Prognosis of West Nile virus associated acute flaccid paralysis: a case series

Jennie Johnstone,Binod Neupane,Steven E Hanna,Michael A Drebot,James B Mahony,Mark B Loeb,Lindsay E Nicolle

doi:10.1186/1752-1947-5-395

Abstract

IntroductionLittle is known about the long-term health related quality of life outcomes in patients with West Nile virus associated acute flaccid paralysis. We describe the quality of life scores of seven patients with acute flaccid paralysis who presented to hospital between 2003 and 2006, and were followed for up to two years.Case presentationsBetween 2003 and 2006, 157 symptomatic patients with West Nile virus were enrolled in a longitudinal cohort study of West Nile virus in Canada. Seven patients (4%) had acute flaccid paralysis. The first patient was a 55-year-old man who presented with left upper extremity weakness. The second patient was a 54-year-old man who presented with bilateral upper extremity weakness. The third patient was a 66-year-old woman who developed bilateral upper and lower extremity weakness. The fourth patient was a 67-year-old man who presented with right lower extremity weakness. The fifth patient was a 60-year-old woman who developed bilateral lower extremity weakness. The sixth patient was a 71-year-old man with a history of Parkinson's disease and acute onset bilateral lower extremity weakness. The seventh patient was a 52-year-old man who presented with right lower extremity weakness. All were Caucasian. Patients were followed for a mean of 1.1 years. At the end of follow-up the mean score on the Physical Component Summary of the Short-Form 36 scale had only slightly increased to 39. In contrast, mean score on the Mental Component Summary of the Short-Form 36 scale at the end of follow-up had normalized to 50.ConclusionDespite the poor physical prognosis for patients with acute flaccid paralysis, the mental health outcomes are generally favorable.

Highlights

Little is known about the long-term health related quality of life outcomes in patients with West Nile virus associated acute flaccid paralysis
Serum IgM was positive for West Nile virus and the patient was diagnosed with West Nile virus acute flaccid paralysis affecting the left upper limb
Contrary to other forms of West Nile virus neuroinvasive disease, most cases of acute flaccid paralysis occur in healthy, non-elderly individuals [9,17,18], advanced age may be associated with an increased risk of mortality [6]

Summary

Introduction

In 1999, West Nile virus caused an outbreak in New York City and has since emerged as an important human pathogen in North America [1,2]. Case six A 71-year-old Caucasian man with a known history of heart failure and Parkinson’s disease with rapidly progressive bilateral lower extremity weakness following a viral prodrome of fever, rash, neck stiffness, fatigue and myalgias (Table 1) presented to the hospital. Case seven A 52-year-old Caucasian man with no known medical problems presented with acute onset of right leg weakness following a viral prodrome of fever, headache, neck stiffness, nausea, vomiting, myalgia and fatigue (Table 1) On examination he was afebrile (temperature of 35.9°C), hemodynamically stable and had flaccid weakness of the entire right lower leg. Serum IgM was positive for West Nile virus and the patient was diagnosed with West Nile virus acute flaccid paralysis affecting the right lower limb He was discharged nine days later following an uncomplicated hospital stay. When the scores for Patient number six were excluded from the analysis, the mean PCS change score was [SD, 14] and the mean MCS change score was [SD, 11]

Discussion

Findings

Conclusion

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