title: Neurologic manifestations and outcome of West Nile virus infection.
abstract: BACKGROUND
  The neurologic manifestations, laboratory findings, and outcome of patients with West Nile virus (WNV) infection have not been prospectively characterized.
  
  
  OBJECTIVE
  To describe prospectively the clinical and laboratory features and long-term outcome of patients with neurologic manifestations of WNV infection.
  
  
  METHODS
  From August 1 to September 2, 2002, a community-based, prospective case series was conducted in St Tammany Parish, La. Standardized clinical data were collected on patients with suspected WNV infection. Confirmed WNV-seropositive patients were reassessed at 8 months.
  
  
  METHODS
  Clinical, neurologic, and laboratory features at initial presentation, and long-term neurologic outcome.
  
  
  RESULTS
  Sixteen (37%) of 39 suspected cases had antibodies against WNV; 5 had meningitis, 8 had encephalitis, and 3 had poliomyelitis-like acute flaccid paralysis. Movement disorders, including tremor (15 [94%]), myoclonus (5 [31%]), and parkinsonism (11 [69%]), were common among WNV-seropositive patients. One patient died. At 8-month follow-up, fatigue, headache, and myalgias were persistent symptoms; gait and movement disorders persisted in 6 patients. Patients with WNV meningitis or encephalitis had favorable outcomes, although patients with acute flaccid paralysis did not recover limb strength.
  
  
  CONCLUSIONS
  Movement disorders, including tremor, myoclonus, and parkinsonism, may be present during acute illness with WNV infection. Some patients with WNV infection and meningitis or encephalitis ultimately may have good long-term outcome, although an irreversible poliomyelitis-like syndrome may result.
authors.affiliation: Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA. zea3@cdc.gov
authors.forename: James J
authors.initials: JJ
authors.lastname: Sejvar
authors.forename: Maryam B
authors.initials: MB
authors.lastname: Haddad
authors.forename: Bruce C
authors.initials: BC
authors.lastname: Tierney
authors.forename: Grant L
authors.initials: GL
authors.lastname: Campbell
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Marfin
authors.forename: Jay A
authors.initials: JA
authors.lastname: Van Gerpen
authors.forename: Aaron
authors.initials: A
authors.lastname: Fleischauer
authors.forename: A Arturo
authors.initials: AA
authors.lastname: Leis
authors.forename: Dobrivoje S
authors.initials: DS
authors.lastname: Stokic
authors.forename: Lyle R
authors.initials: LR
authors.lastname: Petersen
mesh_terms: D000203:Activities of Daily Living; D000914:Antibodies, Viral / Q000097:blood / Q000134:cerebrospinal fluid; D002490:Central Nervous System / Q000000981:diagnostic imaging / Q000473:pathology; D018450:Disease Progression; D004569:Electroencephalography; D004576:Electromyography; D018792:Encephalitis, Viral / Q000175:diagnosis / Q000503:physiopathology; D015600:Glasgow Coma Scale; D006760:Hospitalization; D006801:Humans; D008279:Magnetic Resonance Imaging; D008587:Meningitis, Viral / Q000175:diagnosis* / Q000503:physiopathology; D009069:Movement Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000821:virology*; D009123:Muscle Hypotonia / Q000821:virology; D009207:Myoclonus / Q000821:virology; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D010243:Paralysis / Q000175:diagnosis / Q000503:physiopathology / Q000821:virology*; D014057:Tomography, X-Ray Computed; D014901:West Nile Fever / Q000175:diagnosis* / Q000503:physiopathology*; D014902:West Nile virus / Q000302:isolation & purification
chemical_list: D000914:Antibodies, Viral