Clinical

West Nile should be ruled out in transplant patients with unexplained fever

Last Updated: 2004-05-11 15:55:14 -0400 (Reuters Health)

By Megan Rauscher

NEW YORK (Reuters Health) - A "high index" of suspicion for West Nile virus infection is warranted in transplant recipients who present with unexplained fever and/or neurological symptoms, write clinicians from Omaha in the May 1st issue of Clinical Infectious Diseases.

While the vast majority of West Nile virus infections are mild or asymptomatic, emerging evidence suggests that the infection may be more serious in immunocompromised patients, Dr. R. Brian Stevens and colleagues from Nebraska Medical Center note in their report.

They describe three recipients of kidney and/or pancreas grafts who contracted West Nile virus infection presumably via mosquito bites last summer during a large outbreak of West Nile fever in the state.

"Two of the three patients displayed moderate to severe neurological symptoms, including tremors, paralysis, and coma," Dr. Stevens told Reuters Health, and two developed meningoencephalitis.

"Our approach with these patients was to reduce or suspend their immunosuppression and provide supportive intensive care, including intubation with mechanical ventilation and intravenous nutrition," he explained.

"The three patients all survived and have almost completely recovered, but with lingering neurological complaints, including headache and problems with balance and fine motor control," he reported.

Dr. Stevens' team also reviewed the literature on West Nile virus infections in solid-organ transplant recipients, finding a total of seven cases in kidney and/or pancreas recipients, two in liver recipients, and one each in heart and lung recipients.

Most of these patients developed features consistent with encephalitis and the mortality rate was high, roughly 17%. The reported mortality rate for the general population of patients infected with West Nile virus is just 2%.

The Omaha clinicians are now conducting a study to determine the prevalence of West Nile virus seropositivity among solid organ transplant recipients to find out if the frequency and severity of the disease is greater compared to non-transplanted individuals in the same community.

"Physicians who encounter individuals with inexplicable, persistent fevers should obtain appropriate blood studies to confirm a diagnosis of West Nile virus and provide supportive care," Dr. Stevens said.

"For individuals immunocompromised due either to extremes of age or use of immunosuppressant agents, admission to a hospital for observation and reduction in the immunosuppressant agents is warranted," he added.

Clin Infect Dis 2004;38:1257-1260.