Volume 5, Number 7;  January 25, 2006

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Patient: 41 year old African American male with history of alcohol abuse presenting with recent onset headache and then altered mental status.  Patient was in acute respiratory distress and was intubated.  CSF suggestive of aseptic meningitis.  Laboratory investigation yielded positive for West Nile Virus.   There was great difficulty weaning patient from mechanical ventilation.

Session Handout:

Clinical Question: 

1) What is the current set of clinical characteristics in patients diagnosed with West Nile Virus infection?

Readings:

Link Directly to Fulltext Article at Publisher

<1>

Unique Identifier [PMID]: 16102303

Authors: Hayes EB. Sejvar JJ. Zaki SR. Lanciotti RS. Bode AV. Campbell GL.

Institution: Centers for Disease Control and Prevention, Fort Collins, Colorado 80526, USA. ebh2@cdc.gov

Title: Virology, pathology, and clinical manifestations of West Nile virus disease. [Review] [46 refs]

Source: Emerging Infectious Diseases. 11(8):1174-9, 2005 Aug.

Abstract: West Nile virus (WNV) causes epidemics of febrile illness, meningitis, encephalitis, and flaccid paralysis. Since it was first detected in New York City in 1999, and through 2004, >16,000 WNV disease cases have been reported in the United States. Over the past 5 years, research on WNV disease has expanded rapidly. This review highlights new information regarding the virology, clinical manifestations, and pathology of WNV disease, which will provide a new platform for further research into diagnosis, treatment, and possible prevention of WNV through vaccination. [References: 46]

Publication Type: Journal Article. Review.

Fulltext Available in MDConsult using Journal Search and the search term: 16032627

<2>

Unique Identifier [PMID]: 16032627

Authors: Mazurek JM. Winpisinger K. Mattson BJ. Duffy R. Moolenaar RL.

Institution: Epidemic Intelligence Service, Epidemiology Program office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. ACQ8@cdc.gov

Title: The epidemiology and early clinical features of West Nile virus infection.

Source: American Journal of Emergency Medicine. 23(4):536-43, 2005 Jul.

Abstract: We studied early clinical features of the West Nile virus (WNV) infection. Case patients were Ohio residents who reported to the Ohio Department of Health from August 14 to December 31, 2002, with a positive serum or cerebrospinal fluid for anti-WNV IgM. Of 441 WNV cases, medical records of 224 (85.5%) hospitalized patients were available for review. Most frequent symptoms were fever at a temperature of 38.0 degrees C or higher (n = 155; 69.2%), headache (n = 114; 50.9%), and mental status changes (n = 113; 50.4%). At least one neurological symptom, one gastrointestinal symptom, and one respiratory symptom was present in 186 (83.0%), 119 (53.1%), and 46 (20.5%) patients, respectively. Using multivariate logistic regression and controlling for age, we found that the initial diagnosis of encephalitis (P = .001) or reporting abdominal pain (P < .001) was associated with death. Because initial symptoms of WNV infection are not specific, physicians should maintain a high index of suspicion during the epidemic season, particularly in elderly patients with compatible symptoms.

Publication Type: Journal Article.

Link Directly to Fulltext article in Ovid

<10>

Unique Identifier [PMID]: 15353960

Authors: Cunha BA.

Institution: Infectious Disease Division, Winthrop-University Hospital, Mineola, New York 11501, USA.

Title: Differential diagnosis of West Nile encephalitis. [Review] [62 refs]

Source: Current Opinion in Infectious Diseases. 17(5):413-20, 2004 Oct.

Abstract: PURPOSE OF REVIEW: This article reviews recent developments in West Nile encephalitis. Because of the large number of individuals infected in the United States, an expanded spectrum of the disease has been recognized. Flaccid paralysis presenting as poliomyelitis-like syndrome is being increasingly recognized. RECENT FINDINGS: Since 1999, West Nile encephalitis in the United States has involved thousands of patients providing an opportunity to observe the protean manifestations of the virus. Recently, ophthalmological manifestations have been described that appear to be common and specific for the virus. Clinicians in endemic areas should be careful to distinguish between West Nile encephalitis and its mimics. The virus may occur in patients with underlying disorders that have encephalopathy as a clinical feature, and clinicians should test for the virus during the mosquito season, even in patients that appear to have an explanation for their encephalopathy. West Nile encephalitis may present as viral aseptic meningitis, meningoencephalitis, or encephalitis. Muscle weakness may or may not accompany any of these clinical variants. This virus may be transmitted via blood transfusion. SUMMARY: Clinical manifestations of West Nile encephalitis continue to expand following each year's outbreaks. New neurologic and ophthalmologic manifestations continue to be described. Because of the protean manifestations, testing should be carried out during mosquito season, even in patients that have another explanation for their encephalopathy. There is no effective therapy. Flaccid paralysis may be prolonged/permanent. Prognosis may be related to the degree of relative lymphopenia on presentation, the degree of elevation of serum ferritin levels and advanced age. The course of West Nile encephalitis and its clinical manifestations are the same in normal and compromised hosts. [References: 62]

Publication Type: Journal Article. Review.

Resident Report / Department of Medicine & Grady Branch Library

Emory University School of Medicine

2005 Edition

Participating Faculty:  Carlos Del Rio MD  / Joyce Doyle MD / Lorenzo Difrancesco MD / Erich Folch MD / Alicia Hidron  MD  

Contact: Karl Woodworth