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Published on: November 21, 2017
Altered mental status and fever.
Tokunbo Ajayi1, Ashmeet Bhatia, Barbara Lambl
1Department of Internal Medicine, North Shore Medical Center, Salem, Massachusetts, USA.
West Nile virus neuroinvasive disease (WNND) requires high suspicion in immunocompromised patients. Early WNND diagnosis is crucial, especially in elderly individuals with altered mental status and aseptic meningitis symptoms.
Area of Science:
- Neurovirology
- Immunology
Background:
- West Nile virus (WNV) is the leading cause of neuroinvasive arboviral disease in the USA, with a significant mortality rate of 10-30%.
- Prompt diagnosis of WNV neuroinvasive disease (WNND) is critical, particularly in at-risk populations.
Observation:
- A 61-year-old woman with Crohn's disease and fibromyalgia on chronic steroid therapy presented with fever, confusion, and lethargy.
- Lumbar puncture revealed lymphocytosis and WNV positivity, leading to a WNND diagnosis after initial broad-spectrum antibiotic treatment.
Findings:
- The patient's presentation mimicked aseptic meningitis, highlighting the need for a high index of suspicion for WNND in immunocompromised individuals with altered mental status.
- Genetic variations in the interferon response pathway may influence symptomatic WNV infection risk and disease progression.
Implications:
- This case underscores the importance of considering WNND in the differential diagnosis of neurological symptoms in immunocompromised patients.
- Further research into genetic factors influencing WNV susceptibility and severity could lead to improved patient management and outcomes.