Abstract
The causes and frequency of acute paralysis and respiratory failure with West Nile virus (WNV) infection are incompletely understood. During the summer and fall of 2003, we conducted a prospective, population-based study among residents of a 3-county area in Colorado, United States, with developing WNV-associated paralysis. Thirty-two patients with developing paralysis and acute WNV infection were identified. Causes included a poliomyelitislike syndrome in 27 (84%) patients and a Guillain-Barré–like syndrome in 4 (13%); 1 had brachial plexus involvement alone. The incidence of poliomyelitislike syndrome was 3.7/100,000. Twelve patients (38%), including 1 with Guillain-Barré–like syndrome, had acute respiratory failure that required endotracheal intubation. At 4 months, 3 patients with respiratory failure died, 2 remained intubated, 25 showed various degrees of improvement, and 2 were lost to followup. A poliomyelitislike syndrome likely involving spinal anterior horn cells is the most common mechanism of WNV-associated paralysis and is associated with significant short- and long-term illness and death.
Highlights
The causes and frequency of acute paralysis and respiratory failure with West Nile virus (WNV) infection are incompletely understood
Two hundred nineteen cases of WNV neuroinvasive disease were identified by state-based surveillance in our catchment area; among these, we identified 32 patients with acute paralysis and WNV infection
Sixteen patients (50%) had concomitant encephalitis, 10 (31%) had meningitis, and 6 (19%) had paralysis alone. Those 26 patients with concomitant meningitis or encephalitis represented 12% of the patients identified as having neuroinvasive disease
Summary
The causes and frequency of acute paralysis and respiratory failure with West Nile virus (WNV) infection are incompletely understood. Twelve patients (38%), including 1 with Guillain-Barré–like syndrome, had acute respiratory failure that required endotracheal intubation. Acute paralysis associated with West Nile virus (WNV) infection [1,2,3,4,5,6,7,8] has been attributed to Guillain-Barré syndrome [3], a poliomyelitislike syndrome [2,4,5,6,8], and a generalized myeloradiculitis [1,7]. We conducted a population-based assessment of WNV-infected persons in whom acute paralysis developed to describe the clinical features, mechanisms, and shortterm outcomes
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