Jackson A. Roberts MD, Carla Y. Kim PhD, Soonmyung A. Hwang BS, Amir Hassan MD, Ethan Covington BS, Kimia Heydari BS, Mac Lyerly BS, James J. Sejvar MD, Rodrigo Hasbun MD, Manya Prasad MD, Kiran T. Thakur MD
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Approximately 1% of infections involve the nervous system, most commonly resulting in West Nile encephalitis (WNE), West Nile meningitis (WNM), or acute flaccid paralysis (AFP).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>In this systematic review, we characterized comprehensively the diagnostic and clinical features of WNV neuroinvasive disease (WNND) in the United States, as well as the evidence regarding prognostic factors and long-term outcomes of WNND.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>We identified 47 relevant studies reporting data on acute or longitudinal features of WNND. Across studies, the most common presenting symptoms were fever (88%), nausea/vomiting (58%), and fatigue (50%) coupled neurologically with headache (50%), altered mental status (39%), and focal weakness (32%). Pooled mortality was 9.2%, and 42.1% of reported cases required intensive care unit (ICU) admission. In meta-analyses, chronic kidney disease (odds ratio [OR] = 5.99, 95% confidence interval [CI] = 2.71–13.23), diabetes mellitus (OR = 2.43, 95% CI = 1.54–3.84), and hypertension (OR = 4.01, 95% CI = 2.39–6.72) were associated with an increased risk of mortality. Multidomain neurocognitive impairment was reported in several studies at post-hospitalization follow-up, although with marked heterogeneity between study methodology. Subjective neurocognitive impairment, most notably fatigue (37–75%), memory concerns (11–57%), concentration deficits (17–48%), and depression (17–38%), were also common at post-hospitalization follow-up.</p>\n </section>\n \n <section>\n \n <h3> Interpretation</h3>\n \n <p>These findings underscore the significant mortality and morbidity of WNND in the acute and long-term setting. 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引用次数: 0
摘要
目的：西尼罗病毒（WNV）是美国最常见的虫媒病毒性疾病。大约1%的感染涉及神经系统，最常见的结果是西尼罗脑炎（WNE）、西尼罗脑膜炎（WNM）或急性弛缓性麻痹（AFP）。方法：在本系统综述中，我们全面描述了美国WNV神经侵袭性疾病（WNND）的诊断和临床特征，以及有关WNND预后因素和长期结局的证据。结果：我们确定了47项报告WNND急性或纵向特征的相关研究。在所有研究中，最常见的症状是发热（88%）、恶心/呕吐（58%）和疲劳（50%），并伴有神经系统头痛（50%）、精神状态改变（39%）和局灶性无力（32%）。合并死亡率为9.2%，42.1%的报告病例需要重症监护病房（ICU）入院。在荟萃分析中，慢性肾脏疾病（优势比[OR] = 5.99, 95%可信区间[CI] = 2.71-13.23）、糖尿病（OR = 2.43, 95% CI = 1.54-3.84）和高血压（OR = 4.01, 95% CI = 2.39-6.72）与死亡风险增加相关。在住院后随访的几项研究中报告了多域神经认知障碍，尽管研究方法之间存在明显的异质性。主观神经认知障碍，最明显的是疲劳（37-75%）、记忆问题（11-57%）、注意力缺陷（17-48%）和抑郁（17-38%），在住院后随访中也很常见。解释：这些发现强调了急性和长期WNND的显著死亡率和发病率。我们的研究结果可能为WNND住院患者的风险分层提供额外的效用，并提示需要进一步评估新的治疗方法，以预防实质性疾病相关的急性和长期残疾。Ann neurol 2025。
Clinical, Prognostic, and Longitudinal Functional and Neuropsychological Features of West Nile Virus Neuroinvasive Disease in the United States: A Systematic Review and Meta-Analysis
Objective
West Nile virus (WNV) is the most common cause of arboviral disease in the United States. Approximately 1% of infections involve the nervous system, most commonly resulting in West Nile encephalitis (WNE), West Nile meningitis (WNM), or acute flaccid paralysis (AFP).
Methods
In this systematic review, we characterized comprehensively the diagnostic and clinical features of WNV neuroinvasive disease (WNND) in the United States, as well as the evidence regarding prognostic factors and long-term outcomes of WNND.
Results
We identified 47 relevant studies reporting data on acute or longitudinal features of WNND. Across studies, the most common presenting symptoms were fever (88%), nausea/vomiting (58%), and fatigue (50%) coupled neurologically with headache (50%), altered mental status (39%), and focal weakness (32%). Pooled mortality was 9.2%, and 42.1% of reported cases required intensive care unit (ICU) admission. In meta-analyses, chronic kidney disease (odds ratio [OR] = 5.99, 95% confidence interval [CI] = 2.71–13.23), diabetes mellitus (OR = 2.43, 95% CI = 1.54–3.84), and hypertension (OR = 4.01, 95% CI = 2.39–6.72) were associated with an increased risk of mortality. Multidomain neurocognitive impairment was reported in several studies at post-hospitalization follow-up, although with marked heterogeneity between study methodology. Subjective neurocognitive impairment, most notably fatigue (37–75%), memory concerns (11–57%), concentration deficits (17–48%), and depression (17–38%), were also common at post-hospitalization follow-up.
Interpretation
These findings underscore the significant mortality and morbidity of WNND in the acute and long-term setting. Our findings may additionally provide utility for risk stratification of hospitalized patients with WNND and suggest the need for further evaluation of novel therapeutics to prevent substantial disease-associated acute and long-term disability. ANN NEUROL 2025;98:93–106
期刊介绍：
Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.
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