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Rash as a Prognostic Factor in West Nile Virus Disease

  1. Gregory D. Huhn1 and
  2. Mark S. Dworkin2
  1. 1Division of Infectious Diseases, ACCESS Community Health Network, Chicago, Illinois
  2. 2Division of Infectious Diseases, Illinois Department of Public Health, Chicago, Illinois
  1. Reprints or correspondence: Dr. Gregory D. Huhn, ACCESS Community Health Network, Div. of Infectious Diseases, 1501 S. California Ave., Chicago, IL 60608 (greghuhn{at}gmail.com).

To THE EDITOR—As West Nile virus (WNV) becomes widespread throughout the United States, larger cohort data allow investigators to more precisely identify determinants of clinical outcomes of disease. We commend Bode et al. [1] for uncovering additional factors associated with adverse events in patients hospitalized with WNV infection during an outbreak in 4 Colorado counties in 2003. In this population with high morbidity, multivariate analysis of the presence of rash as a prognostic factor for severe disease and mortality would have been of interest.

Two recent studies of large-scale outbreaks of WNV in the United States have highlighted this finding. In 2002, the Illinois Department of Public Health reported 884 cases of WNV infection and 66 deaths due to infection [2]. Rash was a common finding among all patients for whom information was available (301 [46%] of 654 patients), as well as among patients with neuroinvasive disease (151 [39%] of 390 patients). Among patients with reported rash, age-adjusted risks were significantly decreased for encephalitis (relative risk, 0.67; 95% CI, 0.53–0.84), encephalitis plus death (relative risk, 0.44; 95% CI, 0.21–0.92), and death (relative risk, 0.39; 95% CI, 0.19–0.81). In 2003, the Colorado Epartment of Public Health and Environment reported 2947 cases of WNV infection and 63 deaths due to infection throughout the entire state [3]. A total of 1564 patients (60%) had signs of rash among evaluable cases. Age-adjusted risks for meningitis (OR, 0.7; 95% CI, 0.6–0.9), encephalitis (OR, 0.5; 95% CI, 0.3–0.6), and death (OR, 0.3; 95% CI, 0.1–0.8) were also similarly decreased in patients with reported rash [4].

A characteristic rash typically appears transiently in a diffuse maculopapular pattern at the height of febrile symptoms [4–6]. Few studies have examined the histopathological characteristics of rash lesions in WNV infection. In 1 case series, skin biopsy revealed superficial perivascular lymphocytic infiltrates seen commonly in viral exanthems [6]. Whether the development of rash in WNV infection reflects a functional immunoprotective response to circulating viral antigens requires further investigation and validation. Future surveillance activities should include prospective studies assessing features of rash that might account for its apparent favorable effect against severe disease and mortality in WNV disease.

 
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Acknowledgments

Potential conflicts of interest. G.D.H. and M.S.D.: no conflicts.

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References

  1. ↵
    1. Bode AV,
    2. Sejvar JJ,
    3. Pape WJ,
    4. Campbell GL,
    5. Marfin AA
    . West Nile virus disease: a descriptive study of 228 patients hospitalized in a 4-county region of Colorado in 2003. Clin Infect Dis 2006;42:1234-40.
    Abstract/FREE Full Text
  2. ↵
    1. Huhn GD,
    2. Austin C,
    3. Langkop C,
    4. et al
    . The emergence of West Nile virus during a large outbreak in Illinois in 2002. Am J Trop Med Hyg 2005;72:768-76.
    Abstract/FREE Full Text
  3. ↵
    1. Colorado Department of Public Health and Environment
    . human West Nile virus infections: Colorado, 2003. West Nile virus. Available at: http://www.cdphe.state.co.us/dc/zoonosis/wnv/HUMAN_WNV_03.HTML. Accessed 5 April 2006.
  4. ↵
    1. Ferguson D
    . 6th National Conference on West Nile Virus in the United States. San Jose, CA; 2005. Rash observations about West Nile virus—Colorado, 2003. Available at: http://www.cdc.gov/ncidod/dvbid/westnile/conf/february_2005.htm. Accessed 7 June 2006.
    1. Ferguson DD,
    2. Gershman K,
    3. LeBailly A,
    4. Peterson LR
    . Characteristics of the rash associated with West Nile virus fever. Clin Infect Dis 2005;41:1204-7.
    Abstract/FREE Full Text
  6. ↵
    1. Anderson RC,
    2. Horn KB,
    3. Hoang MP,
    4. Gottlieb E,
    5. Bennin B
    . Punctate exanthem of West Nile virus infection: report of 3 cases. J Am Acad Dermatol 2004;51:820-3.
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  1. Clin Infect Dis. (2006) 43 (3): 388-389. doi: 10.1086/505606
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