Neurologic Manifestations and Outcome of West Nile Virus Infection.
Sejvar, James J. MD; Haddad, Maryam B. MSN, MPH, FNP; Tierney, Bruce C. MD; Campbell, Grant L. MD, PhD; Marfin, Anthony A. MD, MPH; Van Gerpen, Jay A. MD; Fleischauer, Aaron PhD; Leis, A. Arturo MD; Stokic, Dobrivoje S. MD; Petersen, Lyle R. MD, MPH
[Report]
JAMA.
290(4):511-515, July 23/30, 2003.
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Context: The neurologic manifestations, laboratory findings, and outcome of patients with West Nile virus (WNV) infection have not been prospectively characterized.
Objective: To describe prospectively the clinical and laboratory features and long-term outcome of patients with neurologic manifestations of WNV infection.
Design, Setting, and Participants: From August 1 to September 2, 2002, a community-based, prospective case series was conducted in St Tammany Parish, La. Standardized clinical data were collected on patients with suspected WNV infection. Confirmed WNV-seropositive patients were reassessed at 8 months.
Main Outcome Measures: Clinical, neurologic, and laboratory features at initial presentation, and long-term neurologic outcome.
Results: Sixteen (37%) of 39 suspected cases had antibodies against WNV; 5 had meningitis, 8 had encephalitis, and 3 had poliomyelitis-like acute flaccid paralysis. Movement disorders, including tremor (15 [94%]), myoclonus (5 [31%]), and parkinsonism (11 [69%]), were common among WNV-seropositive patients. One patient died. At 8-month follow-up, fatigue, headache, and myalgias were persistent symptoms; gait and movement disorders persisted in 6 patients. Patients with WNV meningitis or encephalitis had favorable outcomes, although patients with acute flaccid paralysis did not recover limb strength.
Conclusions: Movement disorders, including tremor, myoclonus, and parkinsonism, may be present during acute illness with WNV infection. Some patients with WNV infection and meningitis or encephalitis ultimately may have good long-term outcome, although an irreversible poliomyelitis-like syndrome may result.
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