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Calgary Experience with West Nile Virus Neurological Syndrome During the Late Summer of 2003

Published online by Cambridge University Press:  16 February 2016

Ana-Luiza Sayao ,
Oksana Suchowersky ,
Ali Al-Khathaami ,
Brian Klassen ,
Nili R. Katz ,
Robert Sevick ,
Peter Tilley ,
Julie Fox  and
David Patry
Ana-Luiza Sayao
Affiliation:
Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
Oksana Suchowersky
Affiliation:
University of Toronto, Department of Medicine, Toronto, Ontario, Canada
Ali Al-Khathaami
Affiliation:
University of Toronto, Department of Medicine, Toronto, Ontario, Canada
Brian Klassen
Affiliation:
University of Toronto, Department of Medicine, Toronto, Ontario, Canada
Nili R. Katz
Affiliation:
Department of Radiology, University of Calgary, Calgary, AB, Canada
Robert Sevick
Affiliation:
Department of Radiology, University of Calgary, Calgary, AB, Canada
Peter Tilley
Affiliation:
Provincial Laboratory for Public Health (Microbiology), Calgary, AB, Canada
Julie Fox
Affiliation:
Provincial Laboratory for Public Health (Microbiology), Calgary, AB, Canada
David Patry*
Affiliation:
University of Toronto, Department of Medicine, Toronto, Ontario, Canada
*
Foothills Hospital, Department of Clinical Neurosciences, 12th Floor, 1403 – 29 Street NW, Calgary, Alberta T2N 2T9, Canada.
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Abstract

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Background:

Between August 25 and September 25, 2003 seven patients with West Nile virus neurological manifestations were identified through the hospital neurology consultation services in Calgary, Alberta, Canada. Three of the seven patients were treated with interferon alpha-2b (IFN alpha-2b). In this report we document the clinical characteristics of these seven cases.

Methods:

Clinical and laboratory information was obtained from a retrospective review of patient hospital and clinic charts. Patients were included if they had serological evidence of West Nile virus infection and had clinical evidence of aseptic meningitis, encephalomyelitis, cerebellar syndrome or motor neuronopathy. Three patients received a treatment course of three million units IFN alpha-2b, administered by subcutaneous injection once per day for 14 days.

Results:

Four patients had cerebellar signs without change in consciousness, two had both encephalitis and neuromuscular weakness, and one patient had focal lower motor neuron arm weakness. The mean age was 52 (range 24 - 73). All patients had flu-like illness and fever as presenting symptoms and six had severe headaches. Two patients were immunocompromised prior to infection. Two patients with cerebellar signs (one with opsoclonus-myoclonus) improved spontaneously and exhibited only mild residual deficits on discharge. The other two patients with cerebellar findings developed brainstem involvement, one coinciding with and one subsequent to the cerebellar symptoms. Within one week of treatment with IFN alpha-2b these latter two patients showed marked improvement. One patient with encephalitis and neuromuscular weakness, was treated with IFN alpha-2b and subsequently recovered.

Interpretation:

In this case review of seven patients, multiple neurological symptoms occurred in each patient and the neurological presentation was varied. Four patients had predominant cerebellar findings and one patient had opsoclonus-myoclonus, not previously reported. The marked improvement in three patients who received IFN alpha-2b raises preliminary optimism towards this potential treatment.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 31 , Issue 2 , May 2004 , pp. 194 - 203
Copyright
Copyright © The Canadian Journal of Neurological 2004

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