Journal of Neurology

, Volume 261, Issue 6, pp 1104–1111

Clinical characteristics and functional outcome of patients with West Nile neuroinvasive disease in Serbia

Authors

  • Natasa Popovic
    • Clinic for Infectious and Tropical DiseasesClinical Centre Serbia
  • Branko Milosevic
    • Clinic for Infectious and Tropical DiseasesClinical Centre Serbia
    • Medical FacultyUniversity of Belgrade
  • Aleksandar Urosevic
    • Clinic for Infectious and Tropical DiseasesClinical Centre Serbia
  • Jasmina Poluga
    • Clinic for Infectious and Tropical DiseasesClinical Centre Serbia
    • Medical FacultyUniversity of Belgrade
  • Nada Popovic
    • Clinic for Infectious and Tropical DiseasesClinical Centre Serbia
    • Medical FacultyUniversity of Belgrade
  • Goran Stevanovic
    • Clinic for Infectious and Tropical DiseasesClinical Centre Serbia
    • Medical FacultyUniversity of Belgrade
  • Ivana Milosevic
    • Clinic for Infectious and Tropical DiseasesClinical Centre Serbia
    • Medical FacultyUniversity of Belgrade
  • Milos Korac
    • Clinic for Infectious and Tropical DiseasesClinical Centre Serbia
    • Medical FacultyUniversity of Belgrade
  • Nikola Mitrovic
    • Clinic for Infectious and Tropical DiseasesClinical Centre Serbia
  • Lidija Lavadinovic
    • Clinic for Infectious and Tropical DiseasesClinical Centre Serbia
    • Medical FacultyUniversity of Belgrade
  • Jelena Nikolic
    • Clinic for Infectious and Tropical DiseasesClinical Centre Serbia
    • Clinic for Infectious and Tropical DiseasesClinical Centre Serbia
    • Medical FacultyUniversity of Belgrade
Original Communication

DOI: 10.1007/s00415-014-7318-7

Cite this article as:
Popovic, N., Milosevic, B., Urosevic, A. et al. J Neurol (2014) 261: 1104. doi:10.1007/s00415-014-7318-7

Abstract

Neurologic manifestations are prominent characteristic of West Nile virus (WNV) infection. The aim of this article was to describe neurological manifestations in patients with WNV neuroinvasive disease and their functional outcome at discharge in the first human outbreak of WNV infection in Serbia. The study enrolled patients treated in the Clinic for Infectious and Tropical Diseases, Clinical Center Serbia in Belgrade, with serological evidence of acute WNV infection who presented with meningitis, encephalitis and/or acute flaccid paralyses (AFP). Functional outcome at discharge was assessed using modified Rankin Scale (mRS) and Barthel index. Fifty-two patients were analysed. Forty-four (84.6 %) patients had encephalitis, eight (15.4 %) had meningitis, and 13 (25 %) had AFP. Among patients with AFP, 12 resembled poliomyelitis and one had clinical and electrodiagnostic findings consistent with polyradiculoneuritis. Among patients with encephalitis, 17 (32.7 %) had clinical signs of rhombencephalitis, and eight (15.4 %) presented with cerebellitis. Respiratory failure with subsequent mechanical ventilation developed in 13 patients with WNE (29.5 %). Nine (17.3 %) patients died, five (9.6 %) were functionally dependent (mRS 3–5), and 38 (73.1 %) were functionally independent at discharge (mRS 0–2). In univariate analysis, the presence of AFP, respiratory failure and consciousness impairment were found to be predictors of fatal outcome in patients with WNV neuroinvasive disease (p < 0.001, p < 0.001, p = 0.018, respectively). The outbreak of human WNV infection in Serbia caused a notable case fatality ratio, especially in patients with AFP, respiratory failure and consciousness impairment. Rhombencephalitis and cerebellitis could be underestimated presentations of WNV neuroinvasive disease.

Keywords

West Nile virusNeuroinvasive diseaseRhombencephalitisOutcome

Copyright information

© Springer-Verlag Berlin Heidelberg 2014