West nile virus infections are here! are we prepared to face another flavivirus epidemic?

Abstract Emerging arthropod-borne viruses (arboviruses), such as chikungunya and Zika viruses, are a major threat to public health in countries like Brazil where biodiversity is high and medical care is sometimes precarious. West Nile fever is a disease caused by the West Nile Virus (WNV), an RNA virus belonging to the Flaviviridae family. It is transmitted by infected mosquitoes to numerous animals like birds, reptiles and mammals, including human and non-human primates. In the last decade, the number of reported cases of WNV infection in humans and animals has increased in the Americas. Circulation of WNV in forests and rural areas in Brazil has been detected based on serological surveys and, in 2014, the first case of West Nile fever was confirmed in a patient from Piauí State. In 2018, the virus was isolated for the first time from a horse from a rural area in the state of Espírito Santo presenting with a neurological disorder; this raises the possibility that other cases of WNV encephalitis may have occurred without clinical recognition and without laboratory diagnosis by specific assays. The imminent WNV outbreak poses a challenge for Brazilian clinicians and researchers. In this review, we summarize the basic biological and ecological characteristics of this virus and the clinical presentation and treatment of febrile illnesses caused by WNV. We also discuss the epidemiological aspects, prophylaxis of WNV infections, and monitoring strategies that could be applied in the possibility of a WNV outbreak in Brazil.

Development of an Internally Controlled Reverse Transcription Recombinase-aided Amplification Assay for the Rapid and Visual Detection of West Nile Virus / 生物医学与环境科学（英文）

West Nile virus (WNV) causes West Nile fever and West Nile encephalitis. Because infection by WNV creates serious public health problems, its simple, rapid, and visual detection is very important in clinical practice, especially in resource-limited laboratories. We have developed a rapid, specific, and highly sensitive internally controlled reverse transcription recombinase-aided amplification (RTRAA) assay to detect WNV, using both real-time fluorescence and the lateral flow dipstick (LFD) at 39.0 °C for 30 min. The analytical sensitivity of the RT-RAA assay was 10 plasmid copies and 1.6 pfu per reaction with real-time fluorescence, and 1,000 plasmid copies per reaction with the LFD. No crossreaction with other control viruses was observed. Compared with the RT-qPCR assay, the RT-RAA assay demonstrated 100% sensitivity and 100% specificity for WNV.

Case Reports of Neuroinvasive Manifestation of Viral Encephalitis.

West Nile virus (WNV) infection is a mosquito-borne viral disease, which can cause an inflammation of the brain and meningitis. WNV is commonly found in Africa, West Asia, the Middle East and Europe. For the first time in North America, WNV was confirmed in the New York metropolitan area during the summer and fall of 1999. Since then, WNV over-wintered in the northeastern United States and has been described in humans, horses, birds, and mosquitoes. It is estimated that more than 80% of infected persons remain asymptomatic. Of those who develop symptoms, 80–90% develop an uncomplicated, self-limited febrile illness (‘West Nile fever’; WNF) while the remaining persons develop severe diseases including West Nile meningitis (WNM), West Nile encephalitis (WNE), or an acute poliomyelitis- like syndrome. In fact, less than 1% patients will develop neuroinvasive disease, which typically manifests as meningitis, encephalitis, or acute flaccid paralysis [1]. We are presenting two cases admitted at our tertiary medical center-Vidant Medical Center in Eastern North Carolina with neuroinvasive WNV manifestation. Both patients presented with fever, altered mental status, and proceeded to develop respiratory failure. One patient died thirty days after admission and the other survived with residual isolated right lower extremity weakness that required prolonged rehabilitation.

Production and diagnostic application of recombinant domain III of West Nile envelope protein in Brazil

INTRODUCTION: West Nile virus (WNV) is a flavivirus with a natural cycle involving mosquitoes and birds. Over the last 11 years, WNV has spread throughout the Americas with the imminent risk of its introduction in Brazil. METHODS: Envelope protein domain III of WNV (rDIII) was bacterially expressed and purified. An enzyme-linked immunosorbent assay with WNV rDIII antigen was standardized against mouse immune fluids (MIAFs) of different flavivirus. RESULTS: WNV rDIII reacted strongly with St. Louis encephalitis virus (SLEV) MIAF but not with other flaviviruses. CONCLUSIONS: This antigen may be a potentially useful tool for serologic diagnosis and may contribute in future epidemiological surveillance of WNV infections in Brazil.

Serological detection of West Nile virus in horses and chicken from Pantanal, Brazil

In an effort to detect West Nile virus (WNV) in Brazil, we sampled serum from horses and chickens from the Pantanal region of the state of Mato Grosso and tested for flavivirus-reactive antibodies by blocking ELISA. The positive samples were further confirmed for serological evidence of WNV infection in three (8%) of the 38 horses and one (3.2%) of the 31 chickens using an 80% plaque-reduction neutralisation test (PRNT80). These results provide evidence of the circulation of WNV in chickens and horses in Pantanal.

Serological detection of St. Louis encephalitis virus and West Nile virus in equines from Santa Fe, Argentina

St. Louis encephalitis virus (SLEV) and West Nile virus (WNV) present ecological and antigenic similarities and are responsible for serious human diseases. In addition, WNV is a significant pathogen in terms of equine health. The purpose of our study was to analyse the seroprevalence of SLEV and WNV in equine sera collected in Santa Fe Province, Argentina. The seroprevalence determined using the plaque reduction neutralisation test was 12.2% for SLEV, 16.2% for WNV and 48.6% for a combination of both viruses. These results provide evidence of the co-circulation of SLEV and WNV in equines in Santa Fe.

Stable expression and potential use of West Nile virus envelope glycoproteins preM/E as antigen in diagnostic tests

West Nile virus (WNV) envelope glycoproteins preM/E were stably expressed in baby hamster kidney cells and tested as antigen in a fluorescent antibody assay for WNV antibodies. Sera from horses, mice and chicken immunized with an inactivated WNV vaccine and, less consistently, sera from horses acutely infected with WNV, reacted specifically with viral antigens present in preM/E-expressing cells.

O vírus do Nilo Ocidental: [revisão] / West Nile virus: [review]

O vírus do Nilo Ocidental (WNV) é um flavivírus que se mantém na natureza em ciclos alternados de infecção, em pássaros e mosquitos hematófagos, principalmente do gênero Culex. A infecção natural já foi demonstrada em mais de 200 espécies de aves, sendo que a susceptibilidade à infecção e à doença varia amplamente. Os corvídeos e os passeriformes são particularmente susceptíveis, desenvolvendo altos níveis de viremia e também elevada mortalidade. Ocasionalmente, a infecção pode ser transmitida para mamíferos pela picada de mosquitos que realizaram o repasto sangüíneo em aves virêmicas. Os humanos e os eqüinos estão entre os mamíferos mais susceptíveis e freqüentemente desenvolvem um quadro febril, que pode ser acompanhado de infecção neurológica e meningoencefalite fatal. A infecção pelo WNV, inicialmente identificada em Uganda (1937), durante décadas ficou restrita ao Norte da África, ao Oeste da Ásia, ao Oriente Médio e à Europa Mediterrânea, com relatos de casos isolados ou pequenos surtos de doença em humanos e eqüinos. Em 1999, o vírus foi introduzido em Nova Iorque, nos Estados Unidos, onde causou mortalidade de milhares de aves e infectou centenas de pessoas, levando 21 a óbito. A partir de então, a infecção se disseminou por praticamente todos os Estados norte-americanos, causando infecção e/ou doença em mais de 27 mil pessoas (1100 mortes), eqüinos (mais de 25.000 casos) e provocando mortalidade e redução da população de algumas espécies de aves silvestres. Evidências da infecção têm sido progressivamente detectadas em várias espécies animais no México, na América Central, no Caribe e no Norte da América do Sul, indicando a sua disseminação na direção sul. O WNV foi identificado como o agente de meningoencefalite fatal em três eqüinos na Argentina (2006), onde parece estar presente em pássaros nativos pelo menos desde 2005. Pesquisadores e autoridades sanitárias brasileiras da área humana e animal temem que a infecção seja introduzida...

West Nile virus (WNV) is a Flavivirus maintained in nature through alternate cycles of infection in wild birds and haematophagus mosquitoes, mainly Culex sp. Natural infection by WNV has been demonstrated in more than 200 bird species, which present variable susceptibility to infection and disease. Corvids and passeriformes are particularly susceptible and develop high levels of viremia and mortality. Occasionally, the virus may be transmitted to mammals by mosquitoes feeding previously on viremic birds. Human and horses are highly susceptible to WNV infection and often develop fever, which may be followed by neurological infection and fatal meningoencephalitis. Originally identified in Uganda (1937), WNV infection remained for decades restricted to North Africa, East Asia, Middle East and Mediterranean Europe. In these areas, isolated cases of human and horse disease, or small outbreaks were occasionally reported. In 1999, the virus was introduced in New York, USA, where it caused mortality in thousands of wild and captive birds and infected hundreds of people, killing 21. Thereafter, the infection rapidly spread out over the US territory, causing thousands of human infections (more than 27.000 - around 1100 deaths) and equine infections (more than 25.000 cases). WNV infection has also been detected in wild and domestic birds, horses and other mammals across Mexico, Central America and the Caribbean, and northern South America, indicating its dissemination southwards. In 2006, WNV was first identified as the agent of fatal neurological disease in three horses in Argentina, where it has been shown to be circulating in wild birds at least since 2005. Brazilian's human and animal health authorities are concerned with a possible introduction of the virus in the country, where it would find ideal ecological conditions for transmission and spread. This article presents a brief review on the main epidemiological and clinico-pathological...