West Nile Virus neuroinvasive disease

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Ann Neurol. 2006 Sep;60(3):286-300.West Nile virus neuroinvasive disease. LE, DeBiasi R, Goade DE, Haaland KY, Harrington JA, Harnar JB, Pergam SA, King MK, DeMasters BK, Tyler KL.Neurology Services, New Mexico Veterans Affairs Health Care System, University of New Mexico, Albuquerque, NM, USA.Since

1999, there have been nearly 20,000 cases of confirmed symptomatic West

Nile virus (WNV) infection in the United States, and it is likely that

more than 1 million people have been infected by the virus. WNV is now

the most common cause of epidemic viral encephalitis in the United

States, and it will likely remain an important cause of neurological

disease for the foreseeable future. Clinical syndromes produced by WNV

infection include asymptomatic infection, West Nile Fever, and West

Nile neuroinvasive disease (WNND). WNND includes syndromes of

meningitis, encephalitis, and acute flaccid paralysis/poliomyelitis.

The clinical, laboratory, and diagnostic features of these syndromes

are reviewed here. Many patients with WNND have normal neuroimaging

studies, but abnormalities may be present in areas including the basal

ganglia, thalamus, cerebellum, and brainstem. Cerebrospinal fluid

invariably shows a pleocytosis, with a predominance of neutrophils in

up to half the patients. Diagnosis of WNND depends predominantly on

demonstration of WNV-specific IgM antibodies in cerebrospinal fluid.

Recent studies suggest that some WNV-infected patients have persistent

WNV IgM serum and/or cerebrospinal fluid antibody responses, and this

may require revision of current serodiagnostic criteria. Although there

is no proven therapy for WNND, several vaccines and antiviral therapy

with antibodies, antisense oligonucleotides, and interferon

preparations are currently undergoing human clinical trials. Recovery

from neurological sequelae of WNV infection including cognitive

deficits and weakness may be prolonged and incomplete.PMID: 16983682 [w