title: West Nile Virus Retinopathy and Associations with Long Term Neurological and Neurocognitive Sequelae.
abstract: West Nile virus (WNV) has emerged as an important vector-borne pathogen in North America, with more than 3 million estimated to have been infected. Retinopathy from WNV infection has been previously reported in acute cases, though those prior reports did not evaluate the risk of retinopathy based on clinical severity of neurologic disease. The purpose of this cross-sectional study was to perform comprehensive ophthalmological and neurological examinations on 111 patients with a history of West Nile virus infection and describe the ocular manifestations. Out of 111 patients, 27 (24%) had evidence for West Nile virus associated retinopathy (WNVR); this observation was higher (49%) in those patients who initially presented with encephalitis. Individuals with WNVR had more frequent involvement of the macula and peripheral involvement compared to those patients without WNVR (p<0.05). WNVR was also associated with a greater likelihood of abnormal reflexes on neurological exam, poorer learning, greater dependence in activities of daily living, and lower quality of life (p<0.05). WNVR was seen more frequently in elderly patients (age > 60 years), and was associated with higher rates of diabetes mellitus and a history of encephalitis (p<0.05). A multivariable logistic regression revealed that only a history of encephalitis was independently associated with WNVR [Adjusted Odds Ratio = 4.9 (1.8-13.2); p = 0.001]. Our study found that WNVR occurs in one fourth of patients with a history of WNV infection and is more frequently observed in those with apparent severe neurological sequelae (e.g., encephalitis). The clinical relevance of WNVR was supported by its associations with dependence in activities of daily living and lower quality of life. This unique evaluation of WNV patients included fundoscopic examinations and their associations with neurologic impairment. Our findings can be used during ophthalmological consultation for the evaluation, treatment and rehabilitation phases of care for WNV patients.
authors.affiliation: University of Texas Health Science Center at Houston, Medical School, Section of Infectious Diseases, Houston, Texas, United States of America.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Hasbun
authors.affiliation: Baylor College of Medicine, Department of Pediatrics, Section of Pediatric Tropical Medicine, National School of Tropical Medicine, Houston, Texas, United States of America.
authors.forename: Melissa N
authors.initials: MN
authors.lastname: Garcia
authors.affiliation: University of Texas Health Science Center at Houston, Medical School, Ruiz Department of Ophthalmology and Visual Science, Houston, Texas, United States of America.
authors.forename: Judianne
authors.initials: J
authors.lastname: Kellaway
authors.affiliation: Robert Cizik Eye Clinic, Houston, Texas, United States of America.
authors.forename: Laura
authors.initials: L
authors.lastname: Baker
authors.affiliation: University of Texas Health Science Center at Houston, Medical School, Section of Infectious Diseases, Houston, Texas, United States of America.
authors.forename: Lucrecia
authors.initials: L
authors.lastname: Salazar
authors.affiliation: Department of Psychology, University of Houston, Houston, Texas, United States of America.
authors.forename: Steven Paul
authors.initials: SP
authors.lastname: Woods
authors.affiliation: Baylor College of Medicine, Department of Pediatrics, Section of Pediatric Tropical Medicine, National School of Tropical Medicine, Houston, Texas, United States of America.|Department of Psychology, University of Houston, Houston, Texas, United States of America.
authors.forename: Kristy O
authors.initials: KO
authors.lastname: Murray
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications*; D012164:Retinal Diseases / Q000150:complications* / Q000503:physiopathology*; D014901:West Nile Fever / Q000150:complications* / Q000503:physiopathology*; D014902:West Nile virus / Q000502:physiology*; D055815:Young Adult