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Volume 25, Number 11—November 2019
CME ACTIVITY - Research

Lack of Efficacy of High-Titered Immunoglobulin in Patients with West Nile Virus Central Nervous System Disease

John W. GnannComments to Author , Amy Agrawal, John Hart, Martha Buitrago, Paul Carson, Diane Hanfelt-Goade, Ken Tyler, Jared Spotkov, Alison Freifeld, Thomas Moore, Jorge Reyno, Henry Masur, Penelope Jester, Ilet Dale, Yufeng Li, Inmaculada Aban, Fred D. Lakeman, Richard J. WhitleyComments to Author , and for the National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group
Author affiliations: University of Alabama at Birmingham, Birmingham, Alabama, USA (J.W. Gnann, Jr., P. Jester, I. Dale, Y. Li, I. Aban, F.D. Lakeman, R.J. Whitley); National Institutes of Health Clinical Center, Bethesda, Maryland, USA (A. Agrawal, H. Masur); University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA (J. Hart); Idaho Falls Infectious Diseases PLLC, Idaho Falls, Idaho, USA (M. Buitrago); North Dakota State University, Fargo, North Dakota, USA (P. Carson); University of New Mexico, Albuquerque, New Mexico, USA (D. Hanfelt-Goade); University of Colorado at Denver Anschutz Medical Campus, Aurora, Colorado, USA (K. Tyler); Kaiser Permanente South Bay Medical Center, Harbor City, California, USA (J. Spotkov); University of Nebraska Medical Center, Omaha, Nebraska, USA (D. Freifeld); Via Christi Hospital St. Francis, Wichita, Kansas, USA (T. Moore); Infectious Diseases Consultations, Rapid City, South Dakota, USA (J. Reyno)

Main Article

Table 6

Summary of impairment and death at day 90 after randomization for patients with confirmed West Nile virus in study of treatments for West Nile virus central nervous system disease, by treatment arm*

Instrument Omr-IgG-am, n = 33 Polygam, n = 11 Normal saline, n = 11 Total, n = 55
Modified Mini-Mental Status Examination
Normal, score >88 14 (42.4) 6 (54.5) 8 (72.7) 28 (50.9)
Mild/moderately impaired but independent, score 78–88 8 (24.2) 0 2 (18.2) 10 (18.2)
Severely impaired, score <78 5 (15.2) 1 (9.1) 1 (9.1) 7 (12.7)
Dead, score 0 2 (6.0) 3 (27.3) 0 5 (9.1)
Not done/lost to follow-up
 4 (12.1)
 1 (9.0)
 0
 5 (9.1)
Barthel Index
Normal, score >94 15 (45.5) 5 (45.5) 6 (54.5) 26 (47.3)
Mild/moderately impaired but independent, score 90–94 1 (3.0) 0 2 (18.2) 3 (5.5)
Severely impaired, score <90 11 (33.3) 2 (18.2) 3 (27.3) 16 (29.1)
Dead, score 0 2 (6.1) 3 (27.3) 0 5 (9.1)
Not done/lost to follow-up
 4 (12.1)
 1 (9.0)
 0
 5 (9.1)
Glasgow Outcome Score
Normal, score 5 10 (30.3) 3 (27.3) 7 (63.6) 20 (36.4)
Mild/moderately impaired but independent, score 4 9 (27.2) 2 (18.2) 1 (9.1) 12 (21.8)
Severely impaired, score 2–3 9 (27.2) 3 (27.3) 3 (27.3) 15 (27.3)
Dead, score 1 2 (6.0) 3 (27.3) 0 5 (9.1)
Not done/lost to follow-up
 3 (9.0)
 0
 0
 3 (5.5)
Modified Rankin Scale
Normal, score 0 4 (12.1) 0 4 (36.4) 8 (14.5)
Mild/moderately impaired but independent, score 1–3 15 (45.5) 5 (45.5) 4 (36.4) 24 (43.6)
Severely impaired, score 4–5 10 (30.3) 3 (27.3) 3 (27.3) 16 (29.1)
Dead, score 6 2 (6.0) 3 (27.3) 0 5 (9.1)
Not done 2 (6.0) 0 0 2 (3.6)

*Values are no. (%) patients. In comparing Omr-IgG-am with Polygam and Omr-IgG-am with normal saline, we found no significant differences with respect to the impairment and death categories (excluding “not done”) for all instruments listed on this table (p > 0.05 for all values).

Main Article

Page created: October 15, 2019
Page updated: October 15, 2019
Page reviewed: October 15, 2019
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