Neuroinvasive West Nile virus infections after solid organ transplantation: Single center experience and systematic review

Abstract

West Nile virus (WNv) is a major cause of viral encephalitis in the United States. WNv infection is usually asymptomatic or a limited febrile illness in the immunocompetent hosts, although a small percentage can develop neuroinvasive disease. Neuroinvasive disease due to WNv in solid organ transplant recipients occurs at higher rates than observed in the general population and can have long term neurological sequalae. Methods We retrospectively reviewed medical records of all solid organ transplant recipients at our institution who tested positive for WNv from 2010 to 2018. Two reviewers performed electronic searches of Medline, Embase, Cochrane Library of literature of WNv infections in SOT. Descriptive statistics were performed on key variables. Results Eight recipients (mean age 54, five males) were diagnosed with neuroinvasive WNv infection at our institution. Distribution of infection was as follows: five kidney transplants, one in each kidney‐pancreas, liver, and lung. Diagnoses included meningitis (3), encephalitis (1), meningo‐encephalitis (4). Median time from transplant to infection was 49.8 months (2.7–175.4). No infections were considered donor‐derived. Five patients received treatment with IVIG. Six patients were alive at median follow‐up of 49.5 months (21.7–116.8). We identified 29 studies published from 2002 to 2019. Median time from transplant to infection was 14.2 months, with similar allograft distribution; 53% were donor‐derived infections. Conclusion WNv infections in solid organ transplant recipients can be a consequence of organ donation or can be acquired via the community. Infections can be more severe in SOT recipients and lead to neuroinvasive disease.

The role of intravenous immunoglobulin in the treatment of community – Acquired West Nile virus encephalitis after liver transplantation

“…Different immunosuppression-reduction regimes for WNV diagnosis have been described. [1][2][3][4] In our case, MMF was withdrawn and the tacrolimus trough was maintained at 2-4 ng/dl. While awaiting further studies to determine efficacy and optimal dosage strategies, we initiated daily IVIG from the day of diagnosis.…”

“…Dear Editor, We read with interest the review by Abbas et al of neuroinvasive West Nile virus (WNV) infections after solid organ transplantation (SOT). 1 Community-acquired WNV infection after liver transplantation (LT) often goes unreported, and treatment options still remain unclear in this population. [1][2][3] We share another successful recovery of a 69-year-old male with hepatocellular carcinoma and alcoholic cirrhosis who had undergone deceased donor LT in September 2019, subsequently contracting severe neuroinvasive WNV encephalitis.…”

“…The data that support the findings of this study are available from the corresponding author, Andrea Lauterio, upon reasonable request. Andrea Lauterio 1,2 Riccardo De Carlis 1,3 Leonardo Centonze…”

West Nile virus seropositivity in Alanya, a coastal city in the Mediterranean region of Turkey

“…However, none of the seropositive individuals had a history of blood transfusion or organ transplantation, which are known to increase the risk of WNV transmission. 23 , 24 …”

Clinical and Diagnostic Features of West Nile Virus Neuroinvasive Disease in New York City

“…Delays in diagnosis present a serious challenge to developing and evaluating treatments for WNND, for which there exists a very limited evidence base, as prompt administration of therapies in acute infection is likely to yield the greatest clinical effect. In addition, the majority of studies examining the clinical features of WNND have utilized active surveillance during major outbreaks in the early 2000s, while more recent reports have primarily focused on immunocompromised subpopulations of patients, particularly solid organ transplant recipients [18][19][20][21].…”