West Nile virus-associated vasculitis and intracranial hemorrhage

Harroud, Adil; Almutlaq, Ahmad; Pellerin, David; Paz, Dan; Linnell, Grant; Gendron, Daniel

doi:10.1212/nxi.0000000000000641

Cited by 7 publications

(7 citation statements)

References 6 publications

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“…The tissue necrosis observed could be caused either by the vasculitis and/or the direct damage due to the presence of virus. Similarly, also in humans, cases of West Nile virus-associated vasculitis have been reported, suggesting for flaviviruses a similar spectrum of lesions in amplifying and dead-end hosts [ 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Pathology and Pathogenesis of Eurasian Blackbirds (Turdus merula) Naturally Infected with Usutu Virus

Giglia

Agliani

Munnink³

et al. 2021

Viruses

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The Usutu virus (USUV) is a mosquito-borne zoonotic flavivirus. Despite its continuous circulation in Europe, knowledge on the pathology, cellular and tissue tropism and pathogenetic potential of different circulating viral lineages is still fragmentary. Here, macroscopic and microscopic evaluations are performed in association with the study of cell and tissue tropism and comparison of lesion severity of two circulating virus lineages (Europe 3; Africa 3) in 160 Eurasian blackbirds (Turdus merula) in the Netherlands. Results confirm hepatosplenomegaly, coagulative necrosis and lymphoplasmacytic inflammation as major patterns of lesions and, for the first time, vasculitis as a novel virus-associated lesion. A USUV and Plasmodium spp. co-infection was commonly identified. The virus was associated with lesions by immunohistochemistry and was reported most commonly in endothelial cells and blood circulating and tissue mononucleated cells, suggesting them as a major route of entry and spread. A tropism for mononuclear phagocytes cells was further supported by viral labeling in multinucleated giant cells. The involvement of ganglionic neurons and epithelial cells of the gastrointestinal tract suggests a possible role of oral transmission, while the involvement of feather follicle shafts and bulbs suggests their use as a diagnostic sample for live bird testing. Finally, results suggest similar pathogenicity for the two circulating lineages.

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Section: Discussionmentioning

confidence: 99%

Pathology and Pathogenesis of Eurasian Blackbirds (Turdus merula) Naturally Infected with Usutu Virus

Giglia

Agliani

Munnink³

et al. 2021

Viruses

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“…Overall, WNV-associated CNS vascular events are rare [ 12 , 15 , 16 ]. The main hypothesis regarding the pathophysiology of these events is an inflammatory vasculopathy secondary to WNV CNS invasion.…”

Section: Discussionmentioning

confidence: 99%

Neuroinvasive West Nile Infection with an Unusual Clinical Presentation: A Single-Center Case Series

et al. 2020

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The 2018 West Nile Virus (WNV) season in Europe was characterized by an extremely high infection rate and an exceptionally higher burden when compared to previous seasons. Overall, there was a 10.9-fold increase in incidence in Italy, with 577 human cases, 230 WNV neuroinvasive diseases (WNNV) and 42 WNV-attributed deaths. Methods: in this paper we retrospectively reported the neurological presentation of 7 patients admitted to University Hospital of Udine with a diagnosis of WNNV, especially focusing on two patients who presented with atypical severe brain stem involvement. Conclusions: the atypical features of some of these forms highlight the necessity to stay vigilant and suspect the diagnosis when confronted with neurological symptoms. We strongly encourage clinicians to consider WNNV in patients presenting with unexplained neurological symptoms in mild climate-areas at risk.

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“…6 A single case of intracranial hemorrhage and intracranial vasculitis coincident with typical WNV encephalitis has been published. 7 Despite the paucity of reported large vessel involvement, WNV associated chorioretinitis with retinal vasculitis is described in multiple cases, often occurring 2 weeks after infectious symptoms. 8,9 Related flaviviruses have equally not been strongly associated with cardiovascular events, although Dengue virus has been associated with infrequent cases of myocardial dysfunction, 10 lacunar stroke, 11,12 and coagulopathy.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute Cryptogenic Stroke During West Nile Virus Infection: Case Report

Peters

Brown

2020

The Neurohospitalist

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West Nile virus is an emerging infection in North America but has not traditionally been associated with acute vascular events. We report a 57-year-old healthy male who developed pharyngitis and a corporeal rash, followed 1 week later by an acute cryptogenic stroke. Following successful endovascular thrombectomy, cerebrospinal fluid analysis revealed acute West Nile virus infection. While severe cases of vasculopathy have been described with flavivirus infection, stroke associated with relatively mild symptoms has not been. Given increasing evidence that viral and bacterial infections of many varieties may be stroke triggers, West Nile virus and other flaviviruses may represent an uncommon but underappreciated trigger of cryptogenic stroke. We review indirect evidence that viral endothelial tropism or a nonspecific peri-infectious inflammatory state may be causative mechanisms.

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West Nile virus-associated vasculitis and intracranial hemorrhage

Cited by 7 publications

References 6 publications

Pathology and Pathogenesis of Eurasian Blackbirds (Turdus merula) Naturally Infected with Usutu Virus

Pathology and Pathogenesis of Eurasian Blackbirds (Turdus merula) Naturally Infected with Usutu Virus

Neuroinvasive West Nile Infection with an Unusual Clinical Presentation: A Single-Center Case Series

Acute Cryptogenic Stroke During West Nile Virus Infection: Case Report

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