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A Fatal Case of Neuroinvasive West Nile Virus Infection in an Immunocompromised Host

The neuroinvasive form of West Nile disease is an uncommon manifestation of the viral infection. To date, documented cases in Michigan of neuroinvasive decompensation from this virus have been rare. Evaluation requires a broad differential diagnosis and treatment options are still quite limited. Obj...

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Autores principales: Allen, Justin, Conard, Jennifer, Wang, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MSU College of Osteopathic Medicine Statewide Campus System 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746072/
https://www.ncbi.nlm.nih.gov/pubmed/33655115
http://dx.doi.org/10.51894/001c.5967
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author Allen, Justin
Conard, Jennifer
Wang, Michael
author_facet Allen, Justin
Conard, Jennifer
Wang, Michael
author_sort Allen, Justin
collection PubMed
description The neuroinvasive form of West Nile disease is an uncommon manifestation of the viral infection. To date, documented cases in Michigan of neuroinvasive decompensation from this virus have been rare. Evaluation requires a broad differential diagnosis and treatment options are still quite limited. Objective evaluations entailing physical exam and radiographic and laboratory changes are nonspecific. Serologic testing of cerebrospinal fluid by enzyme immunoassay remains the gold standard for diagnosis. However, IgM antibodies typically do not develop until after the fourth to seventh day of symptom onset. This retrospective case report presents an immunocompromised male patient in his mid-70s in whom neuroinvasive West Nile virus was diagnosed postmortem. All information was obtained from the patient’s electronic health record. This patient’s immunocompromised state at the time of West Nile exposure made him more susceptible to neuroinvasive disease progression and ultimately influenced the outcome. Prior to withdrawing care, the patient was treated for methicillin sensitive staphylococcus aureus (MSSA) cellulitis and Type 1 Herpes Simplex virus. In this case, neuroinvasive West Nile virus was a less likely diagnosis given the patient’s physical exam findings and the context of more likely alternative explanations for his cognitive decline. Treatment options for neuroinvasive forms of West Nile virus are still supportive and would not have altered the patient’s hospital course. This case report demonstrates that clinicians must maintain an ongoing index of suspicion for infection in warmer climates where West Nile is becoming more prevalent. Given some patients’ obscure physical exam findings and radiographic imaging results, a thorough history with laboratory conformation is required for a more conclusive diagnosis
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spelling pubmed-77460722021-03-01 A Fatal Case of Neuroinvasive West Nile Virus Infection in an Immunocompromised Host Allen, Justin Conard, Jennifer Wang, Michael Spartan Med Res J Case Report The neuroinvasive form of West Nile disease is an uncommon manifestation of the viral infection. To date, documented cases in Michigan of neuroinvasive decompensation from this virus have been rare. Evaluation requires a broad differential diagnosis and treatment options are still quite limited. Objective evaluations entailing physical exam and radiographic and laboratory changes are nonspecific. Serologic testing of cerebrospinal fluid by enzyme immunoassay remains the gold standard for diagnosis. However, IgM antibodies typically do not develop until after the fourth to seventh day of symptom onset. This retrospective case report presents an immunocompromised male patient in his mid-70s in whom neuroinvasive West Nile virus was diagnosed postmortem. All information was obtained from the patient’s electronic health record. This patient’s immunocompromised state at the time of West Nile exposure made him more susceptible to neuroinvasive disease progression and ultimately influenced the outcome. Prior to withdrawing care, the patient was treated for methicillin sensitive staphylococcus aureus (MSSA) cellulitis and Type 1 Herpes Simplex virus. In this case, neuroinvasive West Nile virus was a less likely diagnosis given the patient’s physical exam findings and the context of more likely alternative explanations for his cognitive decline. Treatment options for neuroinvasive forms of West Nile virus are still supportive and would not have altered the patient’s hospital course. This case report demonstrates that clinicians must maintain an ongoing index of suspicion for infection in warmer climates where West Nile is becoming more prevalent. Given some patients’ obscure physical exam findings and radiographic imaging results, a thorough history with laboratory conformation is required for a more conclusive diagnosis MSU College of Osteopathic Medicine Statewide Campus System 2017-08-24 /pmc/articles/PMC7746072/ /pubmed/33655115 http://dx.doi.org/10.51894/001c.5967 Text en https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (4.0) (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Case Report
Allen, Justin
Conard, Jennifer
Wang, Michael
A Fatal Case of Neuroinvasive West Nile Virus Infection in an Immunocompromised Host
title A Fatal Case of Neuroinvasive West Nile Virus Infection in an Immunocompromised Host
title_full A Fatal Case of Neuroinvasive West Nile Virus Infection in an Immunocompromised Host
title_fullStr A Fatal Case of Neuroinvasive West Nile Virus Infection in an Immunocompromised Host
title_full_unstemmed A Fatal Case of Neuroinvasive West Nile Virus Infection in an Immunocompromised Host
title_short A Fatal Case of Neuroinvasive West Nile Virus Infection in an Immunocompromised Host
title_sort fatal case of neuroinvasive west nile virus infection in an immunocompromised host
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746072/
https://www.ncbi.nlm.nih.gov/pubmed/33655115
http://dx.doi.org/10.51894/001c.5967
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