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September 2012
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EIN Update: West Nile Cases Underscore Lack of Treatment Data

The Emerging Infections Network (EIN) is a forum for infectious diseases consultants and public health officials to report information on clinical phenomena and epidemiological issues with public health significance. Any diagnostic or therapeutic recommendations and all opinions presented are those of the individual contributor. They do not necessarily represent the views of EIN, IDSA (EIN’s sponsor), or the Centers for Disease Control and Prevention (CDC), which funds EIN. The reader assumes all risks in using this information.

A recent EIN discussion highlighted the increase in West Nile virus (WNV) encephalitis cases and the lack of data on treatment.

“We have recently had several cases of WNV meningoencephalitis in the hospital,” an EIN member in Ohio wrote, including a patient who arrived completely lucid with pure meningitis and by day two had signs of encephalitis. “I’m worried that he is going to get worse,” the member continued. “Previously there was discussion of ribavirin for WNV. I can’t find anything else. Has anyone used any other agents? I am aware there is no approved treatment.”

A respondent in Nebraska shared a March 2005 brief report in Clinical Infectious Diseases on the use of interferon in two cases of West Nile encephalitis. 

“We in North Texas are in the midst of an epidemic outbreak of WNV disease, including many neuroinvasive cases, and about 10 deaths so far,” another respondent wrote. “Some of our local individuals are currently involved in trying to set up an IRB-approved protocol to evaluate the efficacy of interferon-alpha2.”

Another EIN member in Texas reported a large concentration of WNV cases locally, “ranging from asymptomatic to post-viral transverse myelitis. Not many have continued to have clinical encephalitis for more than a couple of days, which makes use of interferon of doubtful clinical utility.”

“Our biggest issue has been getting any serologic diagnosis in time to be clinically useful,” the member continued. “The commercial lab we were using gave us turnarounds of two-four weeks in July. The state lab has been better, but still not within the period useful to discontinue other treatment, and as a big county hospital we cannot discount herpetic and bacterial processes, which we continue to see, of course."

An EIN member from Louisiana urged caution in “interpreting the results of any case reports using interferon in WNV infection—as Marvin Turck used to say, the plural of ‘anecdote’ is ‘anecdotes,’ and not ‘data.’ ” Citing involvement with an open-label interferon trial for the treatment of WNV encephalitis and a double-blind placebo trial, the member continued, “We simply don’t know yet whether interferon helps or hurts these patients, anecdotal reports notwithstanding.”

A table of WNV human infections, by state, reported to the Centers for Disease Control and Prevention (CDC) and updated weekly, is available online. As of Sept. 25, a total of 3,545 cases of WNV disease in people, including 147 deaths, had been reported to CDC. Of these, 1,816 (51 percent) were classified as neuroinvasive disease (such as meningitis or encephalitis) and 1,729 (49 percent) were classified as non-neuroinvasive disease.

E-mail the Emerging Infections Network.

The Emerging Infections Network (EIN) is a provider-based sentinel network designed to help the public health community detect trends in emerging infectious diseases.

A joint project of IDSA and the Pediatric Infectious Diseases Society (PIDS) with funding from the Centers for Disease Control and Prevention (CDC), EIN tracks emerging infectious diseases and keeps the public health community up to date with new disease trends, difficult cases, and other issues affecting members’ clinical practices. The Network provides a great opportunity for members to share knowledge quickly across large geographical distances. Both IDSA and PIDS members are eligible to join. Click here for more information or to join EIN.
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