West Nile Virus

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Record number: 
Adverse Occurrence type: 
MPHO Type: 
Time to detection: 
3 - 5 days
Alerting signals, symptoms, evidence of occurrence: 
A 24 year old patient with severe post-partum hemorrhage received 18 units of blood products in the 30 hours following delivery. She required 6 units of RBC and 2 of FFP in the immediate post-partum period and 6 RBC and 4 FFP on the following day. She developed fever on D+2, which was investigated and settled by D+5 when she was discharged home. On D+6 she complained of generalised weakness, chills, fever, headache; as the headache persisted, she received a lumbar puncture on D+26. CSF analysis revealed raised protein of 75mg/dl (normal range 15-45) and 18 WBC (96% PMN). IgM for both West Vile Virus and St Louis encephalitis virus was reactive in CSF and plasma. Plaque reduction neutralisation assay was used to demonstrate WNV IgM specificity. Symptoms of meningitis disappeared and patient recovered within 2 days.
Demonstration of imputability or root cause: 
Blood donors were assessed for recent infection through questionnaires and WNV testing of serum samples. Whole-blood retention segments and untransfused blood components were sent to the CDC to test for the presence of WNV through PCR (TaqMan, Applied Biosystems), IgM ELISA, plaque reduction neutralization testing, and viral culture.
Imputability grade: 
3 Definite/Certain/Proven
Reference attachment: 
Suggest references: 
Harrington T, Kuehnert MJ, Kamel H, Lanciotti RS, Hand S, Currier M, et al. West Nile virus infection transmitted by blood transfusion. Transfusion. 2003;43(8):1018-22.