title: Clinical characteristics and functional outcome of patients with West Nile neuroinvasive disease in Serbia.
abstract: Neurologic manifestations are prominent characteristic of West Nile virus (WNV) infection. The aim of this article was to describe neurological manifestations in patients with WNV neuroinvasive disease and their functional outcome at discharge in the first human outbreak of WNV infection in Serbia. The study enrolled patients treated in the Clinic for Infectious and Tropical Diseases, Clinical Center Serbia in Belgrade, with serological evidence of acute WNV infection who presented with meningitis, encephalitis and/or acute flaccid paralyses (AFP). Functional outcome at discharge was assessed using modified Rankin Scale (mRS) and Barthel index. Fifty-two patients were analysed. Forty-four (84.6 %) patients had encephalitis, eight (15.4 %) had meningitis, and 13 (25 %) had AFP. Among patients with AFP, 12 resembled poliomyelitis and one had clinical and electrodiagnostic findings consistent with polyradiculoneuritis. Among patients with encephalitis, 17 (32.7 %) had clinical signs of rhombencephalitis, and eight (15.4 %) presented with cerebellitis. Respiratory failure with subsequent mechanical ventilation developed in 13 patients with WNE (29.5 %). Nine (17.3 %) patients died, five (9.6 %) were functionally dependent (mRS 3-5), and 38 (73.1 %) were functionally independent at discharge (mRS 0-2). In univariate analysis, the presence of AFP, respiratory failure and consciousness impairment were found to be predictors of fatal outcome in patients with WNV neuroinvasive disease (p < 0.001, p < 0.001, p = 0.018, respectively). The outbreak of human WNV infection in Serbia caused a notable case fatality ratio, especially in patients with AFP, respiratory failure and consciousness impairment. Rhombencephalitis and cerebellitis could be underestimated presentations of WNV neuroinvasive disease.
authors.affiliation: Clinic for Infectious and Tropical Diseases, Clinical Centre Serbia, Bulevar Oslobodjenja 16, 11000, Belgrade, Serbia.
authors.forename: Natasa
authors.initials: N
authors.lastname: Popovic
authors.forename: Branko
authors.initials: B
authors.lastname: Milosevic
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Urosevic
authors.forename: Jasmina
authors.initials: J
authors.lastname: Poluga
authors.forename: Nada
authors.initials: N
authors.lastname: Popovic
authors.forename: Goran
authors.initials: G
authors.lastname: Stevanovic
authors.forename: Ivana
authors.initials: I
authors.lastname: Milosevic
authors.forename: Milos
authors.initials: M
authors.lastname: Korac
authors.forename: Nikola
authors.initials: N
authors.lastname: Mitrovic
authors.forename: Lidija
authors.initials: L
authors.lastname: Lavadinovic
authors.forename: Jelena
authors.initials: J
authors.lastname: Nikolic
authors.forename: Olga
authors.initials: O
authors.lastname: Dulovic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology / Q000821:virology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D055771:Serbia / Q000453:epidemiology; D014901:West Nile Fever / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*