Journal of Neurology

, Volume 261, Issue 6, pp 1104–1111

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

  • Natasa Popovic
  • Branko Milosevic
  • Aleksandar Urosevic
  • Jasmina Poluga
  • Nada Popovic
  • Goran Stevanovic
  • Ivana Milosevic
  • Milos Korac
  • Nikola Mitrovic
  • Lidija Lavadinovic
  • Jelena Nikolic
  • Olga Dulovic
Original Communication

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 virus Neuroinvasive disease Rhombencephalitis Outcome 

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Natasa Popovic
    • 1
  • Branko Milosevic
    • 1
    • 2
  • Aleksandar Urosevic
    • 1
  • Jasmina Poluga
    • 1
    • 2
  • Nada Popovic
    • 1
    • 2
  • Goran Stevanovic
    • 1
    • 2
  • Ivana Milosevic
    • 1
    • 2
  • Milos Korac
    • 1
    • 2
  • Nikola Mitrovic
    • 1
  • Lidija Lavadinovic
    • 1
    • 2
  • Jelena Nikolic
    • 1
  • Olga Dulovic
    • 1
    • 2
  1. 1.Clinic for Infectious and Tropical DiseasesClinical Centre SerbiaBelgradeSerbia
  2. 2.Medical FacultyUniversity of BelgradeBelgradeSerbia

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