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Case Reports in Infectious Diseases
Volume 2012 (2012), Article ID 839458, 4 pages
http://dx.doi.org/10.1155/2012/839458
Case Report

Two Case Reports of Neuroinvasive West Nile Virus Infection in the Critical Care Unit

1Internal Medicine Department, Henry Ford Health System, Wayne State University School of Medicine, 2799 West Grand Boulevard, CFP1, Detroit, MI 48202, USA
2Infectious Diseases Division, Henry Ford Health System, Wayne State University School of Medicine, 2799 West Grand Boulevard, CFP 304, Detroit, MI 48202, USA
3Pulmonary and Critical Care Division, Henry Ford Health System, Wayne State University School of Medicine, 2799 West Grand Boulevard, Detroit, MI 48202, USA

Received 1 June 2012; Accepted 31 July 2012

Academic Editors: M. Ghate, P. Horrocks, S. Talhari, and G. Walder

Copyright © 2012 Edgardo M. Flores Anticona et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We describe the clinical course of two cases of neuroinvasive West Nile Virus (WNV) infection in the critical care unit. The first case is a 70-year-old man who presented during summer with mental status changes. Cerebrospinal fluid (CSF) analysis revealed pleocytosis with lymphocyte predominance. WNV serology was positive in the CSF. His condition worsened with development of left-sided weakness and deterioration of mental status requiring intensive care. The patient gradually improved and was discharged with residual left-sided weakness and near-complete improvement in his mental status. The second case is an 81-year-old man who presented with mental status changes, fever, lower extremity weakness, and difficulty in walking. CSF analysis showed pleocytosis with neutrophil predominance. WNV serology was also positive in CSF. During the hospital stay his mentation worsened, eventually requiring intubation for airway protection and critical care support. The patient gradually improved and was discharged with residual upper and lower extremity paresis. Neuroinvasive WNV infection can lead to significant morbidity, especially in the elderly. These cases should be suspected in patients with antecedent outdoor activities during summer. It is important for critical care providers to be aware of and maintain a high clinical suspicion of this disease process.