 Advertisement | ||||||||
 | ||||||||
|
||||||||
 |
 |
 |
 |
 |
 |
 |
||
|
From the Divisions of Infectious Diseases (Pepperell, Rau, Krajden, Humar, Mederski, Simor, Low, McGeer, Mazzulli, Brunton) and Neurology (Kern, Burton, Jaigobin) and the Departments of Medicine (Kern, Humar, Burton, Jaigobin, Brunton) and Laboratory Medicine and Pathobiology (Krajden, Simor, Low, McGeer, Mazzulli, Fearon, Halliday, Brunton), University of Toronto, Toronto, Ont.; the Division of Neuropathology, Toronto Medical Laboratories, Toronto (Halliday); the Toronto Medical Laboratories and Mount Sinai Hospital Department of Microbiology, Toronto (Low, McGeer, Mazzulli, Brunton); the Credit Valley Hospital, Mississauga, Ont. (Rau); Halton Healthcare Services – Oakville Trafalgar Site, Oakville, Ont. (Rau); St. Joseph's Health Centre, Toronto, Ont. (Krajden); the North York General Hospital, Toronto (Mederski); Sunnybrook & Women's College Health Sciences Centre, Toronto (Simor); the Ontario Ministry of Health and Long-Term Care, Laboratories Branch, Toronto (Fearon); and the National Microbiology Laboratory, Health Canada, Winnipeg, Man. (Artsob, Drebot)
Correspondence to: Dr. James Brunton, Toronto General Hospital, Rm. 13-124 NUW, 200 Elizabeth St., Toronto ON M5G 2C4; fax 416 340-5047
Background: In August and September 2002 an outbreak of West Nile virus (WNV) infection occurred in southern Ontario. We encountered a number of seriously ill patients at our hospitals. In this article we document the clinical characteristics of these cases.
Methods: We conducted a retrospective chart review of patients who came to the attention of infectious disease or neurology consultants or the microbiology laboratories at 7 hospitals in the municipalities of Toronto, Peel and Halton, Ont. Patients were included if they had been admitted to hospital or stayed overnight in the emergency department, had serological evidence of WNV infection and had clinical evidence of WNV fever, aseptic meningitis, encephalomyelitis or motor neuronopathy.
Results: In all, 64 patients met the inclusion criteria; 57 had encephalitis or neuromuscular weakness or both, 5 had aseptic meningitis, and 2 had WNV fever. The mean age was 61 years (range 26–87). The patients were predominantly active, middle-aged or elderly people living independently in the community. Seven patients were immunocompromised A febrile prodromal illness preceded the neurological symptoms in almost all cases. The most common neurological abnormality was decreased level of consciousness; this frequently evolved to severe lower motor neuron neuromuscular weakness. Ataxia and swallowing disorders were frequent and important problems. Sixteen patients (25%) required intubation and mechanical ventilation because of a decreased level of consciousness, inability to clear secretions or respiratory muscle weakness; 9 others had disabling muscle weakness of one or more limbs. Ten patients died. The study patients were in hospital a total of 1856 patient-days, including 532 patient-days in an intensive care unit. Only 28% (13/47) of the patients who survived encephalitis or neuromuscular weakness, or both, were discharged home without additional support. Slow turnaround time for serological test results resulted in delayed diagnosis.
Interpretation: The 2002 WNV infection outbreak in Ontario caused serious morbidity and mortality in the subset of patients who had encephalitis or neuromuscular weakness severe enough to require hospital admission.
Related Articles
This article has been cited by other articles:
|
|
 |
|
  P. A G Tilley, J. D Fox, G. C Jayaraman, and J. K Preiksaitis Maculopapular rash and tremor are associated with West Nile fever and neurological syndromes J. Neurol. Neurosurg. Psychiatry, May 1, 2007; 78(5): 529 - 531. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. A. G. Tilley, R. Walle, A. Chow, G. C. Jayaraman, K. Fonseca, M. A. Drebot, J. Preiksaitis, and J. Fox Clinical Utility of Commercial Enzyme Immunoassays during the Inaugural Season of West Nile Virus Activity, Alberta, Canada J. Clin. Microbiol., September 1, 2005; 43(9): 4691 - 4695. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Hollander, P. W. Schaefer, and E. T. Hedley-Whyte Case 22-2005 - An 81-Year-Old Man with Cough, Fever, and Altered Mental Status N. Engl. J. Med., July 21, 2005; 353(3): 287 - 295. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Gorsche and P. Tilley The rash of West Nile virus infection Can. Med. Assoc. J., May 24, 2005; 172(11): 1440 - 1440. [Full Text] [PDF]
|
|
|
|
 |
|
 G. M. Mutlu, T. Kuzniar, and P. Factor A 41-Year-Old Man With Altered Mental Status and Acute Flaccid Paralysis Chest, January 1, 2005; 127(1): 391 - 394. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Crichlow, J. Bailey, and C. Gardner Cerebrospinal Fluid Neutrophilic Pleocytosis in Hospitalized West Nile virus Patients J Am Board Fam Med, November 1, 2004; 17(6): 470 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Solomon Flavivirus Encephalitis N. Engl. J. Med., July 22, 2004; 351(4): 370 - 378. [Full Text] [PDF]
|
|
|
|
|
|
E. Weir and H. Shapiro West Nile virus: round five Can. Med. Assoc. J., May 25, 2004; 170(11): 1669 - 1670. [Full Text]
|
|
|
|
 |
|
 E. B. Hayes and D. R. O'Leary West Nile Virus Infection: A Pediatric Perspective Pediatrics, May 1, 2004; 113(5): 1375 - 1381. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. R. Petersen, A. A. Marfin, and D. J. Gubler West Nile Virus JAMA, July 23, 2003; 290(4): 524 - 528. [Full Text] [PDF]
|
|
| HOME | CURRENT ISSUE | PAST ISSUES | COLLECTIONS | HELP | SEARCH |
|
|||||
|
Copyright 1995-2003, Canadian Medical Association. All rights reserved. ISSN 1488-2329
(e) 0820-3946 (p)
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association. |
|||||
