This Article  • Full text  • PDF  • Correction  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (124)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in JAMA  Topic Collections  • Viral Infections  • Neurology  • Alert me on articles by topic

James J. Sejvar, MD; Maryam B. Haddad, MSN, MPH, FNP; Bruce C. Tierney, MD; Grant L. Campbell, MD, PhD; Anthony A. Marfin, MD, MPH; Jay A. Van Gerpen, MD; Aaron Fleischauer, PhD; A. Arturo Leis, MD; Dobrivoje S. Stokic, MD; Lyle R. Petersen, MD, MPH

JAMA. 2003;290:511-515.

Context  The neurologic manifestations, laboratory findings, and outcome of patients with West Nile virus (WNV) infection have not been prospectively characterized.

Objective  To describe prospectively the clinical and laboratory features and long-term outcome of patients with neurologic manifestations of WNV infection.

Design, Setting, and Participants  From August 1 to September 2, 2002, a community-based, prospective case series was conducted in St Tammany Parish, La. Standardized clinical data were collected on patients with suspected WNV infection. Confirmed WNV-seropositive patients were reassessed at 8 months.

Main Outcome Measures  Clinical, neurologic, and laboratory features at initial presentation, and long-term neurologic outcome.

Results  Sixteen (37%) of 39 suspected cases had antibodies against WNV; 5 had meningitis, 8 had encephalitis, and 3 had poliomyelitis-like acute flaccid paralysis. Movement disorders, including tremor (15 [94%]), myoclonus (5 [31%]), and parkinsonism (11 [69%]), were common among WNV-seropositive patients. One patient died. At 8-month follow-up, fatigue, headache, and myalgias were persistent symptoms; gait and movement disorders persisted in 6 patients. Patients with WNV meningitis or encephalitis had favorable outcomes, although patients with acute flaccid paralysis did not recover limb strength.

Conclusions  Movement disorders, including tremor, myoclonus, and parkinsonism, may be present during acute illness with WNV infection. Some patients with WNV infection and meningitis or encephalitis ultimately may have good long-term outcome, although an irreversible poliomyelitis-like syndrome may result.

Author Affiliations: Division of Viral and Rickettsial Diseases (Dr Sejvar) and Division of Vector-Borne Infectious Diseases (Drs Campbell, Marfin, and Petersen), National Center for Infectious Diseases, and Epidemic Intelligence Service, Epidemiology Program Office (Drs Tierney and Fleischauer and Ms Haddad), Centers for Disease Control and Prevention, Atlanta, Ga; Department of Neurology, Ochsner Clinic, New Orleans, La (Dr Van Gerpen); Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, Miss (Drs Leis and Stokic).

RELATED ARTICLES

West Nile Virus
Lyle R. Petersen, Anthony A. Marfin, and Duane J. Gubler
JAMA. 2003;290(4):524-528.
EXTRACT | FULL TEXT  

West Nile Virus
Janet M. Torpy, Cassio Lynm, and Richard M. Glass
JAMA. 2003;290(4):558.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Tumor Necrosis Factor Alpha Protects against Lethal West Nile Virus Infection by Promoting Trafficking of Mononuclear Leukocytes into the Central Nervous System
Shrestha et al.
J. Virol. 2008;82:8956-8964.
ABSTRACT | FULL TEXT  

Prognosis after West Nile Virus Infection
Loeb et al.
ANN INTERN MED 2008;149:232-241.
ABSTRACT | FULL TEXT  

Epitope discovery in West Nile virus infection: Identification and immune recognition of viral epitopes
Proc. Natl. Acad. Sci. USA 2008;105:2981-2986.
 

Transmission of Tropical and Geographically Restricted Infections during Solid-Organ Transplantation
Martin-Davila et al.
Clin. Microbiol. Rev. 2008;21:60-96.
ABSTRACT | FULL TEXT  

Fas Ligand Interactions Contribute to CD8+ T-Cell-Mediated Control of West Nile Virus Infection in the Central Nervous System
Shrestha and Diamond
J. Virol. 2007;81:11749-11757.
ABSTRACT | FULL TEXT  

Novel Strategy for Treatment of Viral Central Nervous System Infection by Using a Cell-Permeating Inhibitor of c-Jun N-Terminal Kinase
Beckham et al.
J. Virol. 2007;81:6984-6992.
ABSTRACT | FULL TEXT  

Maculopapular rash and tremor are associated with West Nile fever and neurological syndromes
Tilley et al.
J. Neurol. Neurosurg. Psychiatry 2007;78:529-531.
ABSTRACT | FULL TEXT  

Caspase 3-Dependent Cell Death of Neurons Contributes to the Pathogenesis of West Nile Virus Encephalitis
Samuel et al.
J. Virol. 2007;81:2614-2623.
ABSTRACT | FULL TEXT  

West Nile virus infection presenting as acute flaccid paralysis in an HIV-infected patient: A case report and review of the literature
Torno et al.
Neurology 2007;68:E5-E7.
ABSTRACT | FULL TEXT  

Differential Induction of Type I Interferon Responses in Myeloid Dendritic Cells by Mosquito and Mammalian-Cell-Derived Alphaviruses
Shabman et al.
J. Virol. 2007;81:237-247.
ABSTRACT | FULL TEXT  

Pathogenesis of West Nile Virus Infection: a Balance between Virulence, Innate and Adaptive Immunity, and Viral Evasion
Samuel and Diamond
J. Virol. 2006;80:9349-9360.
FULL TEXT  

PKR and RNase L Contribute to Protection against Lethal West Nile Virus Infection by Controlling Early Viral Spread in the Periphery and Replication in Neurons
Samuel et al.
J. Virol. 2006;80:7009-7019.
ABSTRACT | FULL TEXT  

Physical Therapist Examination, Evaluation, and Intervention for a Patient With West Nile Virus Paralysis
Miller et al.
ptjournal 2006;86:843-856.
ABSTRACT | FULL TEXT  

CSF findings in 250 patients with serologically confirmed West Nile virus meningitis and encephalitis
Tyler et al.
Neurology 2006;66:361-365.
ABSTRACT | FULL TEXT  

Alpha/Beta Interferon Protects against Lethal West Nile Virus Infection by Restricting Cellular Tropism and Enhancing Neuronal Survival
Samuel and Diamond
J. Virol. 2005;79:13350-13361.
ABSTRACT | FULL TEXT  

Neurologic, Neuropsychologic, and Electroencephalographic Findings After European Tick-borne Encephalitis in Children
Schmolck et al.
J Child Neurol 2005;20:500-508.
ABSTRACT  

Neurologic, Neuropsychologic, and Electroencephalographic Findings After European Tick-borne Encephalitis in Children
Schmolck et al.
J Child Neurol 2005;20:500-508.
ABSTRACT  

THE EMERGENCE OF WEST NILE VIRUS DURING A LARGE OUTBREAK IN ILLINOIS IN 2002
HUHN et al.
Am J Trop Med Hyg 2005;72:768-776.
ABSTRACT | FULL TEXT  

Characterization of an In Vitro Model of Alphavirus Infection of Immature and Mature Neurons
Vernon and Griffin
J. Virol. 2005;79:3438-3447.
ABSTRACT | FULL TEXT  

West Nile Virus Infection
Zak et al.
Am. J. Roentgenol. 2005;184:957-961.
ABSTRACT | FULL TEXT  

West Nile Virus Infection: MR Imaging Findings in the Nervous System
Ali et al.
Am. J. Neuroradiol. 2005;26:289-297.
ABSTRACT | FULL TEXT  

Update in Neurology
Samuels
ANN INTERN MED 2005;142:28-36.
FULL TEXT  

West Nile Virus: A Case Report with Flaccid Paralysis and Cervical Spinal Cord: MR Imaging Findings
Kraushaar et al.
Am. J. Neuroradiol. 2005;26:26-29.
ABSTRACT | FULL TEXT  

Post-infectious encephalomyelitis associated with St. Louis encephalitis virus infection
Sejvar et al.
Neurology 2004;63:1719-1721.
ABSTRACT | FULL TEXT  

Cerebrospinal Fluid Neutrophilic Pleocytosis in Hospitalized West Nile virus Patients
Crichlow et al.
J Am Board Fam Med 2004;17:470-472.
ABSTRACT | FULL TEXT  

Clinical Characteristics and Functional Outcomes of West Nile Fever
Watson et al.
ANN INTERN MED 2004;141:360-365.
ABSTRACT | FULL TEXT  

West Nile Virus Encephalomyelitis in Transplant Recipients
Rosenberg
JAMA 2004;292:859-860.
FULL TEXT  

West Nile Virus Infection in the United States
Tyler
Arch Neurol 2004;61:1190-1195.
FULL TEXT  

Naturally Acquired West Nile Virus Encephalomyelitis in Transplant Recipients: Clinical, Laboratory, Diagnostic, and Neuropathological Features
Kleinschmidt-DeMasters et al.
Arch Neurol 2004;61:1210-1220.
ABSTRACT | FULL TEXT  

Flavivirus Encephalitis
Solomon
NEJM 2004;351:370-378.
FULL TEXT  

The aetiology of flaccid paralysis in West Nile virus infection * Authors' reply
Leis et al.
J. Neurol. Neurosurg. Psychiatry 2004;75:940-941.
FULL TEXT  

Stiff-Person Syndrome Following West Nile Fever
Hassin-Baer et al.
Arch Neurol 2004;61:938-941.
ABSTRACT | FULL TEXT  

Additional articles abstracted in ACP Journal Club
Evid. Based Med. 2004;9:67-67.
FULL TEXT  

West Nile Virus Infection: A Pediatric Perspective
Hayes and O'Leary
Pediatrics 2004;113:1375-1381.
ABSTRACT | FULL TEXT  

Other articles noted: 25 Jul 03 to 7 Nov 03
Evid. Based Nurs. 2004;7:e1-1.
FULL TEXT  

Clinical and Laboratory Features of West Nile Virus Infection
JWatch Neurology 2003;2003:1-1.
FULL TEXT  

Spectrum of Neurologic Findings in West Nile Virus Infection
JWatch General 2003;2003:6-6.
FULL TEXT  

Spectrum of Neurologic Findings in West Nile Virus Infection
JWatch Infect. Diseases 2003;2003:1-1.
FULL TEXT  

West Nile Virus
Petersen et al.
JAMA 2003;290:524-528.
FULL TEXT