencephalitis in Two Chronically Immunosuppressed Renal Transplant Recipients

Hardinger

Miller²,

Storch

et al. 2003

American Journal of Transplantation

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Section: Hardinger Et Almentioning

confidence: 78%

West Nile Virus-Associated Meningoencephalitis in Two Chronically Immunosuppressed Renal Transplant Recipients

Hardinger

Miller²,

Storch

et al. 2003

American Journal of Transplantation

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“…Since then, sporadic and major outbreaks, mainly in humans, but also in horses, have been reported during the 1960's in Africa, the middle East and Europe (reviewed in [67]). In the last decade, WNV has re-emerged as an important pathogen for humans and horses, as frequent outbreaks with increased proportion of neurological disease cases have been reported [23,27,39,66,98,99]. Indeed, outbreaks in Romania and Morocco in 1996, Tunisia in 1997, Italy in 1998, Russia, United States and Israel in 1999, and France, United States and Israel in 2000 presented either an increase in the number of severe human cases, an increase in the severity of neurological disease in horses or high bird mortality [14,32].…”

Section: Introductionmentioning

confidence: 99%

West Nile virus infection of horses

2004

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-West Nile virus (WNV) is a flavivirus closely related to Japanese encephalitis and St. Louis encephalitis viruses that is primarily maintained in nature by transmission cycles between mosquitoes and birds. Occasionally, WNV infects and causes disease in other vertebrates, including humans and horses. West Nile virus has re-emerged as an important pathogen as several recent outbreaks of encephalomyelitis have been reported from different parts of Europe in addition to the large epidemic that has swept across North America. This review summarises the main features of WNV infection in the horse, with reference to complementary information from other species, highlighting the most recent scientific findings and identifying areas that require further research.

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“…In New York City, 26% to 32% of hospitalized patients were admitted to the ICU and 11% to 17% required mechanical ventilation (8,16). A case report (17) from Israel suggested neurological improvement in a comatose patient with confirmed WNV infection who was treated with locally collected IVIG.…”

Section: Treatmentmentioning

confidence: 99%

“…Mortality may be much higher among patients admitted to the ICU, especially those requiring mechanical ventilation (14). Important morbidity may follow severe WNV infection, including residual weakness and short-term memory loss (14,16). In a case series of 57 hospitalized WNV patients from Ontario in 2002 (5), 80% of discharged patients had impairment in their functional status from persistent ataxia, weakness and cognitive dysfunction (5).…”

Section: Prognosismentioning

confidence: 99%

West Nile Virus Infection in the Intensive Care Unit: A Case Series and Literature Review

Fan

Brunton

Kern

et al. 2004

Canadian Respiratory Journal

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BACKGROUND: West Nile virus (WNV) is a rapidly spreading infectious disease in North America. Critical care issues related to WNV are not well described. OBJECTIVES: Three cases of severe WNV meningoencephalitis with flaccid paralysis are reported and relevant critical care issues are highlighted. METHODS: Case series and a review of the literature. RESULTS: Three patients with WNV meningoencephalitis and flaccid paralysis were admitted to the authors' academic, tertiary-care intensive care unit (ICU) in the late summer of 2002. All three patients were middle-aged or elderly and presented with a febrile illness that preceded or coincided with their neurological symptoms. Confirmation of WNV infection was problematic because each patient had at least one initial negative serum serology test. Radiological testing yielded nonspecific results. Serial electroencephalograms were consistent with severe toxic metabolic encephalopathy in all cases. All patients had a severe, diffuse axonal polyneuropathy demonstrated by nerve conduction studies and electromyography. Prolonged mechanical ventilation resulted in ICU lengths of stay of 44 to 118 days. At one point, 21% of the ICU beds were dedicated for these patients. All three patients died in hospital -two following the withdrawal of life support. One patient demonstrated resolving encephalitis and was discharged from the ICU after a 118-day ICU stay, but later died in a step-down unit. CONCLUSIONS: The management of WNV-related critical illness creates challenges in making a timely and accurate diagnosis, and predicting patient morbidity and mortality. As a consequence, endof-life discussions with families are especially difficult. The prolonged ICU length of stay and growing incidence of this disease may challenge limited critical care resources. La ventilation mécanique prolongée a occasionné des séjours de 44 à 118 jours à l'unité des soins intensifs. À un moment, 21 % des lits de soins intensifs étaient consacrés à ces patients. Les trois patients sont décédés à l'hôpital, deux d'entre eux après l'arrêt du respirateur, tandis que l'autre a présenté une amélioration de son encéphalite et a reçu son congé de l'unité après un séjour de 118 jours. Il est plus tard décédé dans un autre département de l'hôpital. CONCLUSION : La maladie à VNO critique et sa prise en charge posent des défis; il est notamment difficile d'établir rapidement un diagnostic précis et d'en prévoir la morbidité et de la mortalité. C'est entre autres pourquoi la discussion sur les conditions de fin de vie avec les proches des malades est particulièrement délicate. Le séjour prolongé à l'unité des soins intensifs et l'incidence croissante de cette maladie pourraient en outre menacer gravement les maigres ressources consacrées aux soins critiques. W est Nile virus (WNV) is a newly established infectiousdisease in North America that can cause critical illness. Since its introduction in 1999, this mosquito-borne flavivirus has rapidly spread to 44 states in the United States, as well as southern Ontari...

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Clinical Findings of West Nile Virus Infection in Hospitalized Patients, New York and New Jersey, 2000

Cited by 161 publications

References 5 publications

West Nile Virus-Associated Meningoencephalitis in Two Chronically Immunosuppressed Renal Transplant Recipients

West Nile Virus-Associated Meningoencephalitis in Two Chronically Immunosuppressed Renal Transplant Recipients

West Nile virus infection of horses

West Nile Virus Infection in the Intensive Care Unit: A Case Series and Literature Review

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