Transplant patients vulnerable to West Nile virus.

Transplant patients appear to be especially vulnerable to West Nile virus due to the immunosuppressant drugs they must take to prevent organ rejection.

Thus, physicians must be alert for the virus and not rely on blood tests to confirm the diagnosis in recipients with neurologic symptoms suggestive of the disease, cautioned researchers at the University of Cincinnati in Ohio.

Debby DeSalvo, MD reported treating 2 transplant patients for West Nile virus last summer. Both were white males in their 40s, and each had received a kidney from a living donor. Neither appeared to have been infected by the transplanted organ.

The first patient presented with what appeared to be a viral gastrointestinal (GI) infection and fever but within days had symptoms of brain swelling, DeSalvo described. An initial head CT scan was normal, and a blood test for the mosquito-borne illness was negative. However, because his neurologic problems were worsening, the medical team began presumptive treatment for bacterial and viral meningitis and reduced his antirejection medications. The patient failed to respond, and a second MRI showed massive brain swelling identified as characteristic of West Nile virus. Two weeks after admission, and before further therapy was provided, the man died.

One month later, another transplant recipient presented with symptoms suggestive of a GI infection. Because of the previous case, DeSalvo and colleagues immediately tested him for West Nile virus. While the blood test was negative, an MRI showed the brain swelling associated with the infection. The medical team immediately discontinued the patient's immunosuppressive regimen and started him on a 2-week course of alpha interferon, an investigative treatment for West Nile. Within days, the patient had recovered, and 10 months later, he continues to do well, DeSalvo said.