scholarly journals 647. Diagnoses Associated with Temperature ≥104°F in Adults

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S298-S299
Author(s):  
Sharon Chi ◽  
Gary Simon ◽  
Amy Weintrob
Keyword(s):  
West Nile Virus ◽  
Cell Carcinoma ◽  
Bacterial Infections ◽  
Hospice Care ◽  
Viral Infections ◽  
Medical Center ◽  
Maximum Temperature ◽  
Unknown Primary ◽  
Washington Dc ◽  
West Nile

Abstract Background Temperature ≥104°F (T ≥ 104) is uncommon in adults. The diagnoses and clinical characteristics were reviewed for patients with T ≥ 104. Methods Infectious disease physicians reviewed charts of patients with T ≥ 104 seen at the Washington DC Veterans Affairs Medical Center from 2009 to 2018. The following was collected: demographics, past medical history, medications, WBC, maximum temperature, time to defervescence, etiology of T ≥ 104, and death. Results Less than 0.01% of all patient encounters were associated with T ≥ 104. Of the 60 most recent patients with T ≥ 104 (from 2014 to 2018), the median age was 63.5 years (range 23–97), 65% were African American, 88% were male. 82% of those with T ≥ 104 were hospitalized; 76% of those had the T ≥ 104 on or within 72 hours of admission. 25% of the 60 patients had underlying cancer, 10% HIV, 30% DM, 13% CKD, and 13% were on steroids/immunosuppressants/biologics. The median peak temperature was 104.3°F (interquartile range 104.0 – 104.7); maximum was 106.8°F. 82% had T ≥ 104 for only 1 day and the median time to defervescence was 2 days. There were 55 diagnoses amongst 48 patients; 12 had no identifiable etiology of T ≥ 104. Of the identifiable diagnoses, there were 45 (81.8%) infections, 4 (7.3%) metastatic malignancies (1 Hodgkin’s lymphoma, 1 small cell carcinoma, 1 squamous cell carcinoma, 1 unknown primary), 2 (3.6%) intracranial bleeds, 2 (3.6%) GI bleeds, 1 (1.8%) mixed collagen vascular disease, and 1 (1.8%) neuroleptic malignant syndrome. The most common infections were 15 cases of pneumonia including 2 Legionella, 8 complicated UTI/pyelonephritis, 3 primary bacteremia, 2 West Nile virus, 2 influenza, and 2 cholangitis with bacteremia. The median WBC of infectious diagnoses (9.8) was significantly higher than noninfectious diagnoses (5.8, P = 0.006, T-test). Of the 60 patients, 20% died within 30 days of T ≥ 104 including 2 patients who died of sepsis. 67% of those who died were receiving hospice care. Conclusion T ≥ 104 is rare in adults and is usually associated with bacterial infections such as pneumonia (including Legionella), complicated UTIs/pyelonephritis, and primary bacteremia but may also be seen with viral infections such as West Nile virus and influenza. Mortality is high. Disclosures All authors: No reported disclosures.

Procalcitonin measurement in West Nile virus neuroinvasive disease: a first case series

2021 ◽  
pp. e20200046
Author(s):  
Cheyanne Boehm ◽  
Christopher Doig ◽  
Justin Z Chen ◽  
Wendy I Sligl ◽  
Sean M Bagshaw ◽  
...  
Keyword(s):  
West Nile Virus ◽  
Antimicrobial Therapy ◽  
Critically Ill Patients ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Case Series ◽  
West Nile ◽  
Neuroinvasive Disease ◽  
First Case ◽  
Low Serum

West Nile virus neuroinvasive disease (WNV-NID) is challenging to diagnose. Procalcitonin (PCT) is a useful diagnostic test to identify bacterial infections. We present four cases of WNV-NID with serum PCT measurements. Methods: Daily (days 1–7) serum PCT (bioMérieux) was examined for critically ill patients with sepsis enrolled in a provincial sepsis study. Patients with identified WNV-NID are descriptively analyzed in this case series. PCT values of ≥0.5 ng/mL were suggestive of bacterial infection. Results: Four patients with WNV-NID were identified. Those with viral infections alone had consistently low PCT values ranging from 0.09 ng/mL to 0.34 ng/mL. Those with documented bacterial co-infections had initially elevated PCT levels that decreased by more than 50% with antimicrobial therapy. Conclusion: These cases are the first to report serial PCT measurements in confirmed cases of WNV-NID and support a low serum PCT in WNV-NID.

scholarly journals Acute Cryptogenic Stroke During West Nile Virus Infection: Case Report

2020 ◽  
Vol 11 (1) ◽  
pp. 62-65
Author(s):  
Steven Peters ◽  
Kristen Brown
Keyword(s):  
West Nile Virus ◽  
Virus Infection ◽  
Bacterial Infections ◽  
Cryptogenic Stroke ◽  
Indirect Evidence ◽  
West Nile Virus Infection ◽  
Vascular Events ◽  
West Nile ◽  
Fluid Analysis ◽  
Inflammatory State

West Nile virus is an emerging infection in North America but has not traditionally been associated with acute vascular events. We report a 57-year-old healthy male who developed pharyngitis and a corporeal rash, followed 1 week later by an acute cryptogenic stroke. Following successful endovascular thrombectomy, cerebrospinal fluid analysis revealed acute West Nile virus infection. While severe cases of vasculopathy have been described with flavivirus infection, stroke associated with relatively mild symptoms has not been. Given increasing evidence that viral and bacterial infections of many varieties may be stroke triggers, West Nile virus and other flaviviruses may represent an uncommon but underappreciated trigger of cryptogenic stroke. We review indirect evidence that viral endothelial tropism or a nonspecific peri-infectious inflammatory state may be causative mechanisms.

scholarly journals Spatiotemporal Analysis of West Nile Virus Epidemic in South Banat District, Serbia, 2017–2019

Animals ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 2951
Author(s):  
Sonja Radojicic ◽  
Aleksandar Zivulj ◽  
Tamas Petrovic ◽  
Jakov Nisavic ◽  
Vesna Milicevic ◽  
...  
Keyword(s):  
West Nile Virus ◽  
Negative Binomial ◽  
Climatic Factors ◽  
The United States ◽  
Wild Birds ◽  
Water Levels ◽  
Maximum Temperature ◽  
Negative Binomial Regression Model ◽  
West Nile Fever ◽  
West Nile

West Nile virus (WNV) is an arthropod-born pathogen, which is transmitted from wild birds through mosquitoes to humans and animals. At the end of the 20th century, the first West Nile fever (WNF) outbreaks among humans in urban environments in Eastern Europe and the United States were reported. The disease continued to spread to other parts of the continents. In Serbia, the largest number of WNV-infected people was recorded in 2018. This research used spatial statistics to identify clusters of WNV infection in humans and animals in South Banat County, Serbia. The occurrence of WNV infection and risk factors were analyzed using a negative binomial regression model. Our research indicated that climatic factors were the main determinant of WNV distribution and were predictors of endemicity. Precipitation and water levels of rivers had an important influence on mosquito abundance and affected the habitats of wild birds, which are important for maintaining the virus in nature. We found that the maximum temperature of the warmest part of the year and the annual temperature range; and hydrographic variables, e.g., the presence of rivers and water streams were the best environmental predictors of WNF outbreaks in South Banat County.

scholarly journals Predicting the spatio-temporal spread of West Nile virus in Europe

2021 ◽  
Vol 15 (1) ◽  
pp. e0009022
Author(s):  
José-María García-Carrasco ◽  
Antonio-Román Muñoz ◽  
Jesús Olivero ◽  
Marina Segura ◽  
Raimundo Real
Keyword(s):  
West Nile Virus ◽  
Large Scale ◽  
River Basins ◽  
Maximum Temperature ◽  
Environmental Predictors ◽  
Migration Routes ◽  
West Nile Fever ◽  
Environmental Model ◽  
West Nile ◽  
First Case

West Nile virus is a widely spread arthropod-born virus, which has mosquitoes as vectors and birds as reservoirs. Humans, as dead-end hosts of the virus, may suffer West Nile Fever (WNF), which sometimes leads to death. In Europe, the first large-scale epidemic of WNF occurred in 1996 in Romania. Since then, human cases have increased in the continent, where the highest number of cases occurred in 2018. Using the location of WNF cases in 2017 and favorability models, we developed two risk models, one environmental and the other spatio-environmental, and tested their capacity to predict in 2018: 1) the location of WNF; 2) the intensity of the outbreaks (i.e. the number of confirmed human cases); and 3) the imminence of the cases (i.e. the Julian week in which the first case occurred). We found that climatic variables (the maximum temperature of the warmest month and the annual temperature range), human-related variables (rain-fed agriculture, the density of poultry and horses), and topo-hydrographic variables (the presence of rivers and altitude) were the best environmental predictors of WNF outbreaks in Europe. The spatio-environmental model was the most useful in predicting the location of WNF outbreaks, which suggests that a spatial structure, probably related to bird migration routes, has a role in the geographical pattern of WNF in Europe. Both the intensity of cases and their imminence were best predicted using the environmental model, suggesting that these features of the disease are linked to the environmental characteristics of the areas. We highlight the relevance of river basins in the propagation dynamics of the disease, as outbreaks started in the lower parts of the river basins, from where WNF spread towards the upper parts. Therefore, river basins should be considered as operational geographic units for the public health management of the disease.

scholarly journals Modification of the Host Cell Lipid Metabolism Induced by Hypolipidemic Drugs Targeting the Acetyl Coenzyme A Carboxylase Impairs West Nile Virus Replication

2015 ◽  
Vol 60 (1) ◽  
pp. 307-315 ◽  
Author(s):  
Teresa Merino-Ramos ◽  
Ángela Vázquez-Calvo ◽  
Josefina Casas ◽  
Francisco Sobrino ◽  
Juan-Carlos Saiz ◽  
...  
Keyword(s):  
West Nile Virus ◽  
Virus Replication ◽  
Coenzyme A ◽  
Viral Infections ◽  
Lipid Synthesis ◽  
Dependent Manner ◽  
West Nile ◽  
Acetyl Coa ◽  
Acetyl Coenzyme A ◽  
Acetyl Coenzyme

ABSTRACTWest Nile virus (WNV) is a neurotropic flavivirus transmitted by the bite of mosquitoes that causes meningitis and encephalitis in humans, horses, and birds. Several studies have highlighted that flavivirus infection is highly dependent on cellular lipids for virus replication and infectious particle biogenesis. The first steps of lipid synthesis involve the carboxylation of acetyl coenzyme A (acetyl-CoA) to malonyl-CoA that is catalyzed by the acetyl-CoA carboxylase (ACC). This makes ACC a key enzyme of lipid synthesis that is currently being evaluated as a therapeutic target for different disorders, including cancers, obesity, diabetes, and viral infections. We have analyzed the effect of the ACC inhibitor 5-(tetradecyloxy)-2-furoic acid (TOFA) on infection by WNV. Lipidomic analysis of TOFA-treated cells confirmed that this drug reduced the cellular content of multiple lipids, including those directly implicated in the flavivirus life cycle (glycerophospholipids, sphingolipids, and cholesterol). Treatment with TOFA significantly inhibited the multiplication of WNV in a dose-dependent manner. Further analysis of the antiviral effect of this drug showed that the inhibitory effect was related to a reduction of viral replication. Furthermore, treatment with another ACC inhibitor, 3,3,14,14-tetramethylhexadecanedioic acid (MEDICA 16), also inhibited WNV infection. Interestingly, TOFA and MEDICA 16 also reduced the multiplication of Usutu virus (USUV), a WNV-related flavivirus. These results point to the ACC as a druggable cellular target suitable for antiviral development against WNV and other flaviviruses.

scholarly journals West Nile Virus and the 2012 Outbreak: The Baylor University Medical Center Experience

2015 ◽  
Vol 28 (3) ◽  
pp. 291-295
Author(s):  
Adan Mora ◽  
Mariangeli Arroyo ◽  
Kyle L. Gummelt ◽  
Gates Colbert ◽  
Anna L. Ursales ◽  
...  
Keyword(s):  
West Nile Virus ◽  
Medical Center ◽  
West Nile ◽  
Baylor University

scholarly journals Teicoplanin Derivatives Impact on West Nile Virus Pathogenesis

Proceedings ◽  
2020 ◽  
Vol 50 (1) ◽  
pp. 126
Author(s):  
Henrietta Papp ◽  
Ilona Bereczki ◽  
Pál Herczegh ◽  
Mónika Madai ◽  
Gábor Kemenesi ◽  
...  
Keyword(s):  
West Nile Virus ◽  
Bacterial Infections ◽  
Virus Isolate ◽  
Cytopathic Effect ◽  
Clinical Manifestations ◽  
Viral Titer ◽  
West Nile ◽  
Virus Activity ◽  
Immunodeficiency Virus ◽  
The Central Nervous System

West Nile virus (WNV) is an emerging arbovirus that causes infections worldwide. Clinical manifestations of the infection vary from asymptomatic to fatal illness when it reaches the central nervous system. To date, vaccine and specific antiviral treatments are not available. Teicoplanin is already used to treat Gram-positive bacterial infections. Furthermore, it has been reported to block the entry of pseudotyped Ebola, Middle East respiratory syndrome coronavirus and severe acute respiratory syndrome coronavirus. Moreover, teicoplanin derivatives showed anti-influenza virus, anti-human immunodeficiency virus, anti-hepatitis C virus, and anti-dengue virus activity. In total, 12 teicoplanin derivatives have been tested against our West Nile virus isolate. Vero E6 cells were simultaneously treated with 50 µM of teicoplanin derivatives and infected with WNV at the same time. Virus-induced cytopathic effect and cytotoxicity were examined 4 days post-infection. One compound completely blocked virus pathogenesis, while five compounds reduced the viral titer. Further studies will be conducted to unravel the mode of action of these promising derivatives.

scholarly journals MAVS regulates the quality of the antibody response to West-Nile Virus

2020 ◽  
Vol 16 (10) ◽  
pp. e1009009
Author(s):  
Marvin O’Ketch ◽  
Spencer Williams ◽  
Cameron Larson ◽  
Jennifer L. Uhrlaub ◽  
Rachel Wong ◽  
...  
Keyword(s):  
Immune Response ◽  
West Nile Virus ◽  
Antibody Response ◽  
Adaptive Immunity ◽  
Viral Infections ◽  
Adaptive Immune Response ◽  
Neutralizing Antibody ◽  
West Nile ◽  
Humoral Immune

A key difference that distinguishes viral infections from protein immunizations is the recognition of viral nucleic acids by cytosolic pattern recognition receptors (PRRs). Insights into the functions of cytosolic PRRs such as the RNA-sensing Rig-I-like receptors (RLRs) in the instruction of adaptive immunity are therefore critical to understand protective immunity to infections. West Nile virus (WNV) infection of mice deficent of RLR-signaling adaptor MAVS results in a defective adaptive immune response. While this finding suggests a role for RLRs in the instruction of adaptive immunity to WNV, it is difficult to interpret due to the high WNV viremia, associated exessive antigen loads, and pathology in the absence of a MAVS-dependent innate immune response. To overcome these limitations, we have infected MAVS-deficient (MAVSKO) mice with a single-round-of-infection mutant of West Nile virus. We show that MAVSKO mice failed to produce an effective neutralizing antibody response to WNV despite normal antibody titers against the viral WNV-E protein. This defect occurred independently of antigen loads or overt pathology. The specificity of the antibody response in infected MAVSKO mice remained unchanged and was still dominated by antibodies that bound the neutralizing lateral ridge (LR) epitope in the DIII domain of WNV-E. Instead, MAVSKO mice produced IgM antibodies, the dominant isotype controlling primary WNV infection, with lower affinity for the DIII domain. Our findings suggest that RLR-dependent signals are important for the quality of the humoral immune response to WNV.

scholarly journals AI for Early Warning of Seasonal Infectious Disease: Shapely Additive Explanations Improves Prediction of Extraordinary West Nile virus Events in Europe

2020 ◽  
Author(s):  
Albert A Gayle
Keyword(s):  
Machine Learning ◽  
West Nile Virus ◽  
Early Warning ◽  
Complex Disease ◽  
Virus Disease ◽  
Resource Planning ◽  
Model Complexity ◽  
Maximum Temperature ◽  
West Nile

West Nile virus disease is a growing issue with devastating outbreaks and linkage to climate. It's a complex disease with many factors contributing to emergence and spread. High-performance machine learning models, such as XGBoost, hold potential for development of predictive models which performs well with complex diseases like West Nile virus disease. Such models furthermore allow for expanded ability to discover biological, ecological, social and clinical associations as well as interaction effects. In 1951, a deductive method based on cooperative game theory was introduced: Shapley values. The Shapley method has since been shown to be the only way to derive "true" effect estimations from complex systems. Up till recently, however, wide-scale application has been computationally prohibitive. Herein, we present a novel implementation of the Shapley method applied to machine learning to derive high-quality effect estimations. We set out to apply this method to study the drivers of and predict West Nile virus in Europe. Model validity was furthermore tested using observed information in the time periods following the prospective prediction window. We furthermore benchmarked results of XGBoost models against equivalently specified logistic regression models. High predictive performance was consistently observed. All models were statistically equivalent in terms of AUC performance (96.3% average). The top features across models were found to be vapor pressure, the autoregressive past year's feature, maximum temperature, wind speed, and local GNP. Moreover, when aggregated across quarters, we found that the effect of these features are broadly consistent across model configurations. We furthermore confirmed that for an equivalent level of model sophistication, XGBoost and logistic regressions performed similarly, with an advantage to XGBoost as model complexity increased. Our findings highlight the importance of ecological factors, such as climate, in determining outbreak risk of West Nile virus in Europe. We conclude by demonstrating the feasibility of same-year prospective early warning models that combine same-year observed climate with autoregressive geospatial covariates and long-term bioclimatic features. Scenario-based forecasts could likely be developed using similar methods, to provide for long-term intervention and resource planning, therefore increasing public health preparedness and resilience.

scholarly journals MAVS regulates the quality of the antibody response to West-Nile Virus

2019 ◽  
Author(s):  
Marvin O’Ketch ◽  
Cameron Larson ◽  
Spencer Williams ◽  
Jennifer L. Uhrlaub ◽  
Rachel Wong ◽  
...  
Keyword(s):  
Immune Response ◽  
West Nile Virus ◽  
Antibody Response ◽  
Adaptive Immunity ◽  
Viral Infections ◽  
Adaptive Immune Response ◽  
Neutralizing Antibody ◽  
West Nile ◽  
Humoral Immune

AbstractA key difference that distinguishes viral infections from protein immunizations is the recognition of viral nucleic acids by cytosolic pattern recognition receptors (PRRs) such as RNA-sensing Rig-I-like receptors (RLRs). Insights into the specific functions of cytosolic PRRs in the instruction of adaptive immunity are therefore critical for the understanding of protective immunity to infections. West Nile virus (WNV) infection of mice deficent of MAVS, the essential RLR signaling adaptor, results in a defective adaptive immune response. While this finding suggests a role for RLRs in the instruction of adaptive immunity to WNV, it is difficult to interpret due to the high WNV viremia, associated exessive antigen loads, and pathology in the absence of a MAVS-dependent innate immune response. To overcome these limitations, we have infected MAVS-deficient mice with a single-round-of-infection mutant of WNV called RepliVAX (RWN). RWN-infected MAVS-deficient (MAVSKO) mice failed to produce an effective neutralizing antibody response to WNV despite normal titers of antibodies targeting the viral WNV-E protein. This defect occurred indepedently of antigen loads or overt pathology. The specificity of the antibody response in RWN-infected MAVSKO mice remained unchanged and was still dominated by antibodies that bound the neutralizing lateral ridge (LR) epitope in the DIII domain of WNV-E. Instead, MAVSKO mice produced IgM antibodies, the dominant isotype controlling primary WNV infection, with lower affinity for the DIII domain. Our findings suggest that RLR-dependent signals are important for the quality of the humoral immune response to WNV.

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