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Fatal West Nile virus encephalitis following autologous peripheral blood stem cell transplantation

Bone Marrow Transplantation volume 34, pages 1007–1008 (2004)Cite this article

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WNV is a flavivirus that causes a wide range of clinical illness, ranging from asymptomatic infection to meningoencephalitis.2 Mosquitoes are the natural vector for transmission, with peak activity occurring during late summer and autumn months. Blood products from asymptomatic, viremic donors can also transmit the infection.3 Human data suggest that viremia persists for less than 12 days in the immunocompetent host, but may last as long as 28 days in immunosuppressed individuals.4, 5 The incubation period for development of disease is estimated at 3–14 days.5 A longer period, as long as 21 days, has been observed in immunocompromised patients.6, 7 Recent reports indicate the possibility of fatal central nervous system toxicity associated with WNV infection after hematopoietic stem cell transplantation,8, 9, 10 and highlight the potential acquisition of infection through transfusion.10

A mosquito vector most likely infected the patient reported here. We performed the patient's transplantation in the late summer/early fall, when Delaware had evidence of WNV transmission in the area where the patient resided. Furthermore, all blood donors, as well as the autologous stem cells, tested negative for WNV. Experimentally, components of humoral immunity, particularly IgM and IgG, appear to play critical roles in preventing dissemination of WNV infection to the central nervous system, while CD8+ T-cells may have an important function in clearing infection from tissues and preventing viral persistence.11 Immune suppression during an asymptomatic viremic period, particularly given the depletion of B-cells induced by rituximab and ibritumomab tiuxetan therapy, likely contributed to the development of catastrophic meningoencephalitis.

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Authors and Affiliations

  1. Helen F Graham Cancer Center, Newark, DE, USA

    S E Martin & S Grubbs

  2. Department of Medicine, Christiana Care, Newark, DE, USA

    S E Martin, S Grubbs, J Della Valla & J F Reinhardt

  3. Emerging Infectious Diseases Fellow assigned to the Delaware Public Health Laboratory, Association of Public Health Laboratories, Washington, DC, USA

    N Lilly

  4. Delaware Public Health Laboratory, Smyrna, DE, USA

    J Getchell

  5. Epidemic Intelligence Service assigned to Delaware Health & Social Services, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA

    M Drees

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  1. S E Martin
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Martin, S., Grubbs, S., Della Valla, J. et al. Fatal West Nile virus encephalitis following autologous peripheral blood stem cell transplantation. Bone Marrow Transplant 34, 1007–1008 (2004). https://doi.org/10.1038/sj.bmt.1704726

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