Abstract
West Nile virus (WNV) is a zoonotic arbovirus transmitted by mosquitoes between wild birds (natural hosts) and other vertebrates. Horses and humans are incidental, dead-end hosts, but can develop severe neurological disorders. Owing to the close contact of cerebrospinal fluid (CSF) with the extracellular fluid of the brain, the analysis of CSF composition can reflect central nervous system (CNS) impairments enabling the diagnosis and understanding of various neurodegenerative CNS disorders. Our objective was to compare the findings from the CSF samples of horses with neuroinvasive WNV infection with those of healthy controls. We compared findings from fifteen CSF samples of 13 horses with acute WNV encephalomyelitis with those of 20 healthy controls. Protein, particular enzymes and ions, glucose and lactate showed abnormal levels in a significant number of WNV cases. None of the six horses with elevated glucose concentrations survived. Rather neutrophilic than mononuclear pleocytosis was identified with WNV infection. Neutrophils probably play a role in the development of inflammatory response and brain damage. Although elevated glucose levels reliably predicted the outcome, they might be the consequence of increased plasma levels and reflect general stress rather than CNS pathophysiology. The CSF findings of WNV encephalomyelitis patients are non-specific and variable but facilitate the differential diagnosis.
Highlights
West Nile virus (WNV) is a mosquito-borne zoonotic arbovirus belonging to the genus Flavivirus in the family Flaviviridae (Smithburn et al, 1940) and transmitted in natural cycles between mosquitoes and wild birds (Bakonyi et al, 2013; SzentpaliGavaller et al, 2014)
alkaline phosphatase (ALP) activities, lactate and glucose concentrations were out of the. This is the first paper that describes in detail the characteristics of the cerebrospinal fluid (CSF) of horses with West Nile neuroinvasive disease (WNND) caused by a lineage 2 strain and proposes some clues for prognosis and pathogenesis
The reference ranges set by our control group were consistent with those in previous studies (Mayhew et al, 1977; Andrews et al, 1990; MacWilliams, 2002), except for lactate concentration that was slightly higher and lactate dehydrogenase (LDH) activity that was moderately higher in our reference group
Summary
West Nile virus (WNV) is a mosquito-borne zoonotic arbovirus belonging to the genus Flavivirus in the family Flaviviridae (Smithburn et al, 1940) and transmitted in natural cycles between mosquitoes (mainly the genus Culex) and wild birds (Bakonyi et al, 2013; SzentpaliGavaller et al, 2014). Phylogenetic studies have identified two main lineages of WNV strains. The Hungarian equine WNV outbreak reported in 2008 was the first to be caused by a lineage 2 sub-Saharan strain in Europe. The pathogenicity of this lineage 2 strain resembled that of lineage 1 strains, and its sudden spread was unpredictable (Kutasi et al, 2011; Bakonyi et al, 2013). The epidemiology of WNV in human beings and horses has changed in Europe, with an increasing incidence of West Nile fever as well as of West Nile neuroinvasive disease (WNND) even in more northern regions (Fraisier et al, 2014; Ziegler et al, 2018)
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