A Fatal Neuroinvasive West Nile Virus Infection in a Traveler Returning from Madagascar: Clinical, Epidemiological and Veterinary Investigations

Authors:
  • ECEric Cardinale
    Eric Cardinale
  • POPhilippe Ocquidant
    Philippe Ocquidant
  • RLRichard Lepec
    Richard Lepec
  • HDHélène Delatte
    Hélène Delatte
  • GCGuillaume Camuset
    Guillaume Camuset
  • PDPhilippe Desprès
    Philippe Desprès
  • EBElise Brottet
    Elise Brottet
  • CCCyril Charlin
    Cyril Charlin
  • AMAlain Michault
    Alain Michault
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Abstract
A 58-year-old woman living in Reunion Island and returning from Madagascar was hospitalized for neuroinvasive encephalitis and died 1 month later. West Nile virus (WNV) infection was biologically confirmed by detection of immunoglobulin M (IgM) reactive with WNV antigens in both cerebrospinal fluid and serum, and weak neutralizing activity was also detected. A veterinary survey performed in her traveling area showed a seroprevalence of WNV of 28.7% (95% confidence interval [CI] = 21.1–36.3) in adult poultry, confirming an active circulation of the virus. Development of a severe form could be related to a weak antibody response, because the patient presented low IgM and IgG titers. This case report underlines the constant risk of emergence of West Nile in Indian Ocean territories, including Reunion Island where competent vectors are widely present during the whole year.

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