Three case reports of West Nile virus neuroinvasive disease: lessons from real-life clinical practice

Abstract

Background Despite being an uncommon cause of meningoencephalitis, West Nile virus (WNV) recently provoked significant outbreaks throughout Europe. West Nile neuroinvasive disease (WNND) is associated with significant morbidity and mortality in older and compromised individuals, while its diagnosis may be demanding for the clinician. Here discussed are three cases of WNND with a focus on the diagnostic challenges they presented due to atypical clinical presentation and laboratory findings. Case presentation Between July and September 2020 three patients presented to our attention with signs and symptoms compatible with meningoencephalitis. Among routine procedures, they underwent lumbar puncture and imaging. In the absence of microbiological isolates, biological samples were sent for serology and NAATs for WNV. Following diagnosis, the patients gradually recovered and were discharged either home or to rehabilitation facilities. Conclusions The laboratory findings here discussed, in particular CSF parameters, are only partially consistent with those described in the literature, which highlights the need for further research. While serology and NAATs on blood and urine appear the most reliable techniques in the diagnostic work-up of WNND, utility of NAATs on CSF specimens is limited by the kinetics of WNV viremia in biological fluids. This report underlines that WNND should always be included in the differential diagnosis of meningoencephalitis during WNV transmission period.

Concurrent Longitudinal Extensive Transverse Myelitis and Leptomeningitis in West Nile Virus: A Report of a Rare Case

“…Clinically, our case outlines the ill-defined and non-specific nature of the presentation of West Nile neuroinvasive disease (WNND). WNND can pose a diagnostic challenge for the clinician and if unrecognized, is associated with significant morbidity and mortality in older and compromised individuals [ 17 ]. While a period of high fever is one of the most common clinical presentations of WNV infection, developing in approximately 25% of those infected, it can vary greatly in clinical severity.…”

Encephalitis in travellers: a prospective multicentre study

“…Although all cases of WNV encephalitis were ACCEPTED MANUSCRIPT / CLEAN COPY diagnosed in recent travellers, the risk of an outbreak due to WNV infections in France is real, as sporadic transmission of WNV has been documented in horses, and humans, in France. In addition, WNV lineage 2 is now well established in Europe, responsible for domestic outbreaks every year in neighbouring countries, over recent years (23)(24)(25). No case of rabies was reported in this prospective cohort.…”

Novel Amplicon-Based Sequencing Approach to West Nile Virus

“…In Italy, areas with either proven active asymptomatic WNV circulation or high probability of human infection have been previously reported [ 8 , 9 ], and an increasing number of neuroinvasive human infections have been described [ 10 , 11 ].…”