Neuroinvasive West Nile virus infection in solid organ transplant recipients

Kasule, Sabirah N; Gupta, Simran; Patron, Roberto L.; Grill, Marie F.; Vikram, Holenarasipur R.

doi:10.1111/tid.14004

Cited by 7 publications

(14 citation statements)

References 26 publications

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“…Current Centers for Disease Control and Prevention guidelines do not support the use of these agents in NWNV infection . However, continued use of IVIg and interferon alfa is supported by a number of small studies and case reports demonstrating that it is safe and potentially beneficial, especially in individuals with IS . In our cohort, patients with IS were more likely to receive these therapies, possibly due to higher disease severity, prompting clinicians to consider some of these off-label therapeutic options in the absence of convincing data.…”

Section: Discussionmentioning

confidence: 79%

“…Following the 2021 WNV outbreak in Arizona, we conducted a second search to include only individuals from Arizona for the year 2021. The entire dataset includes patients enrolled in a previously published study of 24 recipients of SOT with NWNV infection …”

Section: Methodsmentioning

confidence: 99%

“…16 However, continued use of IVIg and interferon alfa is supported by a number of small studies and case reports demonstrating that it is safe and potentially beneficial, especially in individuals with IS. 9,[17][18][19][20][21] In our cohort, patients with IS were more likely to receive these therapies, possibly due to higher disease severity, prompting clinicians to consider some of these off-label therapeutic options in the absence of convincing data. Notably, we did find that IVIg use was associated with higher hazards of mortality in our cohort, which reflects bias of preferentially offering treatment to patients who are the most severely ill.…”

Section: Jama Network Open | Infectious Diseasesmentioning

confidence: 99%

“…Between 1999 and 2019, there were 25 920 cases of NWNV infection reported in the United States, of which 2259 were fatal . Limited reports have suggested that individuals who are immunosuppressed (IS), such as recipients of solid organ transplant (SOT), may exhibit atypical clinical features of NWNV infection, leading to delayed diagnosis and potentially worse outcomes …”

Section: Introductionmentioning

confidence: 99%

“…The entire dataset includes patients enrolled in a previously published study of 24 recipients of SOT with NWNV infection. 9 Reasons for exclusion of participants were history of WNV infection or prior documented diagnosis and treatment for WNV unrelated to admission at Mayo Clinic (outside hospital records not available), clinical suspicion for WNV infection but absent supportive diagnostic serum and CSF studies, acute WNV infection and positive serology test result without CNS involvement; and patient declined to offer research authorization at time of hospitalization, which is a requirement for Minnesota residents (eFigure 1 in Supplement 1). Individuals with NWNV infection who were receiving immunosuppressive medications, including high-dose prednisone, calcineurin inhibitors, biologics (eg, immune check point inhibitors, tumor necrosis factor-α inhibitors, Bruton tyrosine kinase inhibitors, and rituximab), or any cytotoxic chemotherapy agent, were considered IS.…”

mentioning

confidence: 99%

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Neuroinvasive West Nile Virus Infection in Immunosuppressed and Immunocompetent Adults

Mbonde,

Gritsch,

Harahsheh

et al. 2024

JAMA Netw Open

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ImportanceWest Nile virus (WNV) is the leading cause of human arboviral disease in the US, peaking during summer. The incidence of WNV, including its neuroinvasive form (NWNV), is increasing, largely due to the expanding distribution of its vector, the Culex mosquito, and climatic changes causing heavy monsoon rains. However, the distinct characteristics and outcomes of NWNV in individuals who are immunosuppressed (IS) and individuals who are not IS remain underexplored.ObjectiveTo describe and compare clinical and radiographic features, treatment responses, and outcomes of NWNV infection in individuals who are IS and those who are not IS.Design, Setting, and ParticipantsThis retrospective cohort study used data from the Mayo Clinic Hospital system collected from July 2006 to December 2021. Participants were adult patients (age ≥18 years) with established diagnosis of NWNV infection. Data were analyzed from May 12, 2020, to July 20, 2023.ExposureImmunosuppresion.Main Outcomes and MeasuresOutcomes of interest were clinical and radiographic features and 90-day mortality among patients with and without IS.ResultsOf 115 participants with NWNV infection (mean [SD] age, 64 [16] years; 75 [66%] male) enrolled, 72 (63%) were not IS and 43 (37%) were IS. Neurologic manifestations were meningoencephalitis (98 patients [85%]), encephalitis (10 patients [9%]), and myeloradiculitis (7 patients [6%]). Patients without IS, compared with those with IS, more frequently reported headache (45 patients [63%] vs 18 patients [42%]) and myalgias (32 patients [44%] vs 9 patients [21%]). In contrast, patients with IS, compared with those without, had higher rates of altered mental status (33 patients [77%] vs 41 patients [57%]) and myoclonus (8 patients [19%] vs 8 patients [4%]). Magnetic resonance imaging revealed more frequent thalamic T2 fluid-attenuated inversion recovery hyperintensities in individuals with IS than those without (4 patients [11%] vs 0 patients). Individuals with IS had more severe disease requiring higher rates of intensive care unit admission (26 patients [61%] vs 24 patients [33%]) and mechanical ventilation (24 patients [56%] vs 22 patients [31%]). The 90-day all-cause mortality rate was higher in the patients with IS compared with patients without IS (12 patients [28%] vs 5 patients [7%]), and this difference in mortality persisted after adjusting for Glasgow Coma Scale score (adjusted hazard ratio, 2.22; 95% CI, 1.07-4.27; P = .03). Individuals with IS were more likely to receive intravenous immunoglobulin than individuals without IS (12 individuals [17%] vs 24 individuals [56%]), but its use was not associated with survival (hazard ratio, 1.24; 95% CI, 0.50-3.09; P = .64).Conclusions and RelevanceIn this cohort study of individuals with NWNV infection, individuals with IS had a higher risk of disease complications and poor outcomes than individuals without IS, highlighting the need for innovative and effective therapies to improve outcomes in this high-risk population.

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Section: Discussionmentioning

confidence: 79%

Section: Methodsmentioning

confidence: 99%

Section: Jama Network Open | Infectious Diseasesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Neuroinvasive West Nile Virus Infection in Immunosuppressed and Immunocompetent Adults

Mbonde,

Gritsch,

Harahsheh

et al. 2024

JAMA Netw Open

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West Nile virus meningoencephalitis and cytokines analysis: review and case report

Argirova,

Kalchev,

Vasilev

et al. 2024

Biotechnology & Biotechnological Equipment

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Neuroinfectious Emergencies

Reynolds

2024

CONTINUUM: Lifelong Learning in Neurology

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OBJECTIVE This article describes nervous system infections and complications that lead to neurologic emergencies. LATEST DEVELOPMENTS New research on the use of dexamethasone in viral and fungal infections is reviewed. The use of advanced MRI techniques to evaluate nervous system infections is discussed. ESSENTIAL POINTS Neurologic infections become emergencies when they lead to a rapid decline in a patient’s function. Emergent complications may result from neurologic infections that, if not identified promptly, can lead to permanent deficits or death. These complications include cerebral edema and herniation, spinal cord compression, hydrocephalus, vasculopathy resulting in ischemic stroke, venous thrombosis, intracerebral hemorrhage, status epilepticus, and neuromuscular respiratory weakness.

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Neuroinvasive West Nile virus infection in solid organ transplant recipients

Cited by 7 publications

References 26 publications

Neuroinvasive West Nile Virus Infection in Immunosuppressed and Immunocompetent Adults

Neuroinvasive West Nile Virus Infection in Immunosuppressed and Immunocompetent Adults

West Nile virus meningoencephalitis and cytokines analysis: review and case report

Neuroinfectious Emergencies

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