Possible benefit of intravenous immunoglobulin therapy in a lung transplant recipient with West Nile virus encephalitis

Abstract

During the summer of 2000, a countrywide epidemic of West Nile fever (WNF) occurred in Israel, with 417 confirmed cases and 35 deaths. Immunosuppressed patients had a 31% case-fatality rate, which was significantly higher compared to non-immunosuppressed patients (13%). We describe a 42-year-old male lung-transplant recipient with serologically confirmed West Nile virus (WNV) encephalitis and deteriorating level of consciousness. He was treated with 0.4 g/kg intravenous immunoglobulin preparation from Israeli donors that contained a high titer of anti-WNV antibodies (1 : 1600). The patient showed rapid improvement within 24 h and complete disappearance of signs and symptoms within 48 h. This is the second case of an immunosuppressed patient responding to the same preparation of intravenous immunoglobulins. Larger studies are required in order to establish the therapeutic role of immunoglobulins in patients with WNF.

Recent progress in West Nile virus diagnosis and vaccination

“…There is currently no antiviral treatment to cure WNV infections and only supportive care can be administered. Ribavirin [138], interferon-α [57,139] and WNV-specific immunoglobulin [56,140] have all been considered as specific treatments for WNV disease, but no rigorously conducted clinical trials have been completed. Diagnostic tests have improved considerably and allow a rapid detection of the presence of WNV.…”

West Nile virus meningoencephalitis

“…Uncontrolled clinical reports describe an apparent beneficial effect in two patients given the Israeli human intravenous immunoglobulin preparation Omr-IgG-am, which contains high titers of neutralizing antibody to WNV, although a third treated patient died. [64][65][66] A multicenter randomized, placebo-controlled trial sponsored by the NIH to test the effectiveness of Omr-IgG-am in humans with WNV disease is currently in progress. 67,68 The humanized monoclonal antibody E16, which targets the WNV envelope protein, recently showed therapeutic efficacy in mice, conferring reduced mortality even when administered as a single dose 5 days after WNV infection.…”

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

“…The first reported solid organ transplant recipient with West Nile virus infection was a severely ill, Israeli lung transplant recipient who responded to a preparation of intravenous immunoglobulin prepared from Israeli donors (8). This preparation was later shown to have high titers of anti-WNV antibody (1 : 1600) as a result of previous outbreaks in Israel.…”