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Fatal fulminant pan-meningo-polioencephalitis due to West Nile virus

Bennet I Omalu1, Abdulrazek A Shakir, Guoji Wang

  • 1Department of Pathology, University of Pittsburgh, PA 15213, USA.

Brain Pathology (Zurich, Switzerland)
|December 6, 2003
PubMed

Insights

This case study details a fatal West Nile virus (WNV) meningoencephalitis in an elderly male. WNV directly infected neurons, causing severe brain inflammation and rapid neurological decline.

Area of Science:

  • Neurology
  • Virology
  • Pathology

Background:

  • West Nile virus (WNV) is a mosquito-borne flavivirus that can cause severe neuroinvasive disease.
  • Fulminant meningoencephalitis is a rare but devastating manifestation of WNV infection.

Observation:

  • An 87-year-old male gardener presented with flu-like symptoms progressing to coma and loss of neurological function within 10 days.
  • Autopsy revealed WNV infection in the brain, spleen, and kidneys, with severe polio-meningoencephalitis predominantly affecting gray matter.
  • Histopathology showed neuronal loss, microglial activation, and significant infiltration of CD8 T-lymphocytes and B-lymphocytes.

Findings:

  • WNV IgM antibodies were detected in serum and CSF.
  • Viral cultures and PCR confirmed WNV in post-mortem tissues.
  • Immunohistochemistry demonstrated WNV within neurons, supporting direct neuronal infection.

Implications:

  • This case highlights the potential for WNV to cause rapidly fatal meningoencephalitis, even in elderly individuals.
  • Direct neuronal infection is the primary mechanism underlying WNV polioencephalitis.
  • Understanding WNV pathogenesis is crucial for developing effective treatments and preventative strategies.

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