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Calgary Experience with West Nile Virus Neurological Syndrome During the Late Summer of 2003

Published online by Cambridge University Press:  16 February 2016

Ana-Luiza Sayao ,
Oksana Suchowersky ,
Ali Al-Khathaami ,
Brian Klassen ,
Nili R. Katz ,
Robert Sevick ,
Peter Tilley ,
Julie Fox  and
David Patry
Ana-Luiza Sayao
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Oksana Suchowersky
Affiliation:
University of Toronto, Department of Medicine, Toronto, Ontario, Canada
Ali Al-Khathaami
Affiliation:
University of Toronto, Department of Medicine, Toronto, Ontario, Canada
Brian Klassen
Affiliation:
University of Toronto, Department of Medicine, Toronto, Ontario, Canada
Nili R. Katz
Affiliation:
Department of Radiology, University of Calgary, Calgary, AB, Canada
Robert Sevick
Affiliation:
Department of Radiology, University of Calgary, Calgary, AB, Canada
Peter Tilley
Affiliation:
Provincial Laboratory for Public Health (Microbiology), Calgary, AB, Canada
Julie Fox
Affiliation:
Provincial Laboratory for Public Health (Microbiology), Calgary, AB, Canada
David Patry*
Affiliation:
University of Toronto, Department of Medicine, Toronto, Ontario, Canada
*
Foothills Hospital, Department of Clinical Neurosciences, 12th Floor, 1403 – 29 Street NW, Calgary, Alberta T2N 2T9, Canada.
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Abstract

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Background:

Between August 25 and September 25, 2003 seven patients with West Nile virus neurological manifestations were identified through the hospital neurology consultation services in Calgary, Alberta, Canada. Three of the seven patients were treated with interferon alpha-2b (IFN alpha-2b). In this report we document the clinical characteristics of these seven cases.

Methods:

Clinical and laboratory information was obtained from a retrospective review of patient hospital and clinic charts. Patients were included if they had serological evidence of West Nile virus infection and had clinical evidence of aseptic meningitis, encephalomyelitis, cerebellar syndrome or motor neuronopathy. Three patients received a treatment course of three million units IFN alpha-2b, administered by subcutaneous injection once per day for 14 days.

Results:

Four patients had cerebellar signs without change in consciousness, two had both encephalitis and neuromuscular weakness, and one patient had focal lower motor neuron arm weakness. The mean age was 52 (range 24 - 73). All patients had flu-like illness and fever as presenting symptoms and six had severe headaches. Two patients were immunocompromised prior to infection. Two patients with cerebellar signs (one with opsoclonus-myoclonus) improved spontaneously and exhibited only mild residual deficits on discharge. The other two patients with cerebellar findings developed brainstem involvement, one coinciding with and one subsequent to the cerebellar symptoms. Within one week of treatment with IFN alpha-2b these latter two patients showed marked improvement. One patient with encephalitis and neuromuscular weakness, was treated with IFN alpha-2b and subsequently recovered.

Interpretation:

In this case review of seven patients, multiple neurological symptoms occurred in each patient and the neurological presentation was varied. Four patients had predominant cerebellar findings and one patient had opsoclonus-myoclonus, not previously reported. The marked improvement in three patients who received IFN alpha-2b raises preliminary optimism towards this potential treatment.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 31 , Issue 2 , May 2004 , pp. 194 - 203
Copyright
Copyright © The Canadian Journal of Neurological 2004

References

1.Hubalek, Z, Halouzka, J. West Nile fever: a re-emerging mosquito borne viral disease in Europe. Emerg Infect Dis 1999;5: 643–650.CrossRefGoogle Scholar
2.Nosal, B. West Nile Virus. Can Med Assoc J 2003;168(11):1443–1444.Google ScholarPubMed
3.Investigations of West Nile virus infections in recipients of organ transplantation and blood transfusion. Morb Mortal Wkly Rep 2002; 51(39): 879.Google Scholar
4.Intrauterine West Nile virus infection. Morb Mortal Wkly Rep 2002; 51(50): 1135–1136.Google Scholar
5.Possible West Nile virus transmission to an infant through breast feeding. Morb Mortal Wkly Rep 2002; 51(39): 877–878.Google Scholar
6.Laboratory-acquired West Nile virus infections. Morb Mortal Wkly Rep 2002; 51(50): 1133–1135.Google Scholar
7.Smithburn, KC, Hughes, TP, Burke, AW, Paul, JH. A neurotropic virus isolated from the blood of a native of Uganda. Am J Trop Med 1940;20: 471–492.CrossRefGoogle Scholar
8.Marfin, AA, Gubler, DJ. West Nile encephalitis : an emerging disease in the United States. Clinl Infect Dis 2001;33: 1713–1719.CrossRefGoogle ScholarPubMed
9.Nash, D, Mostashari, F, Fine, A, et al. The outbreak of West Nile virus infection in the New York city area in 1999. N Eng J Med 2001; 344(24): 1807–1814.CrossRefGoogle ScholarPubMed
10.Pepperell, C, Rau, N, Krajden, S, et al. West Nile virus infection in 2002: morbidity and mortality amongst patients admitted to hospital in South Central Ontario. Can Med Assoc J 2003; 168(11): 1399–1405.Google Scholar
11.Tuckwell, J. First bird with West Nile virus found in Alberta. Government of Alberta. http://www.gov.ab.ca/acn/200307/14761.htmlGoogle Scholar
12.The West Nile Virus Home Page of the US Centers for Disease Control and Prevention. http://www.cdc.gov/ncid/dvbid/westnile/Google Scholar
13.Hubalek, Z. Comparative symptomatology of West Nile fever. Lancet 2001; 258: 254–255.CrossRefGoogle Scholar
14.Campbell, GL, Margin, AA, Lanciotti, RS, Gubler, DJ. West Nile virus. Lancet Infect Dis 2002; 2(9): 519–529.CrossRefGoogle ScholarPubMed
15.Jeha, LE, Sila, CA, Lederman, RJ, et al. West Nile virus infection: a new acute paralytic illness. Neurology 2003; 61: 55–59.CrossRefGoogle ScholarPubMed
16.Leis, AA, Stokic, DS, Polk, JL,, et al. A poliomyelitis-like syndrome from West Nile virus infection. N Eng J Med 2002; 347(16): 1279–1280.CrossRefGoogle ScholarPubMed
17.Li, J, Loeb, JA, Shy, ME, et al. Asymmetric flaccid paralysis: a neuromuscular presentation of West Nile virus infection. Ann Neurol 2003; 53(6): 703–710.CrossRefGoogle ScholarPubMed
18.Jordan, I, Briese, T, Fischer, N, et al. Ribavirin inhibits West Nile virus replication and cytopathic effect in neural cells. J Infect Dis 2000; 182: 1214–1217.CrossRefGoogle ScholarPubMed
19. Anderson, JF. Efficacy of interferon alpha-2b and ribavirin against West Nile virus in vitro. Emerg Infect Dis 2002; 8(1):107–108.CrossRefGoogle ScholarPubMed
20.Rahal, JJ. West Nile infection. 2 – week treatment course of interferon alpha-2b. New York Hospital Queens. Website: http://www.nyhq.org/posting/rahal.htmlGoogle Scholar
21.Quirk, M.First treatment trial for West Nile infection begins. Lancet Infect Dis 2002:2;589.CrossRefGoogle ScholarPubMed
22.Alberta Health and Wellness: WNV Evidence in Alberta. http://www.health.gov.ab.ca/healthier/disease/west_nile_testing.htmlGoogle Scholar
23.Petersen, LR, Marfin, AA. West Nile virus: a primer for the clinician. Ann Int Med 2002; 137(3): 173–179.CrossRefGoogle ScholarPubMed
24.Beatty, B, Calisher, C, Shope, R. Arboviruses. In: Lennette, E, Lennette, D, Lennette, E, (Eds). Diagnostic Procedures for Viral, Rickettsial, and Chlamydial Infections. (7th ed). Washington: American Public Health Assoc, 1995:189–212.Google Scholar
25.Fine, A. Testing for West Nile virus. Lancet 2000;356:1110.CrossRefGoogle ScholarPubMed
26.Boom, R, Sol, C, Salimans, M, et al. Rapid and simple method for purification of nucleic acids. J Clin Microbiol 1990;28:495–503.CrossRefGoogle ScholarPubMed
27.Lanciotti, RS, Kerst, AJ. Nucleic acid sequence-based amplification assays for rapid detection of West Nile and St. Louis encephalitis viruses. J Clin Microbiol 2001;39:4506–4513.CrossRefGoogle ScholarPubMed
28.Khakoo, S, Glue, P, Grellier, L, et al. Ribavirin and interferon alpha-2b in chronic hepatitis C: assessment of possible pharmacokinetic and pharmacodynamic interactions. Br J Clin Pharmacol 1998; 46: 563–570.CrossRefGoogle ScholarPubMed
29.Hayes, CG. West Nile virus: Uganda 1937 to New York City, 1999. Ann NYAcad Sci 2001; 951: 25–37.CrossRefGoogle ScholarPubMed
30.Leis, AA, Stokic, DS, Webb, RM, et al. Clinical spectrum of muscle weakness in human West Nile virus infection. Muscle Nerve. 2003; 28: 302–308.CrossRefGoogle ScholarPubMed
31.Carson, PJ, Steidler, T, Patron, R, et al. Plasma cell pleocytosis in cerebrospinal fluid in patients with West Nile virus encephalitis. Clin Infect Dis 2003; 37: e12–15.CrossRefGoogle ScholarPubMed
32.Ceausu, E, Erscoiu, S, Calistu, P, et al. Clinical manifestations of West Nile viral outbreaks. Roman J Virol 1997; 48: 3–11.Google Scholar
33.Glass, JD, Samels, O, Rich, MM. Poliomyelitis due to West Nile virus. N Eng J Med 2002; 347(16): 1280–1281.CrossRefGoogle ScholarPubMed
34.Sampson, BA, Arbrustmacher, V. West Nile virus encephalitis: the neuropathology of four fatalities. Ann NY Acad Sci 2001; 951:172–178.CrossRefGoogle ScholarPubMed
35.Weiss, D, Carr, D, Kellachan, J, et al. Clinical findings of West Nile virus infection in hospitalized patients, New York and New Jersey, 2000. Emerg Infect Dis 2001;7:654–658.CrossRefGoogle ScholarPubMed
36.Lanciotti, RS, Kerst, AJ, Nasci, RS, et al. Rapid detection of West Nile virus from human clinical specimens, field-collected mosquitoes, and avian samples by a TaqMan reverse transcriptase-PCR assay. J Clin Microbiol 2000;38:4066–4071.CrossRefGoogle ScholarPubMed
37.Nash, D, Mostashari, F, Fine, A, et al. The outbreak of West Nile virus infection in the New York City area in 1999.[comment]. N Eng J Med 2001;344:1807–1814.CrossRefGoogle ScholarPubMed
38.Morse, DL. West Nile virus – not a passing phenomenon. N Eng J Med 2003; 348(22):2173.CrossRefGoogle Scholar