ORIGINAL ARTICLEA Cluster Study of Predictors of Severe West Nile Virus Infection
Section snippets
PATIENTS AND METHODS
During an outbreak of WNV infection that occurred in the region of Monastir, Tunisia, between August 15 and October 24, 2003, 64 patients aged 20 to 85 years were consecutively hospitalized in the infectious diseases ward (n=44) or in the intensive care unit (n=20) for clinical manifestations consistent with WNV infection. All patients were immunocompetent and presented with evidence of an acute infection (fever, elevated white blood cell count, and elevated C-reactive protein level), along
RESULTS
A diagnosis of infection with WNV was confirmed in 36 (56%) of the 64 patients. IgM antibodies to WNV were detected in the CSF (n=31) or in serum (n=5). None of the remaining 28 patients had positive WNV test results in blood or CSF, and polymerase chain reaction of the CSF produced positive results in 12 patients for enteroviruses and in 4 patients for herpes simplex virus. The clinical characteristics of patients with WNV infection and of the control group are given in Table 1. The
DISCUSSION
Our study shows that a unique multifocal chorioretinitis is a frequent and specific marker of WNV infection. Infection with WNV is an emerging infectious disease that remains a diagnostic challenge for clinicians in the absence of specific clinical features that allow distinguishing WNV from other causes of viral encephalitis. Therefore, additional clinical tools for diagnosis are needed. Sejvar et al1 recently emphasized the frequent occurrence of movement disorders and parkinsonism in WNV
CONCLUSION
Multifocal chorioretinitis with a typical funduscopic appearence unique to WNV infection is highly suggestive of the disease. Ophthalmologic examination should be part of the routine examination of a patient in whom WNV infection is considered, particularly when a clinical syndrome of viral meningoencephalitis is present.
Acknowledgments
We are indebted to Professor Christian Brun Buisson (Hôpital Henri Mondor, Créteil, France) for his help in preparation of the submitted manuscript.
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