Volume 25, Number 2—February 2019
Research Letter
West Nile Virus Infection in Travelers Returning to United Kingdom from South Africa
Vivak Parkash
, Kate Woods, Liana Kafetzopoulou, Jane Osborne, Emma Aarons, and Katharine Cartwright
, Kate Woods, Liana Kafetzopoulou, Jane Osborne, Emma Aarons, and Katharine Cartwright
Table
Diagnostic investigations for the index case of West Nile virus infection in a woman from the United Kingdom who traveled to South Africa*
| Test | Result | Reference range | Day of testing† |
|---|---|---|---|
| Blood tests | |||
| White cell count | 12.2 × 109 cells/L | 3.5–9.5 × 109/L | 1 |
| C-reactive protein | 81 mg/L | 0–5 mg/L | 1 |
| Creatine kinase | 593 U/L | 25–200 U/L | 1 |
| Glucose |
7 mmol/L |
3–6 mmol/L |
1 |
| Liver function tests | |||
| Alkaline phosphatase | 60 IU/L | 30–130 IU/L | 3 |
| Aspartate aminotransferase | 33 IU/L | 0–32 IU/L | 3 |
| Gamma glutamyl transferase | 78 IU/L | 0–40 IU/L | 3 |
| Gamma glutamyl transferase | 155 IU/L | 0–40 IU/L | 11 |
| Alanine aminotransferase | 35 IU/L | 0–33 IU/L | 3 |
| Alanine aminotransferase |
37 IU/L |
0–33 IU/L |
6 |
| Malaria testing | |||
| Rapid antigen detection‡ | Negative | 1 | |
| Thick/thin blood films |
Negative |
1, 2, 3 |
|
| Lumbar puncture | |||
| Visual appearances | Clear, colorless CSF | 2 | |
| Opening pressure | 22 cm H2O | 5–18 cm H2O | 2 |
| Leukocyte count | 102 × 106 cells/L | <5 × 106 cells/L | 2 |
| Leukocyte differential | 80% polymorphonuclear cells; 20% lymphocytes | ||
| CSF protein | 1.24 g/L | 0.15–0.45 g/L | 2 |
| CSF glucose |
3 mmol/L |
3.3–4.4 mmol/L |
2 |
| CSF molecular assays | |||
| Herpes simplex virus DNA | Not detected | 2 | |
| Varicella zoster virus DNA | Not detected | 2 | |
| Enterovirus RNA | Not detected | 2 | |
| Meningococcus DNA | Not detected | 2 | |
| Pneumococcus DNA | Not detected | 2 | |
| Listeria DNA |
Not detected |
2 |
|
| Serology and blood cultures | |||
| Blood cultures | No growth after 5 d | 1, 3, 5 | |
| HIV screen | Negative | 3 | |
| Syphilis screen |
Negative |
3 |
|
| Imaging and EEG | |||
| Chest radiograph | Unremarkable | 1 | |
| Contrast MRI of the brain | No leptomeningeal enhancement; established right cerebellar infarct | 5 | |
| EEG | Rhythmic irregular delta slow-wave activity (suggestive of encephalopathy) | 11 | |
*CSF, cerebrospinal fluid; EEG, electroencephalogram; MRI, magnetic resonance imaging.
†After hospital admission.
‡Plasmodium lactate dehydrogenase (pLDH) test (OptiMAL-IT, Bio-Rad, http://www.bio-rad.com).
Page created: January 18, 2019
Page updated: January 18, 2019
Page reviewed: January 18, 2019
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