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Patient#3’s brain MRI performed at 16 days from symptoms onset, showing lobar white matter hyperintensities (black arrows) on T2-FLAIR sequences. Motion artifacts are present
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Background
Despite being an uncommon cause of meningoencephalitis, West Nile virus (WNV) recently provoked significant outbreaks throughout Europe. West Nile neuroinvasive disease (WNND) is associated with significant morbidity and mortality in older and compromised individuals, while its diagnosis may be demanding for the clinician. Here discussed...
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Objective
West Nile Virus (WNV), which causes widespread outbreaks in different parts of the world, is a risk to public health in Turkey, too. Community-based study data are needed to identify measures against possible outbreaks. This study aimed to determine the seroprevalence of community-based WNV in Manisa and to investigate the relationship be...
Introduction
Routine laboratory screening is based on the detection of WNV specific IgM and IgG in blood and cerebrospinal fluid. Confirmation is then classically applied by real time RT-PCR (rRT-PCR) in Cerebrospinal fluid (CSF), which often gives negative results due to too short virorachia and late sampling. rRT-PCR was applied-for the first tim...
Purpose of Review
West Nile virus (WNV) is an arbovirus transmitted by mosquitos of the genus Culex. Manifestations of WNV infection range from asymptomatic to devastating neuroinvasive disease leading to flaccid paralysis and death. This review examines WNV epidemiology and ecology, with an emphasis on travel-associated infection.
Recent Findings...
Background & objectives:
West Nile virus (WNV) is transmitted by a mosquito-borne virus whose natural reservoir is birds. Humans and horses are considered accidental hosts. Even if the vast majority of WNV infections in humans have asymptomatic or mild disease settings, serious neurological disorders with lethal outcomes can also be observed in ar...
Introduction:
West Nile virus is an asymptomatic infection in most cases, but it can present with a rare complication of deadly neuroinvasive disease.
Case presentation:
A 81-year-old White man presented with altered mental status and fever of unknown origin. After extensive workup, he was diagnosed with West Nile encephalitis based on positive...
Citations
... Clinically, our case outlines the ill-defined and non-specific nature of the presentation of West Nile neuroinvasive disease (WNND). WNND can pose a diagnostic challenge for the clinician and if unrecognized, is associated with significant morbidity and mortality in older and compromised individuals [17]. While a period of high fever is one of the most common clinical presentations of WNV infection, developing in approximately 25% of those infected, it can vary greatly in clinical severity. ...
Here we report a rare case with concurrent longitudinal extensive transverse myelitis (LETM) and leptomeningitis due to West Nile virus infection. A 47-year-old man initially presented with a six-day progressive, intermittent low-grade fever, headache, diplopia, malaise, myalgia, lower back pain, and difficulty walking that developed into progressive asymmetric paralysis. Initial lab work was notable for mild lactic acidosis and hyperCKemia. Brain MRI with contrast demonstrated small foci of leptomeningeal enhancement in the cerebellum, pons, medulla, and right CN VI at the cisternal segment. MRI of the spine was remarkable for edema in the spinal cord extending from T10 to L1 with diffuse enlargement of the cord contour at T11 to L1 and subtle enhancement of nerve roots within the thecal sac and cauda equina regions. The patient responded partially to five-day intravenous immunoglobulin therapy (total dose, 2 g/kg). Electromyography four months after the onset of symptoms also showed chronic reinnervation with active denervating features in thoracolumbar myotomes. Clinically, this case highlights the ill-defined and non-specific nature of the presentation of West Nile neuroinvasive disease. It can pose a diagnostic challenge for clinicians and, if unrecognized, is associated with significant morbidity and mortality in older and compromised individuals.
... Although all cases of WNV encephalitis were diagnosed in recent travellers, the risk of an outbreak due to WNV infections in France is real, as sporadic transmission of WNV has been documented in horses, and humans, in France and as West Nile virus lineage 2 is now well established in Europe, responsible for domestic outbreaks every year in neighbouring countries, over recent years. [23][24][25] No case of rabies was reported in this prospective cohort. In Europe, the 18 consecutive cases of rabies reported during years 2006-2019 were all travel related, mostly from Asia and Africa. ...
Background:
As the epidemiology of encephalitis varies from one country to another, international travel may be an important clue for the diagnostic workout of this puzzling disease.
Methods:
We performed an ancillary study using the ENCEIF prospective cohort conducted in 62 clinical sites in France from 2016 to 2019. All cases of encephalitis in adults that fulfilled a case definition derived from the International Encephalitis Consortium were included. Travellers were defined as patients who spent at least one night in a foreign country within the last six months.
Results:
Of the 494 encephalitis patients enrolled, 69 (14%) were travellers. As compared to non-travellers, they were younger (median age, 48 years [interquartile range, 36-69] vs. 66 [49-76], P < 0.001), less likely to be immunocompromised: 2/69 (3%) vs 56/425 (13%), P = 0.02, and reported more arthralgia: 7/69 (10%) vs. 11/425 (3%), P = 0.007. The risk of poor outcome at hospital discharge (Glasgow outcome scale ≤ 3), was similar for travellers and for non-travellers after adjustment (aOR 0.80 [0.36-1.80], P = 0.594). Arboviruses were the main causes of encephalitis in travellers: 15/69 (22%) vs. 20/425 (5%) in non-travellers, P < 0.001, and Herpes simplex virus (HSV) was the second (9/69, 13%). Of note, in 19% (13/69) of cases, the risk of encephalitis in travellers may have been decreased with a vaccine.
Conclusion:
The two primary causes of encephalitis in travellers are arboviruses, and HSV. Empirical treatment of encephalitis in travellers must include aciclovir. Pre-travel advice and vaccination may decrease the risk of encephalitis in travellers.
West Nile virus is a re-emerging arbovirus whose impact on public health is increasingly important as more and more epidemics and epizootics occur, particularly in America and Europe, with evidence of active circulation in Africa. Because birds constitute the main reservoirs, migratory movements allow the diffusion of various lineages in the world. It is therefore crucial to properly control the dispersion of these lineages, especially because some have a greater health impact on public health than others. This work describes the development and validation of a novel whole-genome amplicon-based sequencing approach to West Nile virus. This study was carried out on different strains from lineage 1 and 2 from Senegal and Italy. The presented protocol/approach showed good coverage using samples derived from several vertebrate hosts and may be valuable for West Nile genomic surveillance.
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.
