scholarly journals Two Case Reports of Neuroinvasive West Nile Virus Infection in the Critical Care Unit

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Edgardo M. Flores Anticona ◽  
Hadeel Zainah ◽  
Daniel R. Ouellette ◽  
Laura E. Johnson
Keyword(s):  
Critical Care ◽  
West Nile Virus ◽  
Lower Extremity ◽  
Mental Status ◽  
Critical Care Unit ◽  
Disease Process ◽  
Care Providers ◽  
West Nile ◽  
Lower Extremity Weakness ◽  
Csf Analysis

We describe the clinical course of two cases of neuroinvasive West Nile Virus (WNV) infection in the critical care unit. The first case is a 70-year-old man who presented during summer with mental status changes. Cerebrospinal fluid (CSF) analysis revealed pleocytosis with lymphocyte predominance. WNV serology was positive in the CSF. His condition worsened with development of left-sided weakness and deterioration of mental status requiring intensive care. The patient gradually improved and was discharged with residual left-sided weakness and near-complete improvement in his mental status. The second case is an 81-year-old man who presented with mental status changes, fever, lower extremity weakness, and difficulty in walking. CSF analysis showed pleocytosis with neutrophil predominance. WNV serology was also positive in CSF. During the hospital stay his mentation worsened, eventually requiring intubation for airway protection and critical care support. The patient gradually improved and was discharged with residual upper and lower extremity paresis. Neuroinvasive WNV infection can lead to significant morbidity, especially in the elderly. These cases should be suspected in patients with antecedent outdoor activities during summer. It is important for critical care providers to be aware of and maintain a high clinical suspicion of this disease process.

scholarly journals Rapidly progressive neurologic decline and morbilliform rash presenting in a patient with lymphoma

2018 ◽  
Vol 8 (4) ◽  
Author(s):  
Dean Ehrlich ◽  
Jennifer Phan ◽  
Gavin Hui ◽  
Alexandra Drakaki
Keyword(s):  
West Nile Virus ◽  
Lower Extremity ◽  
The United States ◽  
Immunoglobulin M ◽  
Initial Presentation ◽  
West Nile ◽  
Ongoing Research ◽  
Lower Extremity Weakness ◽  
Bilateral Lower Extremity ◽  
Morbilliform Rash

A 67-year-old male with past medical history of mantle cell lymphoma and atrial fibrillation presented with a truncal rash, bilateral lower extremity weakness, and confusion. Within three days of presentation, his condition rapidly deteriorated with the onset of diffuse flaccid paralysis, aphasia, and severe alteration in mental status. Initial results from serum studies, lumbar puncture, magnetic resonance imaging, and electroencephalogram were not diagnostic. However, on the ninth day after initial presentation, the West Nile Virus (WNV) immunoglobulin M antibody returned positive from the cerebrospinal fluid. West Nile Virus encephalitis is endemic worldwide, and is the most common viral encephalitis in the United States. WNV presents in a variety of ways, and the recognition by physicians is crucial due to the estimated 2- 12% mortality rate and significant longterm morbidity of neuroinvasive disease. The initial management and long term prognosis are points of ongoing research. This case represents a particularly profound example of neuroinvasive WNV. Our patient made a significant recovery after his initial presentation with aggressive supportive care, however still suffers from bilateral lower extremity weakness more than a year later.

West Nile Virus

2016 ◽  
Author(s):  
Matthew Finn
Keyword(s):  
West Nile Virus ◽  
Rna Virus ◽  
Immunoglobulin M ◽  
Enzyme Linked Immunosorbent Assay ◽  
Mosquito Vector ◽  
West Nile ◽  
Csf Analysis ◽  
Neuroinvasive Disease ◽  
Breeding Grounds ◽  
Arboviral Disease

West Nile virus (WNV) is a single-stranded RNA virus of the Flavivirus family that is transmitted via a mosquito vector, typically causing fever and capable of causing meningoencephalitis. Although mortality is low, it can lead to debilitating neuroinvasive disease in some patients. WNV is a leading cause of domestically-acquired arboviral disease and most commonly occurs in late August and early September. Consider WNV in otherwise unexplained cases of meningitis or encephalitis. Initial testing should consist of cerebrospinal fluid (CSF) analysis and West Nile immunoglobulin M enzyme-linked immunosorbent assay in serum and/or CSF. WNV is a nationally notifiable disease. Prevention remains the key to controlling this disease. Reducing the breeding grounds of the Culex mosquito and using insect repellant to prevent bites are two important strategies.

scholarly journals Mental Status after West Nile Virus Infection

2006 ◽  
Vol 12 (8) ◽  
pp. 1260-1262 ◽  
Author(s):  
Kathleen Y. Haaland ◽  
Joseph Sadek ◽  
Steven Pergam ◽  
Leonor A. Echevarria ◽  
Larry E. Davis ◽  
...  
Keyword(s):  
West Nile Virus ◽  
Virus Infection ◽  
Mental Status ◽  
West Nile Virus Infection ◽  
West Nile

West Nile Neuroinvasive Disease With Atypical CSF Findings: A Case Report

2021 ◽  
pp. 194187442199537
Author(s):  
Devin Simon
Keyword(s):  
West Nile Virus ◽  
Virus Infection ◽  
Rare Complication ◽  
Cauda Equina ◽  
Late Summer ◽  
West Nile Virus Infection ◽  
Inpatient Rehabilitation ◽  
West Nile ◽  
Csf Analysis ◽  
Neuroinvasive Disease

West Nile Neuroinvasive Disease (WNND) is a rare complication of West Nile Virus infection with the capability of mimicking other neurologic diseases. This infection should be considered in the differential diagnosis for patients presenting in the late summer months with altered mentation, fever, and focal neurologic deficits without an otherwise clear etiology. A 63-year-old male presented with acute onset fever, confusion, falls, ataxia, vertical nystagmus, and right leg weakness. Although magnetic resonance imaging of the brain and cervical spine were unremarkable, the lumbar spine revealed enhancement of ventral nerve roots in the cauda equina. Cerebrospinal fluid (CSF) analysis was significant for elevated protein without pleocytosis, which was more suggestive of albuminocytologic dissociation. Both serum and CSF IgM labs testing for West Nile Virus were positive. Despite a 5 day course of immunoglobulin therapy, his symptoms did not significantly improve. He eventually was transferred to inpatient rehabilitation for several days prior to returning home. This case highlights the variable presentations of acute West Nile Virus infection in the rare setting of neuroinvasive disease, which can make diagnosis difficult. The CSF analysis may also not always show results consistent with an acute viral infection, which can make determining the underlying etiology more challenging.

scholarly journals West Nile Virus Infection in the Intensive Care Unit: A Case Series and Literature Review

2004 ◽  
Vol 11 (5) ◽  
pp. 354-358 ◽  
Author(s):  
Eddy Fan ◽  
Dale M Needham ◽  
James Brunton ◽  
Ralph Z Kern ◽  
Thomas E Stewart
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
West Nile Virus ◽  
Tertiary Care ◽  
Case Series ◽  
Flaccid Paralysis ◽  
West Nile ◽  
Metabolic Encephalopathy ◽  
Critical Care Issues

BACKGROUND:West Nile virus (WNV) is a rapidly spreading infectious disease in North America. Critical care issues related to WNV are not well described.OBJECTIVES:Three cases of severe WNV meningoencephalitis with flaccid paralysis are reported and relevant critical care issues are highlighted.METHODS:Case series and a review of the literature.RESULTS:Three patients with WNV meningoencephalitis and flaccid paralysis were admitted to the authors' academic, tertiary-care intensive care unit (ICU) in the late summer of 2002. All three patients were middle-aged or elderly and presented with a febrile illness that preceded or coincided with their neurological symptoms. Confirmation of WNV infection was problematic because each patient had at least one initial negative serum serology test. Radiological testing yielded nonspecific results. Serial electroencephalograms were consistent with severe toxic metabolic encephalopathy in all cases. All patients had a severe, diffuse axonal polyneuropathy demonstrated by nerve conduction studies and electromyography. Prolonged mechanical ventilation resulted in ICU lengths of stay of 44 to 118 days. At one point, 21% of the ICU beds were dedicated for these patients. All three patients died in hospital -- two following the withdrawal of life support. One patient demonstrated resolving encephalitis and was discharged from the ICU after a 118-day ICU stay, but later died in a step-down unit.CONCLUSIONS:The management of WNV-related critical illness creates challenges in making a timely and accurate diagnosis, and predicting patient morbidity and mortality. As a consequence, end-of-life discussions with families are especially difficult. The prolonged ICU length of stay and growing incidence of this disease may challenge limited critical care resources.

scholarly journals Physical Therapist Examination, Evaluation, and Intervention for a Patient With West Nile Virus Paralysis

2006 ◽  
Vol 86 (6) ◽  
pp. 843-856 ◽  
Author(s):  
Nancy H Miller ◽  
David J Miller ◽  
Joanna L Goldberg
Keyword(s):  
West Nile Virus ◽  
Physical Therapist ◽  
Single Point ◽  
The United States ◽  
Assistive Device ◽  
Full Time ◽  
West Nile ◽  
Lower Extremity Weakness ◽  
Disease Case ◽  
Practice Approach

Abstract Background and Purpose. The incidence of West Nile virus (WNV) has increased in the United States since 1999. A small percentage of people with WNV develop West Nile neuroinvasive disease (WNND) with encephalitis and flaccid paralysis. The purpose of this report is to describe the physical therapist management and outcomes for a patient with WNND and the therapist’s efforts to use an evidence-based practice approach in the management of a patient with this disease. Case Description. The patient was an active 55-year-old woman in excellent health who became acutely ill with asymmetrical lower-extremity weakness. The physical therapist reviewed the available literature, consulted with medical and physical therapist experts and the patient, and elected to use a poliovirus “period of recovery” approach combining intensive strengthening and monitoring of fatigue. Outcomes. The patient progressed from an initial nonambulatory status to ambulation with a single-point cane at week 18 after onset of symptoms. She began to ambulate without an assistive device by week 20. The patient returned to work part-time by week 22 and full-time by week 43. Discussion. These outcomes demonstrate the recovery of a patient with WNND after an intensive strengthening program.[Miller NH, Miller DJ, Goldberg JL. Physical therapist examination, evaluation, and intervention for a patient with West Nile virus paralysis. Phys Ther. 2006;86:843– 856.]

Interventions to Improve Interprofessional Bedside Rounds in a Paediatric Critical Care Unit

2020 ◽  
Vol 64 (1) ◽  
pp. 680-683
Author(s):  
Alanna Bateman ◽  
Sonia Pinkney ◽  
Jessica Tomasi ◽  
Peter Laussen ◽  
Patricia Trbovich
Keyword(s):  
Critical Care ◽  
Best Practices ◽  
Health Care Providers ◽  
Critical Care Unit ◽  
Participatory Design ◽  
Intervention Design ◽  
Care Providers ◽  
Interprofessional Communication ◽  
Team Members ◽  
Paediatric Critical Care

Communication errors are the leading root cause of preventable adverse events in hospitals. Patient care rounds provide the most important opportunity for interprofessional communication; however, rounds involve many interprofessional team members, and it can be challenging to achieve optimal communication and team functioning. While rounding best practices have been identified, implementations of best practices have produced mixed results, and little emphasis has been placed on explicitly aligning interventions to user needs. The goal of this study was to elucidate health care providers’ (HCPs) rounding needs and to align intervention design to those needs to improve interprofessional communication within a paediatric critical care unit (CCU). Interview and survey data were collected to identify needs and a participatory design approach was taken to transform needs into intervention(s). The main needs identified led to specific changes included in the intervention design such as changes in the structure, content and timing of morning rounds.

scholarly journals West Nile virus encephalitis induced opsoclonus-myoclonus syndrome

2014 ◽  
Vol 6 (2) ◽  
Author(s):  
Chad J. Cooper ◽  
Sarmad Said
Keyword(s):  
West Nile Virus ◽  
Case Reports ◽  
Total Abdominal Hysterectomy ◽  
Altered Mental Status ◽  
Neurological Status ◽  
Abdominal Hysterectomy ◽  
Sudden Onset ◽  
West Nile ◽  
Csf Analysis ◽  
Opsoclonus Myoclonus Syndrome

West Nile virus (WNV) is an arthropod borne neurotropic single stranded RNA flavivirus with <1% developing presenting with neurological disease. Immunocompromised and elderly patients are more prone to developing WNV meningitis or encephalitis. Definitive diagnosis of WNV meningoencephalitis is a combination of clinical suspicion and cerebrospinal fluid (CSF) serology. Forty-eight year old Caucasian female presented with a sudden onset of altered mental status after being found unresponsive. She was confused with intermittent bouts of alertness/lethargy and unintelligible responses to questioning. Her medical problems included endometrial cancer that was in remission after undergoing a total abdominal hysterectomy with bilateral salpingectomy and postoperative chemotherapy with paclitaxel and carboplatin. Pertinent physical examination revealed muscle strength that was significantly decreased, nuchal rigidity and +2 pitting edema of both lower extremities. Computed tomography and magnetic resonance imaging of the brain were negative for any intracranial pathology. CSF analysis was consistent with aseptic meningitis with all CSF serology being negative except for positive WNV antibody. A few days after being admitted she developed involuntary random movements of her eyes and generalized jerking movements (myoclonus). This was determined to be opsoclonus myoclonus syndrome (OMS) induced by the WNV meningoencephalitis. She then received five consecutive days of plasmapheresis with a significant improvement in her neurological status. Opsoclonusmyoclonus syndrome (OMS) is a rare neurological disorder associated with chaotic multidirectional eye movements, myoclonus and less frequently cerebellar ataxia. OMS affects as few as 1 in 10,000,000 people per year. The pathogenesis is not fully understood with the majority of cases of opsoclonus-myoclonus syndrome being idiopathic. According to current medical literature there have only been two previous case reports of opsoclonus myoclonus syndrome associated with WNV encephalitis.

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