OBJECTIVES: Acute flaccid paralysis (AFP) has recently emerged as a major central nervous system complication associated with West Nile virus (WNV) infection. The spectrum of clinical presentations of AFP in WNV infection and its sequelae have not been well-studied. METHODS: We describe three patients with AFP due to WNV infection and review the clinical presentations of 56 patients with this complication derived from published studies. RESULTS: Patients with AFP and WNV presented with a spectrum of illness ranging from single extremity paralysis to quadriparalysis with cranial nerve involvement. Patients commonly developed respiratory failure (54%) and bladder dysfunction (22%). While fever was nearly universal (92%), signs of meningismus were less common (17%). Cerebrospinal fluid (CSF) analysis generally revealed a modest pleocytosis, and imaging studies were not diagnositic. Persistent neurologic impairment occurred in all survivors; overall mortality rate was high (22%) and was associated with both the extent of paralysis and advanced age. CONCLUSION: AFP in the setting of WNV is associated with significant mortality and long-term morbidity.
OBJECTIVES: Acute flaccid paralysis (AFP) has recently emerged as a major central nervous system complication associated with West Nile virus (WNV) infection. The spectrum of clinical presentations of AFP in WNV infection and its sequelae have not been well-studied. METHODS: We describe three patients with AFP due to WNV infection and review the clinical presentations of 56 patients with this complication derived from published studies. RESULTS:Patients with AFP and WNV presented with a spectrum of illness ranging from single extremity paralysis to quadriparalysis with cranial nerve involvement. Patients commonly developed respiratory failure (54%) and bladder dysfunction (22%). While fever was nearly universal (92%), signs of meningismus were less common (17%). Cerebrospinal fluid (CSF) analysis generally revealed a modest pleocytosis, and imaging studies were not diagnositic. Persistent neurologic impairment occurred in all survivors; overall mortality rate was high (22%) and was associated with both the extent of paralysis and advanced age. CONCLUSION: AFP in the setting of WNV is associated with significant mortality and long-term morbidity.
Authors: Jennie Johnstone; Steven E Hanna; Lindsay E Nicolle; Michael A Drebot; Binod Neupane; James B Mahony; Mark B Loeb Journal: J Med Case Rep Date: 2011-08-19