A high number of severe neurologic clinical forms during an epidemic of West Nile virus infection.

The serologic confirmation of more than 800 cases hospitalized during the viral meningoencephalitis epidemic caused by the West Nile virus (WNV) that affected the South-East of Romania during the summer of 1996 consolidated the case definition in over 80% of the patients admitted to the hospital with neurological impairments. Other clinical forms of the WN infection were reported only scarcely during the epidemic and were seroconfirmed at a lower rate (60%). IgM capture ELISA (MAC-ELISA) is a test of choice for the rapid diagnosis. The major advantage of MAC-ELISA procedure is the high probability of accurate diagnosis of WN infection when the test is performed only with acute serum or cerebrospinal fluid (CSF) specimens obtained while the patient is still hospitalized. Rapid diagnosis by MAC-ELISA is important for the institution of public health control, but the results obtained have also some predictive values. We report the serological patterns of 65 pairs of CSF and serum samples collected in the early days of neuroinfection for diagnostic purposes. An unexpected onset of the intrathecal specific humoral immune response before serum immunoglobulins synthesis was recorded in 25% of cases. For 14 patients with intrathecal onset of IgM synthesis, their records evaluated retrospectively showed a severe evolution. The presence of only IgM antibodies in CSF is a characteristic which matched with other laboratory variables described which predict poor evolution in viral encephalitis: pleocytosis, elevated protein concentration in CSF (> 100 mg per deciliter), hyponatremia (< 130 mmol per liter).