engleski

Clinical characteristics and outcomes in patients with severe West Nile neuroinvasive disease in Croatia

Background: West Nile virus (WNV) neuroinvasive disease is a rare (<1%), but often severe manifestation of WNV infection. The clinical presentation varies and includes meningitis, encephalitis, and poliomyelitis-like syndrome. Risk factors include older age, comorbidities (arterial hypertension, diabetes) and immunosuppression. So far, 92 clinical cases of neuroinvasive WNV infection were reported in Croatia. The aim of this study was to analyze the clinical characteristics of patients with severe WNV neuroinvasive infection, hospitalized at the Department for Intensive Care Medicine and Neuroinfectology, University Hospital for Infectious Diseases “Dr Fran Mihaljevic”, Zagreb, from 2013 to 2019. Materials/methods: Among 23 patients with severe WNV infection, 18 (78.2%) were male. Twenty-one patients were from Croatia, while two cases were imported from Hungary and the USA, respectively. Diagnosis was confirmed by detection of WNV RNA in cerebrospinal fluid (CSF) and/or urine samples using RT-PCR and/or detection of WNV IgM and IgG antibodies of low avidity in serum and CSF samples. Results: The median patient’s age was 72 (range 33-84) years. Majority of patients reported underlying diseases, most commonly arterial hypertension (19/82.6%) and diabetes (9/39.1%). Three patients had kidney transplantation. The most common clinical presentations were encephalitis (13/56.5%) and encephalitis with acute flaccid paralysis (9/39.1%). Twelve patients (52.2%) were mechanically ventilated with the median duration of 12 (range 5-73) days. The median ICU stay was 19 days (range 5-73) while the median hospital stay was 34 days (range 7-97). Two patients (8.7%) died during the ICU treatment and 15 patients had moderate to severe disability at discharge, evaluated by modified Rankin Scale (mRS), score 3-5. The follow-up was performed in July 2019. Nineteen of 21 patients were available. Additional five patients (21.7%) died while five patients (21.7%) had moderate to severe disability. An improvement, according to mRS, was reported in 11 patients (47.8%). Conclusions: WNV neuroinvasive disease affected mainly the elderly with comorbidities. These patients often need a prolonged intensive treatment and have moderate to severe neurological disability. Improvement is noted after several months in one half of the patients.

Clinical characteristics ; patients ; West Nile ; neuroinvasive disease ; Croatia

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