West Nile virus-associated flaccid paralysis.
The causes and frequency of acute paralysis and respiratory failure with West Nile virus (WNV) infection are incompletely understood. During the summer and fall of 2003, we conducted a prospective, population-based study among residents of a 3-county area in Colorado, United States, with developing WNV-associated paralysis. Thirty-two patients with developing paralysis and acute WNV infection were identified. Causes included a poliomyelitislike syndrome in 27 (84%) patients and a Guillain-Barré-like syndrome in 4 (13%); 1 had brachial plexus involvement alone. The incidence of poliomyelitislike syndrome was 3.7/100,000. Twelve patients (38%), including 1 with Guillain-Barré-like syndrome, had acute respiratory failure that required endotracheal intubation. At 4 months, 3 patients with respiratory failure died, 2 remained intubated, 25 showed various degrees of improvement, and 2 were lost to followup. A poliomyelitislike syndrome likely involving spinal anterior horn cells is the most common mechanism of WNV-associated paralysis and is associated with significant short- and long-term illness and death.
Sejvar
James J
JJ
Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. JSejvar@cdc.gov
Bode
Amy V
AV
Marfin
Anthony A
AA
Campbell
Grant L
GL
Ewing
David
D
Mazowiecki
Michael
M
Pavot
Pierre V
PV
Schmitt
Joseph
J
Pape
John
J
Biggerstaff
Brad J
BJ
Petersen
Lyle R
LR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D020275:Guillain-Barre Syndrome / Q000821:virology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009123:Muscle Hypotonia / Q000821:virology*; D016017:Odds Ratio; D010243:Paralysis / Q000821:virology*; D012131:Respiratory Insufficiency / Q000821:virology; D014901:West Nile Fever / Q000134:cerebrospinal fluid / Q000150:complications*