Severe West Nile Virus Neuroinvasive Disease: Clinical Characteristics, Short- and Long-Term Outcomes.

Marija Santini,Ivana Župetić,Irena Tabain,Giovanni Savini,Vladimir Savić,Marija Kusulja,Vladimir Stevanović,Neven Papić,Tanja Potočnik-Hunjadi,Klaudija Višković,Vladimir Krajinović,Filip Glavač,Armin Mehmedović,Eddy Listeš,Ljubo Barbić,Lana Gorenec,Sara Haberle,Marko Kutleša,Elizabeta Dvorski,Tamara Butigan,Tatjana Vilibić-Čavlek,Ivo Grgić ,Snježana Židovec Lepej ,Gordana Kolarić-Sviben

doi:10.3390/pathogens11010052

Abstract

West Nile Virus Neuroinvasive Disease (WNV NID) requires prolonged intensive care treatment, resulting in high mortality and early disability. Long-term results are lacking. We have conducted an observational retrospective study with a prospective follow-up of WNV NID patients treated at the Intensive Care Unit (ICU), University Hospital for Infectious Diseases, Zagreb, Croatia, 2013–2018. Short-term outcomes were vital status, length of stay (LOS), modified Rankin Scale (mRS), and disposition at discharge. Long-term outcomes were vital status and mRS at follow-up. Twenty-three patients were identified, 78.3% males, median age 72 (range 33–84) years. Two patients (8.7%) died in the ICU, with no lethal outcomes after ICU discharge. The median ICU LOS was 19 days (range 5–73), and the median hospital LOS was 34 days (range 7–97). At discharge, 15 (65.2%) patients had moderate to severe/mRS 3–5, 6 (26.0%) had slight disability/mRS 2–1, no patients were symptom-free/mRS 0. Ten (47.6%) survivors were discharged to rehabilitation facilities. The median time to follow-up was nine months (range 6–69). At follow-up, seven patients died (30.5%), five (21.7%) had moderate to severe/mRS 3–5, one (4.3%) had slight disability/mRS 2–1, six (26.1%) had no symptoms/mRS 0, and four (17.4%) were lost to follow-up. Briefly, ten (43.5%) survivors improved their functional status, one (4.3%) was unaltered, and one (4.3%) aggravated. In patients with severe WNV NID, intensive treatment in the acute phase followed by inpatient rehabilitation resulted in significant recovery of functional status after several months.

Highlights

West Nile Virus (WNV) is a re-emerging mosquito-borne virus, increasingly present in most European countries
In a six-year period (2013–2018), 23 adult patients with West Nile Virus Neuroinvasive Disease (WNV NID) were treated at the Department of Intensive Care Medicine and Neuroinfectology, the 18-bed Intensive Care
42.4% of a total of 53 patients treated at the University Hospital for Infectious Diseases (UHID) for any form of WNV infection during the observed period

Summary

Introduction

West Nile Virus (WNV) is a re-emerging mosquito-borne virus, increasingly present in most European countries. Develop a self-limited flu-like disease (20%), 1% will develop the severe form of West Nile. Patients with severe WNV encephalitis may present with stupor or coma [5]. Acute paralysis associated with WNV infection has been attributed to a poliomyelitis-like syndrome, myeloradiculitis, and Guillain–Barré Syndrome (GBS) [6]. WNV poliomyelitis with or without brainstem involvement is the most common neuromuscular manifestation of WNV infection, resulting in asymmetric paralysis. The motor neurons in the anterior horns and in the brainstem are the major sites of pathology responsible for neuromuscular signs; inflammation may involve motor axons (polyradiculitis) and peripheral nerves (GBS) [7,8]. In comparison to patients with poliomyelitis-like syndrome, those resembling GBS have symmetric weakness with sensory loss [9]

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