Neuroinvasive St. Louis Encephalitis Virus Infection in Solid Organ Transplant Recipients

Area of Science:

• Neuroscience
• Infectious Diseases
• Immunology

Background:

• Solid organ transplant recipients are at increased risk for opportunistic infections.
• West Nile virus (WNV) and St. Louis encephalitis virus (SLEV) are mosquito-borne flaviviruses causing neuroinvasive disease.
• Accurate diagnosis of SLEV is challenging due to serologic cross-reactivity with WNV.

Observation:

• Three organ transplant recipients in Phoenix, Arizona, presented with meningoencephalitis.
• Initial WNV testing was inconclusive; SLEV infection was later confirmed.
• Clinical manifestations included fever, headache, confusion, diarrhea, and rigors.

Findings:

• One patient died within 72 hours of hospitalization.
• Two patients received a combination therapy of interferon-alpha-2b (IFN) and intravenous IgG (IVIG).
• Patients treated with IFN plus IVIG demonstrated clinical improvement within 72 hours.

Implications:

• The combination of IFN plus IVIG may be a potential therapeutic option for neuroinvasive SLEV infection in immunocompromised individuals.
• Early diagnosis and treatment are crucial for improving outcomes in flaviviral encephalitis.
• Further research is needed to establish standardized treatment protocols for SLEV infections.