Clinical

Neurologic damage of West Nile encephalitis more severe in transplant recipients

Last Updated: 2004-08-16 16:00:12 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Although many features of West Nile virus (WNV) encephalitis are similar in transplant recipients and non-immunocompromised patients, new research indicates that recipients often experience more severe neurologic damage.

The findings, which appear in the Archives of Neurology for August, are based on a study of 11 transplant recipients who were treated for WNV infection in Colorado in 2003. The organ transplants included four kidney, two stem cell, two liver, one lung, and two kidney/pancreas, and the time from transplantation to WNV infection ranged from 5 months to 15 years.

All but one of the patients had early disease manifestations typically seen in non-immunocompromised patients, senior author Dr. Kenneth L. Tyler, from the University of Colorado in Denver, and colleagues note.

Meningoencephalitis occurred in 10 patients, including 3 cases involving acute flaccid paralysis, the authors state. In one patient, acute flaccid paralysis developed in the absence of encephalitis. Significant movement disorders were noted in six patients.

CSF testing, MRI, and EEG revealed abnormalities in all or nearly all of the patients evaluated with these modalities.

Two of the patients died from their infection, the investigators point out. Of the remaining nine survivors, three had residual neurologic deficits.

"Naturally acquired WNV encephalitis in transplant recipients shows diagnostic, clinical, and laboratory features similar to those reported in non-immunocompromised individuals, but neuroimaging, EEG, and autopsy results verify that these patients develop neurologic damage at the severe end of the spectrum," the investigators point out.

In a related editorial, Archives of Neurology editor Dr. Roger N. Rosenberg comments that the present study "is significant because it documents that lethality of WNV encephalomyelitis in immunocompromised patients and alerts the neurologic community to be vigilant about the occurrence of severe disease consequences in this population."

Arch Neurol 2004;61:1181,1210-1220.