title: Acute flaccid paralysis and West Nile virus infection.
abstract: Acute weakness associated with West Nile virus (WNV) infection has previously been attributed to a peripheral demyelinating process (Guillain-Barré syndrome); however, the exact etiology of this acute flaccid paralysis has not been systematically assessed. To thoroughly describe the clinical, laboratory, and electrodiagnostic features of this paralysis syndrome, we evaluated acute flaccid paralysis that developed in seven patients in the setting of acute WNV infection, consecutively identified in four hospitals in St. Tammany Parish and New Orleans, Louisiana, and Jackson, Mississippi. All patients had acute onset of asymmetric weakness and areflexia but no sensory abnormalities. Clinical and electrodiagnostic data suggested the involvement of spinal anterior horn cells, resulting in a poliomyelitis-like syndrome. In areas in which transmission is occurring, WNV infection should be considered in patients with acute flaccid paralysis. Recognition that such weakness may be of spinal origin may prevent inappropriate treatment and diagnostic testing.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. zea3@cdc.gov
authors.forename: James J
authors.initials: JJ
authors.lastname: Sejvar
authors.forename: A Arturo
authors.initials: AA
authors.lastname: Leis
authors.forename: Dobrivoje S
authors.initials: DS
authors.lastname: Stokic
authors.forename: Jay A
authors.initials: JA
authors.lastname: Van Gerpen
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Marfin
authors.forename: Risa
authors.initials: R
authors.lastname: Webb
authors.forename: Maryam B
authors.initials: MB
authors.lastname: Haddad
authors.forename: Bruce C
authors.initials: BC
authors.lastname: Tierney
authors.forename: Sally A
authors.initials: SA
authors.lastname: Slavinski
authors.forename: Jo Lynn
authors.initials: JL
authors.lastname: Polk
authors.forename: Victor
authors.initials: V
authors.lastname: Dostrow
authors.forename: Michael
authors.initials: M
authors.lastname: Winkelmann
authors.forename: Lyle R
authors.initials: LR
authors.lastname: Petersen
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011782:Quadriplegia / Q000150:complications* / Q000821:virology; D013118:Spinal Cord Diseases / Q000150:complications / Q000821:virology; D014901:West Nile Fever / Q000150:complications* / Q000175:diagnosis; D014902:West Nile virus / Q000302:isolation & purification