West Nile virus among hospitalized, febrile patients: a case for expanding diagnostic testing.
In Georgia, most individuals reported with West Nile virus (WNV) disease have been diagnosed with West Nile neuroinvasive disease (WNND). Relatively few cases of West Nile Fever (WNF) are reported, and the burden of illness due to WNV is likely underestimated. From July through October 2003, WNV serologic testing was performed on enrolled patients>or=18 years of age with fever admitted to a large, urban hospital in Atlanta, Georgia through the emergency department (ED). Patients' history, clinical, and laboratory data were recorded. Residual blood drawn in the ED was tested to determine the presence of WNV IgG and IgM antibodies. Of 254 patients tested for WNV, four (1.6%) patients were positive for WNV IgM and IgG antibodies, and had a clinical illness compatible with WNV. None of the four positive patients were clinically suspected of having WNV infection; discharge diagnoses included pneumonia, migraine, stroke, and gout. These four patients accounted for 80% of all WNV diagnosed in this hospital, 44% of all cases in Fulton County, and 7% of all cases reported in Georgia in 2003. The occurrence of WNV disease may be substantially greater than currently reflected in disease statistics in Georgia and many other states. When indicators of WNV activity are present and patients are likely to have had intensive mosquito exposure, WNV should be considered in the differential diagnosis of seriously ill, febrile patients.
Center for Public Health Preparedness and Research, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA. ewhitn2@sph.emory.edu
Ellen A Spotts
EA
Whitney
Katherine L
KL
Heilpern
Christopher W
CW
Woods
C Christina
CC
Bahn
Elizabeth A
EA
Franko
Carlos
C
Del Rio
Benjamin J
BJ
Silk
Jonathan J
JJ
Ratcliff
Katherine A
KA
Bryant
Mahin M
MM
Park
Sandra J
SJ
Watkins
Lauren B
LB
Caram
Henry M
HM
Blumberg
Ruth L
RL
Berkelman
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003955:Diagnostic Tests, Routine / Q000592:standards; D005260:Female; D005334:Fever / Q000821:virology; D005845:Georgia / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D013997:Time Factors; D014901:West Nile Fever / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D014902:West Nile virus / Q000276:immunology / Q000302:isolation & purification*
D007074:Immunoglobulin G; D007075:Immunoglobulin M