Neurologic Manifestations and Outcome of West Nile Virus Infection

TLDR

Neurologic manifestations, laboratory findings, and outcomes of West Nile virus infection have not been prospectively characterized. The study aimed to prospectively describe the clinical and laboratory features and long‑term outcomes of patients with neurologic manifestations of West Nile virus infection. A community‑based prospective case series collected standardized clinical data on suspected WNV patients and reassessed confirmed seropositive cases at 8 months. Of 39 suspected cases, 16 (37%) were WNV‑seropositive (5 meningitis, 8 encephalitis, 3 acute flaccid paralysis); movement disorders (tremor, myoclonus, parkinsonism) were common, one patient died, and at 8‑month follow‑up fatigue, headache, and myalgias.

Abstract

ContextThe neurologic manifestations, laboratory findings, and outcome of patients with West Nile virus (WNV) infection have not been prospectively characterized.ObjectiveTo describe prospectively the clinical and laboratory features and long-term outcome of patients with neurologic manifestations of WNV infection.Design, Setting, and ParticipantsFrom 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 MeasuresClinical, neurologic, and laboratory features at initial presentation, and long-term neurologic outcome.ResultsSixteen (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.ConclusionsMovement 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.