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Neuroinvasive St. Louis Encephalitis Virus Infection in Solid Organ Transplant Recipients
Author(s) -
Hartmann C. A.,
Vikram H. R.,
Seville M. T.,
Orenstein R.,
Kusne S.,
Blair J. E.,
Grys T. E.,
Patron R. L.
Publication year - 2017
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14336
Subject(s) - medicine , meningoencephalitis , encephalitis , serology , plaque reduction neutralization test , virology , immunology , virus , antibody
In summer 2015, three unrelated solid organ transplant recipients in Phoenix, Arizona, had meningoencephalitis suggestive of West Nile virus ( WNV ) infection. Testing was inconclusive but was later confirmed as St. Louis encephalitis ( SLE ). We retrospectively reviewed clinical manifestations, treatment, and outcomes of these transplant recipients. Common symptoms were fever, rigors, diarrhea, headache, and confusion. One patient died 3 days after hospitalization. Therapy for the other two patients was initiated with interferon α‐2b ( IFN ) and intravenous IgG ( IVIG ; IFN  plus  IVIG in combination). Both patients tested positive for WNV by serologic assay, but SLE virus ( SLEV ) infection was later confirmed by plaque reduction neutralization test at a reference laboratory. Clinical improvement was observed within 72 h after initiation of IFN  plus  IVIG . SLEV has been an uncommon cause of neuroinvasive disease in the United States. Accurate, timely diagnosis is hindered because of clinical presentation similar to neuroinvasive WNV and SLE , serologic cross‐reactivity, and lack of a commercially available serologic assay for SLEV . There is currently no approved therapy for flaviviral neuroinvasive disease. Anecdotal reports indicate varying success with IFN , IVIG , or IFN  plus  IVIG in WNV neuroinvasive disease. The same regimen might be of value for immunocompromised persons with neuroinvasive SLEV infection.

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