{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T12:40:03Z","timestamp":1773492003534,"version":"3.50.1"},"reference-count":58,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T00:00:00Z","timestamp":1714694400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institutes of Health","award":["1K23NS105935-01"],"award-info":[{"award-number":["1K23NS105935-01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>West Nile virus (WNV) neuroinvasive disease (WNND) occurs in approximately 1 percent of WNV-infected patients and typically presents as encephalitis, meningitis, or acute flaccid paralysis (AFP). WNND remains a difficult inpatient diagnosis, creating significant challenges for prognostication and therapy selection. We characterized the clinical and diagnostic features of WNND cases at two major academic medical centers in New York City in routine clinical practice. We retrospectively reviewed the charts of thirty-six patients with WNND, including twenty-six encephalitis, four meningitis, and six AFP cases. The most common presenting symptoms were fever (86.1%) and gastrointestinal symptoms (38.9%) in addition to altered mental status (72.2%), lethargy (63.9%), gait disturbances (46.2%), and headache (44.4%). Fourteen (48.3%) patients displayed acute magnetic resonance imaging (MRI) findings, particularly T2 hyperintensities in the bilateral thalami, brainstem, and deep white matter. New York State Department of Health WNV CSF IgM testing was utilized for diagnosis in 58.3% of patients; however, just 38.1% had the result by discharge, compared to 85.6% of those who underwent serum IgM testing. The median length of stay was 13.5 days, 38.9% were intubated, and three patients (8.9%) died during acute hospitalization. Our findings underscore the morbidity, mortality, and diagnostic challenges of WNND, suggesting the potential utility of serum IgM testing in combination with confirmatory CSF testing to expedite diagnosis in the acute setting.<\/jats:p>","DOI":"10.3390\/pathogens13050382","type":"journal-article","created":{"date-parts":[[2024,5,3]],"date-time":"2024-05-03T05:52:02Z","timestamp":1714715522000},"page":"382","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Clinical and Diagnostic Features of West Nile Virus Neuroinvasive Disease in New York City"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2231-2454","authenticated-orcid":false,"given":"Jackson A.","family":"Roberts","sequence":"first","affiliation":[{"name":"Program in Neuroinfectious Diseases, Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla Y.","family":"Kim","sequence":"additional","affiliation":[{"name":"Program in Neuroinfectious Diseases, Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9158-0837","authenticated-orcid":false,"given":"Amy","family":"Dean","sequence":"additional","affiliation":[{"name":"Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, Albany, NY 12237, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8867-0989","authenticated-orcid":false,"given":"Karen E.","family":"Kulas","sequence":"additional","affiliation":[{"name":"Diagnostic Immunology, Wadsworth Center, New York State Department of Health, Albany, NY 12237, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5168-763X","authenticated-orcid":false,"given":"Kirsten","family":"St. George","sequence":"additional","affiliation":[{"name":"Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, Albany, NY 12237, USA"},{"name":"Department of Biomedical Science, University at Albany, SUNY, Albany, NY 12222, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hai E.","family":"Hoang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Weill Cornell Medical Center, New York, NY 10065, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiran T.","family":"Thakur","sequence":"additional","affiliation":[{"name":"Program in Neuroinfectious Diseases, Department of Neurology, Columbia University Irving Medical Center, New York, NY 10032, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"137","DOI":"10.2987\/8756-971X-28.4s.137","article-title":"The contribution of Culex pipiens complex mosquitoes to transmission and persistence of West Nile virus in North America","volume":"28","author":"Andreadis","year":"2012","journal-title":"J. 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