Neuroinvasive St. Louis Encephalitis Virus Infection in Solid Organ Transplant Recipients

C. A. Hartmann, H. R. Vikram, M. T. Seville, R. Orenstein, S. Kusne, J. E. Blair, Thomas Grys, R. L. Patron

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

In summer 2015, three unrelated solid organ transplant recipients in Phoenix, Arizona, had meningoencephalitis suggestive of West Nile virus (WNV) infection. Testing was inconclusive but was later confirmed as St. Louis encephalitis (SLE). We retrospectively reviewed clinical manifestations, treatment, and outcomes of these transplant recipients. Common symptoms were fever, rigors, diarrhea, headache, and confusion. One patient died 3 days after hospitalization. Therapy for the other two patients was initiated with interferon α-2b (IFN) and intravenous IgG (IVIG; IFN plus IVIG in combination). Both patients tested positive for WNV by serologic assay, but SLE virus (SLEV) infection was later confirmed by plaque reduction neutralization test at a reference laboratory. Clinical improvement was observed within 72 h after initiation of IFN plus IVIG. SLEV has been an uncommon cause of neuroinvasive disease in the United States. Accurate, timely diagnosis is hindered because of clinical presentation similar to neuroinvasive WNV and SLE, serologic cross-reactivity, and lack of a commercially available serologic assay for SLEV. There is currently no approved therapy for flaviviral neuroinvasive disease. Anecdotal reports indicate varying success with IFN, IVIG, or IFN plus IVIG in WNV neuroinvasive disease. The same regimen might be of value for immunocompromised persons with neuroinvasive SLEV infection.

Original languageEnglish (US)
Pages (from-to)2200-2206
Number of pages7
JournalAmerican Journal of Transplantation
Volume17
Issue number8
DOIs
StatePublished - Aug 1 2017

Keywords

  • clinical research/practice
  • encephalopathy
  • infection and infectious agents
  • infectious disease
  • intravenous immunoglobulin/IVIG
  • viral
  • viral: West Nile

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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