Risk factors for encephalitis and death from West Nile virus infection

Murray, Kristy O.; Baraniuk, Sarah; Resnick, Melissa; Arafat, Raouf R.; Kilborn, C.; Cain, Kevin P.; Shallenberger, Rick; York, T. L.; Martínez, Diana; Hellums, J. S.; Hellums, D.; Malkoff, Marc; Elgawley, N.; McNeely, Wesley; Khuwaja, Salma; Tesh, Robert B.

doi:10.1017/s0950268806006339

Cited by 148 publications

(137 citation statements)

References 20 publications

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“…Our results corroborated findings from previous studies that older age is associated with more severe WNV disease, particularly hospitalization and development of encephalitis. 1,3,[5][6][7][8] In our study, the risk of severe illness increased with increasing age above 60 years. Although we found an increased risk of severe illness among males, sex was not associated with development of encephalitis or meningitis.…”

Section: Discussionsupporting

confidence: 48%

“…Many of the previously conducted studies examined factors associated with the most severe outcomes (e.g., encephalitis with muscle weakness and death) among cohorts of hospitalized patients. 1,7,[14][15][16] These studies generally included small numbers of patients, limiting power to detect associations. Two previous studies evaluated risk factors for neuroinvasive disease among all WNV disease cases reported to state health departments.…”

Section: Discussionmentioning

confidence: 99%

“…Hypertension, cerebrovascular disease, renal disease, and diabetes also have been identified as possible risk factors for severe WNV disease. 1,[5][6][7][13][14][15][16] However, findings have been inconsistent between previous studies, and many of these studies were performed on cohorts of hospitalized patients with relatively small sample sizes.…”

Section: Introductionmentioning

confidence: 98%

“…[1][2][3][4] The risk of WNV neuroinvasive disease increases with age and is highest among older adults. 1,3,[5][6][7] Among patients with neuroinvasive disease, patients aged 50 years have substantially higher case fatality rates and are more likely to be reported as cases of encephalitis compared with younger patients. 8 With the exception of increased age, risk factors for poor outcomes among persons infected with WNV have not been clearly defined.…”

Section: Introductionmentioning

confidence: 99%

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Medical Risk Factors for Severe West Nile Virus Disease, United States, 2008–2010

Lindsey¹,

Staples²,

Lehman³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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Abstract. We conducted enhanced surveillance to identify medical risk factors for severe illness (i.e., hospitalization or death) and neuroinvasive disease (i.e., encephalitis or meningitis) among all West Nile virus disease cases reported from selected states from 2008 to 2010. Of the 1,090 case-patients included in the analysis, 708 (65%) case-patients were hospitalized, 641 (59%) case-patients had neuroinvasive disease, and 55 (5%) case-patients died. Chronic renal disease (adjusted odds ratio [aOR] = 4.1; 95% confidence interval [CI] = 1.4-12.1), history of cancer (aOR = 3.7; 95% CI = 1.8-7.5), history of alcohol abuse (aOR = 3.0; 95% CI = 1.3-6.7), diabetes (aOR = 2.2; 95% CI = 1.4-3.4), and hypertension (aOR = 1.5; 95% CI = 1.1-2.1) were independently associated with severe illness on multivariable analysis. Although the same medical conditions were independently associated with encephalitis, only hypertension was associated with meningitis. The only condition independently associated with death was immune suppression. Prevention messages should be targeted to persons with these conditions.

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Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Medical Risk Factors for Severe West Nile Virus Disease, United States, 2008–2010

Lindsey¹,

Staples²,

Lehman³

et al. 2012

The American Journal of Tropical Medicine and Hygiene

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“…The incubation phase for WNV infection in humans is 2-14 days (Pauli et al, 2013;Suthar et al, 2013). Whilst most WNV infections in humans are asymptomatic, infection of neurons can result in neuroinvasive disease Hayes & Gubler, 2006;Murray et al, 2006;Pauli et al, 2013;Suthar et al, 2013). Between 1999 and 2013, the Centers for Disease Control and Prevention reported that 17 463 of a total 39 557 cases (44 %) in the USA presented with neuroinvasive disease, with a cumulative mortality rate (1668 cases) of~4 % (ArboNET: http://www.cdc.gov/westnile/resourcepages/ survResources.html).…”

Section: Introductionmentioning

confidence: 99%

Anti-inflammatory activity of intravenous immunoglobulins protects against West Nile virus encephalitis

Srivastava

Ramakrishna

Cantin

2015

Journal of General Virology

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West Nile virus (WNV), an important global human pathogen, targets neurons to cause lethal encephalitis, primarily in elderly and immunocompromised patients. Currently, there are no approved therapeutic agents or vaccines to treat WNV encephalitis. Recent studies have suggested that inflammation is a major contributor to WNV encephalitis morbidity. In this study we evaluated the use of IVIG (intravenous immunoglobulins -a clinical product comprising pooled human IgG) as an anti-inflammatory treatment in a model of lethal WNV infection. We report here that IVIG and pooled human WNV convalescent sera (WNV-IVIG) inhibited development of lethal WNV encephalitis by suppressing central nervous system (CNS) infiltration by CD45 high leukocytes. Pathogenic Ly6C high CD11b + monocytes were the major infiltrating subset in the CNS of infected control mice, whereas IVIG profoundly reduced infiltration of these pathogenic Ly6C high monocytes into the CNS of infected mice. Interestingly, WNV-IVIG was more efficacious than IVIG in controlling CNS inflammation when mice were challenged with a high-dose inoculum (10 5 versus 10 4 p.f.u.) of WNV. Importantly, adsorption of WNV E-glycoprotein neutralizing antibodies did not abrogate IVIG protection, consistent with virus neutralization not being essential for IVIG protection. These findings confirmed the potent immunomodulatory activity of generic IVIG, and emphasized its potential as an effective immunotherapeutic drug for encephalitis and other virus induced inflammatory diseases.

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Emerging Viral Infections of the Central Nervous System

Tyler¹

2009

Arch Neurol

107

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n this 2-part review, I will focus on emerging virus infections of the central nervous system (CNS). Part 1 will introduce the basic features of emerging infections, including their definition, epidemiology, and the frequency of CNS involvement. Important mechanisms of emergence will be reviewed, including viruses spreading into new host ranges as exemplified by West Nile virus (WNV), Japanese encephalitis (JE) virus, Toscana virus, and enterovirus 71 (EV71). Emerging infections also result from opportunistic spread of viruses into known niches, often resulting from attenuated host resistance to infection. This process is exemplified by transplantassociated cases of viral CNS infection caused by WNV, rabies virus, lymphocytic choriomeningitis, and lymphocytic choriomeningitis-like viruses and by the syndrome of human herpesvirus 6 (HHV6)-associated posttransplantation acute limbic encephalitis. The second part of this review begins with a discussion of JC virus and the occurrence of progressive multifocal leukoencephalopathy in association with novel immunomodulatory therapies and then continues with an overview of the risk of infection introduced by imported animals (eg, monkeypox virus) and examples of emerging diseases caused by enhanced competence of viruses for vectors and the spread of vectors (eg, chikungunya virus) and then concludes with examples of novel viruses causing CNS infection as exemplified by Nipah and Hendra viruses and bat lyssaviruses.

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Risk factors for encephalitis and death from West Nile virus infection

Cited by 148 publications

References 20 publications

Medical Risk Factors for Severe West Nile Virus Disease, United States, 2008–2010

Medical Risk Factors for Severe West Nile Virus Disease, United States, 2008–2010

Anti-inflammatory activity of intravenous immunoglobulins protects against West Nile virus encephalitis

Emerging Viral Infections of the Central Nervous System

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