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There was a neuro+ID theme at case conference this week! Case 2 was West Nile meningoencephalitis. Michelle reviewed neuroinvasive WNV infections.
#IDTwitter #IDMedEd #IDFellows @ID_fellows
There was a neuro+ID theme at case conference this week! Case 2 was West Nile meningoencephalitis. Michelle reviewed neuroinvasive WNV infections.
#IDTwitter #IDMedEd #IDFellows @ID_fellows
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Potential mechanisms for neuroinvasion:
🚩Direct inf of vasc endothelium
🚩Cytokines disrupt BBB integrity➡️pass thru vasc endothelium
🚩Trojan🐎: infected monocytes trafficked into CNS
🚩Retrograde axonal transport after inf of peripheral neurons
ncbi.nlm.nih.gov/pmc/articles/P…
Potential mechanisms for neuroinvasion:
🚩Direct inf of vasc endothelium
🚩Cytokines disrupt BBB integrity➡️pass thru vasc endothelium
🚩Trojan🐎: infected monocytes trafficked into CNS
🚩Retrograde axonal transport after inf of peripheral neurons
ncbi.nlm.nih.gov/pmc/articles/P…
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Chart illustrating clinical features of different types of weakness assoc'd with WNV infection
ncbi.nlm.nih.gov/pmc/articles/P…
Chart illustrating clinical features of different types of weakness assoc'd with WNV infection
ncbi.nlm.nih.gov/pmc/articles/P…
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🧪Dx:🩸or CSF WNV-specific IgM
📌After WNV acquired, viremia x~10d➡️detectable in CSF x2-3d (when sxs develop)
📌IgM usu detectable 3-8d after onset of illness, persist 30-90d
📌If serum collected w/i 8d of illness onset, absence of IgM does not r/o dx
nejm.org/doi/full/10.10…
🧪Dx:🩸or CSF WNV-specific IgM
📌After WNV acquired, viremia x~10d➡️detectable in CSF x2-3d (when sxs develop)
📌IgM usu detectable 3-8d after onset of illness, persist 30-90d
📌If serum collected w/i 8d of illness onset, absence of IgM does not r/o dx
nejm.org/doi/full/10.10…
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📍Mortality neuroinvasive dz ~10-20%
📍Management primarily supportive
📍Case studies, animal models have studied ACV, steroids, IVIg, IFN, ribavirin➡️overall lack of evidence for recommended use
📍Mortality neuroinvasive dz ~10-20%
📍Management primarily supportive
📍Case studies, animal models have studied ACV, steroids, IVIg, IFN, ribavirin➡️overall lack of evidence for recommended use
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❓ of IVIg often comes up. Let's take a look:
Anecdotal cases of successful tx with passive immunotherapy reported + Study in animals suggesting IVIg enriched with WNV Ab may be useful: ncbi.nlm.nih.gov/pmc/articles/P…
...but RCT of IVIg did not show benefit 👇
❓ of IVIg often comes up. Let's take a look:
Anecdotal cases of successful tx with passive immunotherapy reported + Study in animals suggesting IVIg enriched with WNV Ab may be useful: ncbi.nlm.nih.gov/pmc/articles/P…
...but RCT of IVIg did not show benefit 👇
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dx.doi.org/10.3201/eid251…
🔹RCT: Omr-IgG-am (human Ig w/WNV plaque-reduction neutraliz 1:200) v controls (standard IVIg; NS)
🔹1ary endpoint = safety
🔹2ary = cognitive/fxnl status
🔹Study terminated early: slow accural, lack of supply
🔹No diff in safety or illness outcomes
dx.doi.org/10.3201/eid251…
🔹RCT: Omr-IgG-am (human Ig w/WNV plaque-reduction neutraliz 1:200) v controls (standard IVIg; NS)
🔹1ary endpoint = safety
🔹2ary = cognitive/fxnl status
🔹Study terminated early: slow accural, lack of supply
🔹No diff in safety or illness outcomes
