Fatal Case of West Nile Neuroinvasive Disease in Bulgaria
November 22nd, 2016“….A 69-year-old man was admitted to the Emergency Center, Military Medical Academy (Sofia, Bulgaria), on August 27, 2015, because of fever, headache, hand tremor, muscle weakness and disability of lower extremities, nausea, and vomiting. These signs and symptoms developed 3 days before hospitalization. The patient reported being bitten by insects through the summer. He also had concomitant cardiovascular disease. In the 24-hour period after hospitalization, a consciousness disorder and deterioration of the extremities’ weakness developed, and the patient had a Glasgow come score <8.
The patient was transferred to Department of Intensive Care. Neurologic examination showed neck stiffness, positive bilateral symptoms of Kernig and Brudzinski, right facial paralysis, and areflexia of the lower extremities. The patient underwent intubation, and despite complex medical therapy, a cardiopulmonary disorder developed, and he died 14 days after admission.
Laboratory test results at admission were within reference ranges. Lumbar puncture was performed, and cerebrospinal fluid (CSF) testing showed a clear color, leukocytes 39 ×106 cells/L (reference range 0–5 ×106 cells/L), polymorphonucleocytes 2% (0%–6%), lymphocytes 93% (40%–80%), monocytes 5% (15%–45%), protein 0.57 g/L (0.2–0.45 g/L), glucose 4.3 mmol/L (2.2–3.9 mmol/L), and chloride 127.9 mmol/L (98–106 mmol/L)….”
Microbiological investigations of blood, CSF, urine, and throat swab specimens showed no bacterial growth. Immunoserologic test results for neurotropic infectious and parasitologic agents were negative, except for a positive result for IgM against WNV.