Abstract Details

Title Clinical Characteristics and Outcomes of Neuroinvasive West Nile virus infection in Immunosuppressed and Immunocompetent individuals treated at the Mayo Clinic Hospitals

Topic Infectious Disease

Presentation(s) P11 - Poster Session 11 (11:45 AM-12:45 PM)

Poster/Presentation
Number 4-004

Background Despite the increasing incidence of NiWNV infection in the United States, disease characteristics in IS individuals are not adequately described.

Objective To compare the clinical characteristics and outcomes of neuroinvasive West Nile virus (NiWNV) infection in immunosuppressed (IS) and immunocompetent (IC) patients.

Design/Methods We extracted relevant data from all NiWNV patients treated between July 2003 and Sept 2019 at the Mayo Clinic hospitals. Individuals were classified as IS or IC depending on presence of; transplant history, active cancer, type 2 diabetes, end stage renal disease or treatment with any immunosuppressive agent. Chi-Square or Kruskal-Wallis and logistic regression were used to compare relevant variables and determine predictors of mortality respectively.

Results

We included 83 patients (51 IC and 32 IS), mean age 62 years, presenting with meningoencephalitis (83%), encephalitis (11%) and myeloradiculitis (6%). Presenting symptoms included malaise (75%), fever (69%), altered mentation (66%), and myalgias (35%). MRI imaging was abnormal in 74% (51/69), demonstrating T2 FLAIR hyperintensities in 45% (brainstem, thalamus, temporal lobes), leptomeningeal enhancement (12%) and acute strokes in (23%).

Clinical features and diagnoses were similar between the two groups except for myalgia (45% vs 19%) and thalamic MRI T2 FLAIR (13% vs 0%) abnormalities which were more common in IS. IS patients were more likely to be treated with intravenous immunoglobulin (59% vs 12% p=<0.01) or interferon therapy (44% vs 10%, p=0.0003) but had increased odds of 90-day mortality on univariate analysis (Odds ratio 2.18; 95% CI 1.06-4.49, p=0.035). Other factors negatively associated with 90-day mortality on univariate analysis were positive CSF WNV PCR, intensive care admission, GCS<8 and mechanical ventilation, while the presence of positive serum WNV IgM antibodies was protective.

Conclusions

Compared to IC, IS patients with NiWNV are at a greater mortality risk despite treatment. Larger studies validating targetable predictors of outcomes are warranted.

Authors/Disclosures
David Gritsch, MD, PhD (Mayo Clinic) PRESENTER	Dr. Gritsch has nothing to disclose.
Ehab Y. Harahsheh, MBBS (Mayo Clinic College of Medicine)	Dr. Harahsheh has nothing to disclose.
	No disclosure on file
Shemonti Hasan, MD (Mayo Clinic)	Dr. Hasan has nothing to disclose.
Angela Parsons, DO (OhioHealth Physicians Group)	Dr. Parsons has nothing to disclose.
Cynthia M. Stonnington, MD (Mayo Clinic Arizona)	Dr. Stonnington has nothing to disclose.
Richard Butterfield	No disclosure on file
Harn Shiue, PharmD (Mayo Clinic Arizona Hospital)	Dr. Shiue has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Marie F. Grill, MD (Mayo Clinic)	Dr. Grill has nothing to disclose.