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• W2084492412 abstract "BackgroundIn the 2003 West Nile virus (WNV) epidemic, Colorado reported more WNVcases than any other state, including an unprecedented number in organ transplantrecipients.MethodsPhysicians caring for transplant recipients hospitalized with naturallyacquired WNV encephalitis provided data to characterize the clinical symptoms,results of diagnostic studies, and outcomes.ResultsEleven transplant recipients were identified (4 kidney, 2 stem cell,2 liver, 1 lung, and 2 kidney/pancreas). Seven were directly admitted to 1of the 2 hospitals in the study, and 4 were referred to 1 of these centersfrom regional hospitals. All but 1 patient had a prodrome typical of WNV encephalitisin nonimmunosuppressed patients. Ten patients developed meningoencephalitis,which in 3 cases was associated with acute flaccid paralysis. One patientdeveloped acute flaccid paralysis without encephalitis. Six patients had significantmovement disorders including tremor, myoclonus, or parkinsonism. All patientshad cerebrospinal fluid pleocytosis and WNV-specific IgM in the cerebrospinalfluid and/or serum. Cerebrospinal fluid cytologic studies (n = 5) showed atypicallymphocytes, some resembling plasma cells; however, flow cytometry (n = 3)showed that cells were almost exclusively of T-cell (not B-cell or plasmacell) lineage. Magnetic resonance images of the brain were abnormal in 7 of8 tested patients, and electroencephalograms were abnormal in 7 of 7, with2 showing periodic lateralized epileptiform discharges. Nine of 11 patientssurvived infection, but 3 had significant residual deficits. One patient died17 days after admission, and autopsy findings revealed severe panencephaliticchanges with multifocal areas of necrosis in the cerebral deep gray nuclei,brainstem, and spinal cord as well as diffuse macrophage influx in the periventricularwhite matter. A second patient died of complications of WNV encephalitis 6months after hospital admission.ConclusionsNaturally acquired WNV encephalitis in transplant recipients shows diagnostic,clinical, and laboratory features similar to those reported in nonimmunocompromisedindividuals, but neuroimaging, electroencephalography, and autopsy resultsverify that these patients develop neurological damage at the severe end ofthe spectrum." @default.
• W2084492412 created "2016-06-24" @default.
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• W2084492412 date "2004-08-18" @default.
• W2084492412 modified "2023-10-16" @default.
• W2084492412 title "West Nile Virus Encephalomyelitis in Transplant Recipients" @default.
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• W2084492412 doi "https://doi.org/10.1001/jama.292.7.859" @default.
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