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Delayed-onset and recurrent limb weakness associated with West Nile virus infection

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Abstract

Human neurologic illness following infection with West Nile virus (WNV) may include meningitis, encephalitis, and acute flaccid paralysis (AFP). Most WNV-associated AFP is due to involvement of the spinal motor neurons producing an anterior (polio)myelitis. WNV poliomyelitis is typically characterized by acute and rapidly progressing limb weakness occurring early in the course of illness, which is followed by death or clinical plateauing with subsequent improvement to varying degrees. We describe four cases of WNV poliomyelitis in which the limb weakness was characterized by an atypical temporal pattern, including one case with onset several weeks after illness onset, and three cases developing relapsing or recurrent limb weakness following a period of clinical plateauing or improvement. Delayed onset or recurrent features may be due to persistence of viral infection or delayed neuroinvasion with delayed injury by excitotoxic or other mechanisms, by immune-mediated mechanisms, or a combination thereof. Further clinical and pathogenesis studies are needed to better understand the mechanisms for these phenomena. Clinicians should be aware of these clinical patterns in patients with WNV poliomyelitis.

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Authors and Affiliations

  1. Division of Viral and Rickettsial Diseases, Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop A-39, 30333, Atlanta, GA, USA

    James J. Sejvar

  2. Neurology Service, New Mexico VA Health Care System, Albuquerque, New Mexico, USA

    Larry E. Davis

  3. Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA

    Larry E. Davis

  4. Department of Clinical Neurosciences (Neurology) (Clinical), Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA

    Erica Szabados

  5. Departments of Internal Medicine (Neurology) and of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada

    Alan C. Jackson

Authors
  1. James J. Sejvar
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  2. Larry E. Davis
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  3. Erica Szabados
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  4. Alan C. Jackson
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Correspondence to James J. Sejvar.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or other institutions.

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Sejvar, J.J., Davis, L.E., Szabados, E. et al. Delayed-onset and recurrent limb weakness associated with West Nile virus infection. Journal of NeuroVirology 16, 93–100 (2010). https://doi.org/10.3109/13550280903586378

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  • DOI: https://doi.org/10.3109/13550280903586378

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