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West Nile Virus Infection in Kidney and Pancreas Transplant Recipients in the Dallas-Fort Worth Metroplex During the 2012 Texas Epidemic

Yango, Angelito F.1,6; Fischbach, Bernard V.1; Levy, Marlon2; Chandrakantan, Arun3; Tan, Valerie3; Spak, Cedric4; Melton, Larry3; Rice, Kim3; Barri, Yousri3; Rajagopal, Arthi3; Klintmalm, Goran5

doi: 10.1097/01.TP.0000438621.81686.ab
Clinical and Translational Research

Background: In 2012, the United States experienced one of its worst West Nile virus (WNV) epidemics, reporting 5,387 human cases and final death toll of 243. Texas was at the epicenter of the outbreak, with 1,875 reported cases and 89 deaths that year. The Texas outbreak centered mainly in the Dallas-Fort Worth area where 30 deaths were reported. We report three cases of severe WNV infection complicated by meningoencephalitis in our organ transplant population.

Methods: Clinical data were collected from chart review. Therapy and outcomes on three identified patients were reviewed and compared with previously reported cases of WNV infection in kidney/pancreas transplant recipients and the general population.

Results: Two recipients of kidney and one recipient of a combined kidney and pancreas transplant were treated at our center for WNV infection. All three patients presented with a rapid decline in mental status within 24 hours of admission consistent with meningoencephalitis. Diagnosis was made based on detection of WNV IgM in the serum. All patients received intravenous immunoglobulin (IVIG) therapy at 400 mg/kg × 3 to 4 doses. As a result, two patients had a full recovery, and one patient died.

Conclusion: Transplant recipients have a higher risk of neurologic complications from WNV infection. In areas where WNV is endemic, clinicians must have a high index of suspicion when treating patients presenting with fever, headache, and confusion. Full recovery in two of three patients suggests a potential role of IVIG therapy in controlling active WNV infection, particularly in immunosuppressed patients.

1 Dallas Nephrology Associates, Fort Worth, TX.

2 Baylor All Saints Transplant Administration, Fort Worth, TX.

3 Dallas Nephrology Associates, Dallas, TX.

4 Baylor University Medical Center, Dallas, TX.

5 Baylor Transplant Service, Dallas, TX.

6 Address correspondence to: Angelito Yango, Dallas Nephrology Associates 1250 Eighth Avenue Suite 500 Fort Worth, TX 76104.

The authors declare no funding or conflicts of interest.


A.F.Y., A.C., B.F., and V.T. participated in writing of the manuscript. All the authors provided critical review of the manuscript.

Received 1 July 2013. Revision requested 10 July 2013.

Accepted 30 October 2013.

© 2014 by Lippincott Williams & Wilkins