Table 2 Clinical and laboratory features of the reported patients
From: Emergence of human West Nile Virus infection in Sri Lanka
| Â | Patient #1 | Patient #2 | Patient #3 |
|---|---|---|---|
Age (years) and sex | 17, male | 36, female | 49, male |
Clinical presentation | |||
 Fever | + (high grade, 3 days) | + (high grade, 3 days) | + (high grade, 5 days) |
 Headache | - | + (severe, 3 days) | + (5 days) |
 Nausea/vomiting | - | + | + |
 Altered level of consciousness | + (confusion) | + (confusion) | + (agitation, 5 days) |
 Seizures | 2 x GTCS | - | 2 x GTCS |
 Other | Asthenia, polyarthralgia | Photophobia | - |
 Past medical history | Nil | Nil | Hypertension |
 Neurological examination | GCS 14/15; confused; no focal signs, neck stiffness or paralysis; normal cranial nerves and tendon reflexes. | GCS 11/15; neck stiffness and increased limb tone; normal tendon reflexes; no focal signs; disconjugate gaze but otherwise normal cranial nerves. | GCS 10/15; neck stiffness; increased limb tone and tendon reflexes. |
 General and other systems examination | Normal; no rash; BP 110/70 mmHg | Normal; no rash; BP 100/60 mmHg | No rash; BP 140/90 mmHg |
Blood investigations | |||
 Haemoglobin (g/dl) | 14.8 | 10.5 | 14.3 |
 White cell count (x 109/L) | 5,400 | 12,200 N85% | 13,200 |
 Platelet count (x 109/L) | 154,000 | 235,000 | 263,000 |
 ESR (mm/h) | Not done | Not done | 03 |
 CRP (mg/L) | ND | 96 | ND |
 ALT (U/L) | 46 | ND | 106 |
 AST (U/L) | 85 | ND | 156 |
 SAP (U/L) | 221 | ND | 157 |
 Creatinine (μmol/L) | 60 | ND | 66 |
 Sodium (mmol/l) | 140 | ND | 118 |
 Potassium (mmol/l) | 3.9 | ND | 3.9 |
Cerebrospinal fluid | |||
 Colour | Colourless | Colourless | Colourless |
 Protein (mg/dl) | 42 | 48 | 26 |
 Glucose | 4.3 | 2.2 | 2.7 |
 Lymphocytes | 01 | 00 | 10 |
 Polymorphs | 00 | 64 | 02 |
 Erythrocytes | 01 | 32 | 3500 |
 Gram stain | Negative | Negative | Negative |
 Culture | Negative | Negative | Negative |
 Other |  |  | PCR TB: negative |
 Random plasma glucose (mmol/l) | 6.5 | 4.5 | 8.1 |
Neuroimaging | |||
 CT brain | Normal | Cerebral oedema | Cerebral oedema |
 MRI brain | Not done | Not done | Meningeal enhancement |
EEG | Bilateral slow wave discharges | Bilateral slow wave discharges | Bilateral slow wave discharges |
Treatment | IV aciclovir, dexamethasone and cefotaxime; stopped after 4Â days. Oral phenytoin 100Â mg BD continued. | IV ceftriaxone, aciclovir and dexamethasone; latter 2 stopped after 2Â days. | IV ceftriaxone, aciclovir and thiamine; IV antibiotics continued for 12Â days. Thiamine stopped after 8Â days. |
Outcome | Complete recovery | Complete recovery | Complete recovery |