Program Schedule

Clinical Characteristics and Outcomes of West Nile Neuroinvasive Disease in Immunocompromised Hosts: A case-Control Study

Session: Poster Abstract Session: Transplant Infectious Diseases
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Westnile neuroinvasive disease (WND) can result in significant morbidity and mortality even in immunocompetent hosts. The clinical features and outcomes in immunocompromised hosts have not been very well described

Methods: A case control study was performed involving patients receiving cancer care in our institution . All patients with a positive IgM or IgG  in CSF were indentified as cases and randomly matched to three test-negative controls. Clinical presentations, outcomes, lab parameters, csf profiles and radiological studies were compared between the two groups 

Results: Seven cases and tewnty-one controls met inclusion criteria .  The underlying reason for immudeficiency for the cases was Multiple Myeloma in five patients HIV in one patient and renal transplant in another. The most common clinical symptom for the WND cases was fever in five patients (71%) whereas this was present in only nine (52%) of contols . Incidences of cranial nerve palsies, focal motor weakness and reflex abnormalities were not different between the two groups. CSF chemistry profiles was normal in the WN cases whereas CSF protienachia was more common four (19%) in the test-negative controls . CSF WBC was elevated in three (42%) of cases and twelve (57%) controls. Radiological studies were abnormal on three cases and 10 controls (two controls did not have studies ) Death within ninety days occured in two (29% ) cases compared to two controls ( 9.5 %)

Conclusion: WND presentation in immunocompromised hosts is similar to other CNS disorders and is often not associated with abnormal CSF profile or radiological imaging. Clinicians should maintain a high index of suspicion and a low threshold for CSF sampling in such patients

Senu Apewokin, MD1, Aasiya Matin, M.D.2, Naveen Sanath Kumar, MD3, Shebli Atrash, MD4, Bakhous Aziz5, Jameel Muzaffar3, Vyjayanthi Ganga, M.D.2 and Monica Grazziutti, MD3, (1)Medicine, University Of Arkansas For Medical Sciences, Little Rock, AR, (2)Myeloma Institute or Research and Therapy, UNIVERSTIY OF ARKANSAS FOR MEDICAL SCIENCES, LITTLE ROCK, AR, (3)The Myeloma Institute for Research and Therapy/University of Arkansas for Medical Sciences, Little Rock, AR, (4)Myeloma, UAMS myeloma institute., little rock, AR, (5)Mirt, 4301 West Markham, little ROCK, AR


S. Apewokin, T 2 biosystem: Investigator, Research grant
Viracor: Investigator, Research grant

A. Matin, None

N. Sanath Kumar, None

S. Atrash, None

B. Aziz, None

J. Muzaffar, None

V. Ganga, None

M. Grazziutti, None

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