Organ transplant recipients who become infected with
Between July 2003 and October 2003, there were 2,947 confirmed cases of WNV and 63 deaths in
B.K. Kleinschmidt-DeMasters, MD, of the University of Colorado Health Sciences Center,
The researchers found that all but one patient had the usual early symptoms of WNV as documented in non-immunosuppressed patients. Ten patients developed meningoencephalitis (inflammation of the brain and membrane surrounding the brain and spinal cord), and three of the 10 also developed acute flaccid paralysis (paralysis associated with loss of muscle tone). One patient developed acute flaccid paralysis without encephalitis. Six patients had significant movement disorders, including tremor.
Magnetic resonance imaging (MRI) of the brain revealed abnormalities in seven of eight tested patients. Nine of the 11 patients studied survived their infections, but three of them had significant problems caused by their infections and two patients died of complications of WNV.
"Naturally acquired WNV encephalitis in transplant recipients shows diagnostic, clinical, and laboratory features similar to those reported in nonimmunocompromised individuals, but neuroimaging, electroencephalography, and autopsy results verify that these patients develop neurological damage at the severe end of the spectrum," the authors write.
In an accompanying editorial, Roger N. Rosenberg, MD, of the University of Texas Southwestern Medical Center, Dallas, and editor, The Archives of Neurology, writes, "The report of Kleinschmidt-DeMasters and colleagues is significant because it documents the lethality of WNV encephalomyelitis in immunosuppressed patients and alerts the neurological community to be vigilant about the occurrence of severe disease consequences in this population."