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1 May 2006

Volume 42, Number 9
Clinical Infectious Diseases 2006;42:1234–1240
This article is in the public domain, and no copyright is claimed.
1058-4838/2006/4209-0003
DOI: 10.1086/503038
MAJOR ARTICLE

West Nile Virus Disease: A Descriptive Study of 228 Patients Hospitalized in a 4‐County Region of Colorado in 2003

Amy V. Bode,1,a

James J. Sejvar,3

W. John Pape,2

Grant L. Campbell,1 and

Anthony A. Marfin1,a

1Division of Vector‐Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, and 2Colorado Department of Public Health and Environment, Denver, Colorado; and 3Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Background.Risk factors for complications of West Nile virus disease and prognosis in hospitalized patients are incompletely understood.

Methods.Demographic characteristics and data regarding potential risk factors, hospitalization, and dispositions were abstracted from medical records for residents of 4 Colorado counties who were hospitalized in 2003 with West Nile virus disease. Univariate and multivariate analyses were used to identify factors associated with West Nile encephalitis (WNE), limb weakness, or death by comparing factors among persons with the outcome of interest with factors among those without the outcome of interest.

Results.Medical records of 221 patients were reviewed; 103 had West Nile meningitis, 65 had WNE, and 53 had West Nile fever. Respiratory failure, limb weakness, and cardiac arrhythmia occurred in all groups, with significantly more cases of each in the WNE group. Age, alcohol abuse, and diabetes were associated with WNE. Age and WNE were associated with limb weakness. The mortality rate in the WNE group was 18%; age, immunosuppression, requirement of mechanical ventilation, and history of stroke were associated with death. Only 21% of patients with WNE who survived returned to a prehospitalization level of function. The estimated incidence of West Nile fever cases that required hospitalization was 6.0 cases per 100,000 persons; West Nile fever was associated with arrhythmia, limb weakness, and respiratory failure.

Conclusions.Persons with diabetes and a reported history of alcohol abuse and older persons appear to be at increased risk of developing WNE. Patients with WNE who have a history of stroke, who require mechanical ventilation, or who are immunosuppressed appear to be more likely to die. Respiratory failure, limb weakness, and arrhythmia occurred in all 3 categories, but there were significantly more cases of all in the WNE group.

Received 25 October 2005; accepted 10 January 2005; electronically published 30 March 2006.

Reprints or correspondence: Dr. Amy Bode ().

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  • Present affiliations: Public Health–Seattle and King County, Washington (A.V.B.); and Division of Global Migration and Quarantine, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Seattle, Washington (A.A.M.).

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