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Melanie G Kitagawa, Nick Ettinger, Day Breen, Jennifer Erklauer, Emmanuel Chang, Honey Herce, Katherine King, Swati Naik, Transmission of West Nile Virus Through a Hematopoietic Stem Cell Transplant, Journal of the Pediatric Infectious Diseases Society, Volume 7, Issue 2, June 2018, Pages e52–e54, https://doi.org/10.1093/jpids/pix100
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West Nile virus (WNV) is a Flavivirus that can cause fatal encephalitis in susceptible hosts. It was first identified in the United States in 1999 in New York City but has since become endemic. In immunocompetent hosts, WNV infection is typically self-limited; only 1 in 150 develop meningitis/encephalitis [1]. The usual incubation period is 2 to 14 days, and polymerase chain reaction (PCR) results are negative by day 3 to 5 of illness [1, 2]. In those few with meningitis/encephalitis, their cerebrospinal fluid (CSF) tests positive for immunoglobulin M (IgM) at day 3 to 5 of illness, and their serum tests positive for IgM at day 6 to 8 [1, 3]. Once the virus has crossed into the central nervous system space, infection leads to acute neuronal necrosis with inflammation, including involvement of the spinal motor neurons. In the 1999 outbreak in New York, 32% of the patients with encephalitis had hyporeflexia and 10% had flaccid paralysis, and in 80% of those for whom electromyography was performed, the test revealed axonal polyneuropathy [3]. In another study, 93% of the patients experienced significant neurological deficits, and 25% were in a coma [4]. The incidence of WNV waxes and wanes; in Texas in 2015, 275 cases of WNV were reported, 71% of which were neuroinvasive and resulted in a total of 16 deaths [5].
