HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) CME: Take the course for this article: Volume 66, Number 3, February 14, 2006 Data Supplement All Versions of this Article: 01.wnl.0000195890.70898.1fv1 66/3/361    most recent Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tyler, K. L. Articles by Kleinschmidt-DeMasters, B. K. Search for Related Content PubMed PubMed Citation Articles by Tyler, K. L. Articles by Kleinschmidt-DeMasters, B. K. Related Collections Viral infections Cerebrospinal Fluid

CSF findings in 250 patients with serologically confirmed West Nile virus meningitis and encephalitis

From the Departments of Neurology (K.L.T., R.J.G., B.K.K.-D.), Pathology (B.K.K.-D.), Neurosurgery (B.K.K.-D.), Medicine, Microbiology, and Immunology (K.L.T.), University of Colorado Health Sciences Center, Denver; Neurology Service, Denver Veterans Affairs Medical Center (K.L.T.); Colorado Department of Public Health and Environment (J.P.); and Department of Pathology, Exempla Lutheran Hospital (M.C.).

Address correspondence and reprint requests to Dr. Kenneth L. Tyler, Neurology B-182, University of Colorado Health Sciences Center, 4200 East 9th Avenue, Denver, CO 80262; e-mail: ken.tyler{at}uchsc.edu

Objective: To provide a large, comprehensive evaluation of the CSF findings in patients with serologically confirmed West Nile virus (WNV), CNS disease, and their correlation with outcome.

Methods: CSF samples from 334 WNV-infected hospitalized patients were analyzed. Information was available and extracted from the medical records of 250 of these patients, and CSF parameters correlated with clinical and epidemiologic features of disease (e.g., patient age, sex, outcome).

Results: Patients with meningitis had a mean of 226 cells/mm³, and those with encephalitis had a mean of 227 cells/mm³. Three percent of meningitis patients and 5% of encephalitis patients had fewer than 5 cells/mm³, and approximately 8% of both groups had more than 500 cells/mm³. Patients with meningitis had a mean of 41% neutrophils, and those with encephalitis had 45%. Forty-five percent of meningitis patients and 37% of encephalitis patients had at least 50% neutrophils in their initial CSF specimen. Neither the mean percent neutrophils nor their distribution differed significantly between groups. Forty-seven percent of encephalitis patients and 16% of meningitis patients had CSF protein of 100 mg/dL or greater (p < 0.01). Although specific CSF parameters, including nucleated cell count and protein concentration, correlated significantly with outcome, multivariate analysis suggested that their total predictive value was modest. Age was an additional predictor of outcome independent of CSF variables in all patients.

Conclusions: Serologically confirmed West Nile virus meningitis and encephalitis produce similar degrees of CSF pleocytosis and are frequently associated with substantial CSF neutrophilia. Patients with encephalitis have higher CSF protein concentrations and are more likely to have adverse outcomes, including admission to long-term care facilities or even death after their acute illness. CSF findings were only a modest predictor of disease outcome, with patient age adding important independent prognostic information.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the February 14 issue to find the title link for this article.

This article was previously published in electronic format as an Expedited E-Pub on December 28, 2005, at www.neurology.org.

K.L.T. is supported by the Reuler-Lewin Family Professorship of Neurology.

Disclosure: The authors report no conflicts of interest.

Drs. Tyler and Pape are government employees whose work falls within the public domain.

Received August 4, 2005. Accepted in final form October 24, 2005.

This article has been cited by other articles:

				M. C. Silva, A. Guerrero-Plata, F. D. Gilfoy, R. P. Garofalo, and P. W. Mason Differential Activation of Human Monocyte-Derived and Plasmacytoid Dendritic Cells by West Nile Virus Generated in Different Host Cells J. Virol., December 15, 2007; 81(24): 13640 - 13648. [Abstract] [Full Text] [PDF]

				K. L. Tyler, A. J. Aksamit Jr, B. M. Keegan, and J. E. Parisi An 85-year-old man with chronic lymphocytic leukemia and altered mental status Neurology, February 6, 2007; 68(6): 460 - 467. [Full Text] [PDF]

				CSF Findings in WNV Infection Are Not Prognosticators Journal Watch (General), February 28, 2006; 2006(228): 4 - 4. [Full Text]