{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T18:01:35Z","timestamp":1787508095247,"version":"build-2736575974"},"reference-count":26,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: West Nile virus (WNV) infection has a broad clinical spectrum ranging from asymptomatic or mild disease to severe neuroinvasive forms. Data on hospitalized patients with atypical or non-neurological presentations remain limited. Materials and Methods: We conducted a retrospective multicenter observational study including 30 patients with laboratory-confirmed WNV infection admitted to internal medicine wards during a seasonal outbreak in Southern Italy. Clinical characteristics, hematological parameters, and in-hospital outcomes were analyzed. Results: Median age was 77 years, and 53% of patients were male. Neurological involvement was observed in 50% of patients, whereas 37% presented with septic-like manifestations. Overall in-hospital mortality was 43%, and early mortality within 10 days occurred in 17%. Neurological involvement was significantly more frequent among non-survivors and was associated with increased in-hospital mortality. Higher monocyte percentages were associated with overall mortality, whereas eosinopenia, leukopenia, and thrombocytopenia were associated with early mortality in exploratory analyses. Conclusions: Hospitalized patients with WNV infection may present with heterogeneous clinical phenotypes extending beyond classical neuroinvasive disease. Neurological involvement appears to be the main clinical marker of adverse outcome, while selected hematological parameters may provide preliminary prognostic information. Given the limited sample size and retrospective design, these findings should be considered hypothesis-generating.<\/jats:p>","DOI":"10.3390\/medicina62071364","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T01:05:07Z","timestamp":1784163907000},"page":"1364","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Spectrum and Exploratory Mortality Markers in Hospitalized Patients with Different Clinical Presentations of West Nile Virus Infection: A Multicenter Cohort from Southern Italy"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8484-4598","authenticated-orcid":false,"given":"Pierpaolo","family":"Di Micco","sequence":"first","affiliation":[{"name":"Internal Medicine Ward,\u00a0P.O. Santa Maria delle Grazie, 80078 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6414-8475","authenticated-orcid":false,"given":"Giuseppe","family":"Cardillo","sequence":"additional","affiliation":[{"name":"Laboratory Unit, MedyLab Srl., 40128 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2656-5467","authenticated-orcid":false,"given":"Egidio","family":"Imbalzano","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Messina University Hospital, 98121 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodolfo","family":"Nasti","sequence":"additional","affiliation":[{"name":"Internal Medicine Unit, Ospedale Evangelico Villa Betania, 80147\u00a0Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0834-7546","authenticated-orcid":false,"given":"Maria Gabriella","family":"Coppola","sequence":"additional","affiliation":[{"name":"Internal Medicine Ward, Benevento Hospital, 82100 Benevento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2570-6910","authenticated-orcid":false,"given":"Concetta","family":"Schiano","sequence":"additional","affiliation":[{"name":"Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania Luigi Vanvitelli, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0613-1074","authenticated-orcid":false,"given":"Carmine","family":"Siniscalchi","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Parma University Hospital, 43125 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Carrasco, L., Utrilla, M.J., Fuentes-Romero, B., Fernandez-Novo, A., and Martin-Maldonado, B. (2024). West Nile Virus: An Update Focusing on Southern Europe. Microorganisms, 12.","DOI":"10.3390\/microorganisms12122623"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1111\/1469-0691.12211","article-title":"West Nile virus in Europe: Emergence, epidemiology, diagnosis, treatment, and prevention","volume":"19","author":"Sambri","year":"2013","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1007\/s10096-025-05135-3","article-title":"Emerging West Nile virus infections in T\u00fcrkiye","volume":"44","author":"Alhan","year":"2025","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1001\/jama.2013.8042","article-title":"West Nile virus: Review of the literature","volume":"310","author":"Petersen","year":"2013","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"106449","DOI":"10.1016\/j.ejim.2025.106449","article-title":"From vectors to victims: Understanding the threat of West Nile virus infection","volume":"139","author":"Gallo","year":"2025","journal-title":"Eur. J. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Najafi, S., Jojani, M., Najafi, K., Costanzo, V., Vicidomini, C., and Roviello, G.N. (2026). West Nile Virus: Epidemiology, Surveillance, and Prophylaxis with a Comparative Insight from Italy and Iran. Vaccines, 14.","DOI":"10.3390\/vaccines14010057"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1001\/jama.290.4.511","article-title":"Neurologic manifestations and outcome of West Nile virus infection","volume":"290","author":"Sejvar","year":"2003","journal-title":"JAMA"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Leis, A.A., and Stokic, D.S. (2012). Neuromuscular manifestations of West Nile virus infection. Front. Neurol., 3.","DOI":"10.3389\/fneur.2012.00037"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Tetaj, N., Bocci, M.G., Capecchi, G., Lesci, A., Rubino, D., Sabatini, V., Taloni, G., Mattiucci, E., Ascoli, T., and Maffongelli, G. (2026). West Nile virus neuroinvasive disease and cardiac involvement in critically ill patients in central Italy: A case series. Front. Med., 13.","DOI":"10.3389\/fmed.2026.1792053"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Hart, J., Tillman, G., Kraut, M.A., Chiang, H.S., Strain, J.F., Li, Y., Agrawal, A.G., Jester, P., Gnann, J.W., and Whitley, R.J. (2014). West Nile virus neuroinvasive disease: Neurological manifestations and prospective longitudinal outcomes. BMC Infect. Dis., 14.","DOI":"10.1186\/1471-2334-14-248"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.avsg.2024.01.019","article-title":"Prognostic Value of Neutrophil\/Lymphocyte Ratio for Pulmonary Embolism: A Meta-Analysis and External Validation","volume":"105","author":"Li","year":"2024","journal-title":"Ann. Vasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1111\/bjh.18737","article-title":"Machine learning to predict major bleeding during anticoagulation for venous thromboembolism: Possibilities and limitations","volume":"201","author":"Mora","year":"2023","journal-title":"Br. J. Haematol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Siniscalchi, C., Ticinesi, A., Guerra, A., Parise, A., Cerundolo, N., Prati, B., Simoni, R., Porro, E., and Meschi, T. (2025). The prognostic value of Clinical Frailty Scale in COVID-19 pneumonia across different pandemic phases: A comparison between the first and the fourth wave. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1549444"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Siniscalchi, C., Di Micco, P., Guerra, A., Simoni, R., Magro, J., Parise, A., Cerundolo, N., Imbalzano, E., Tana, C., and Finardi, L. (2025). Platelet count and clinical outcomes in hospitalized patients with COVID-19 pneumonia. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1614447"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Siniscalchi, C., Guerra, A., Cerundolo, N., Di Micco, P., Tana, C., Prati, B., Parise, A., Nouvenne, A., and Meschi, T. (2026). Enduring insights from sex differences in COVID-19: A retrospective post hoc analysis from a large Italian patient cohort. Front. Med., 13.","DOI":"10.3389\/fmed.2026.1764966"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Cardillo, G., Siniscalchi, C., Coppola, M.G., Imbalzano, E., Nasti, R., and Di Micco, P. (2026). Utility of blood biomarkers in inpatients with West Nile virus infection: An exploratory study. Front. Med., 13.","DOI":"10.3389\/fmed.2026.1783007"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1017\/S0950268806006339","article-title":"Risk factors for encephalitis and death from West Nile virus infection","volume":"134","author":"Murray","year":"2006","journal-title":"Epidemiol. Infect."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"F1000 Faculty Rev-105","DOI":"10.12688\/f1000research.7404.1","article-title":"West Nile Virus Infection in the Central Nervous System","volume":"5","author":"Winkelmann","year":"2016","journal-title":"F1000Research"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1146\/annurev-immunol-042718-041417","article-title":"Neuroinflammation During RNA Viral Infections","volume":"37","author":"Klein","year":"2019","journal-title":"Annu. Rev. Immunol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1515\/jomb-2016-0022","article-title":"The Importance of Haematological and Biochemical Findings in Patients with West Nile Virus Neuroinvasive Disease","volume":"35","author":"Poluga","year":"2016","journal-title":"J. Med. Biochem."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Pavesi, A., Tiecco, G., Rossi, L., Sforza, A., Ciccarone, A., Compostella, F., Lovatti, S., Tomasoni, L.R., Castelli, F., and Quiros-Roldan, E. (2024). Inflammatory Response Associated with West Nile Neuroinvasive Disease: A Systematic Review. Viruses, 16.","DOI":"10.3390\/v16030383"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Constant, O., Barthelemy, J., Nagy, A., Salinas, S., and Simonin, Y. (2022). West Nile Virus Neuroinfection in Humans: Peripheral Biomarkers of Neuroinflammation and Neuronal Damage. Viruses, 14.","DOI":"10.3390\/v14040756"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Roe, K., Orillo, B., and Verma, S. (2014). West Nile virus-induced cell adhesion molecules on human brain microvascular endothelial cells regulate leukocyte adhesion and modulate permeability of the in vitro blood-brain barrier model. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0102598"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/1742-2094-7-73","article-title":"Pro-inflammatory cytokines derived from West Nile virus (WNV)-infected SK-N-SH cells mediate neuroinflammatory markers and neuronal death","volume":"7","author":"Kumar","year":"2010","journal-title":"J. Neuroinflamm."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1704","DOI":"10.1002\/ajh.27379","article-title":"The prognostic value of blood cellular indices in pulmonary embolism","volume":"99","author":"Siddiqui","year":"2024","journal-title":"Am. J. Hematol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1089\/vbz.2023.0056","article-title":"New Prognostic Parameter of West Nile Virus: Platelet Distribution Width","volume":"24","author":"Genc","year":"2024","journal-title":"Vector Borne Zoonotic Dis."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/7\/1364\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T01:35:59Z","timestamp":1784165759000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/7\/1364"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":26,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["medicina62071364"],"URL":"https:\/\/doi.org\/10.3390\/medicina62071364","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]}}}