ABSTRACT
Background. According to the Centers for Disease Control and Prevention, Florida was the third leading state in reported West Nile Neuroinvasive Disease (WNND) infections in 2020. WNND accounts for less than 1% of all West Nile virus (WNV) infections but carries a 10% mortality rate. The clinical characteristics of WNND have not been well described in Florida, an area with high mosquito activity. We hereby describe the clinical characteristics of WNND at two large hospitals in Miami. Methods. A 10-year retrospective study was performed at the University of Miami Hospital and Mount Sinai Medical Center to identify adult patients with confirmed WNV infection and neuroinvasion. Patient demographics, symptoms, neurological exam findings, laboratory diagnostics, intensive care unit (ICU), and hospital length of stay (LOS), and outcomes were described. Results. Eleven patients (73% male, mean age 64.4 ± 16.3 years) were identified between January 2010 to December 2020. The most prevalent comorbidities were HTN (64%) and DM (27%). The most common positive findings on the review of symptoms were fever (100%), confusion (81.8%), and headache (63.6%). The mean hospital LOS was 15.5 ±11.3 days, while the mean ICU LOS was 7.2 ± 11.9 days. The majority of patients (75%) spent more than 2 weeks in the ICU. Subject age was correlated with hospital LOS with a Pearson correlation of 0.624 (p=0.04). The survival rate was 91%. At the time of discharge, 80% of patients continued to have neurological symptoms. Figure 1: The percentage of subjects with different types of WNND. The section titled others, includes atypical presentations such as amnesia, focal neurological deficits (ataxia, hemiparesis), and myelopathy. Figure 2: Month and year of presentation at the time of hospital admission. Figure 3: Clinical presentation (%). Conclusion. This is the largest case series of WNND in Florida. Most cases occurred during summer 2020, which corresponds to the peak of the COVID-19 pandemic. Despite pandemic restrictions, we may have seen an increase in WNV cases due to higher-than-normal temperatures promoting mosquito abundance, increased outdoor activities due to the COVID-19 pandemic, and/or the redistribution of public health resources towards the pandemic rather than mosquito control. Residual neurological symptoms and impaired functional outcomes are common. Within the limitation of our small sample size, subject age appeared to correlate with hospital LOS. This correlation should be further explored in a larger case series. A high index of suspicion for WNND is suggested for patients presenting with fever and neurologic symptoms in Florida.
ABSTRACT
Background Admission to the Intensive Care Unit (ICU) is one of the most used indicators to estimate the magnitude of the current COVID-19 pandemic. This study was performed to assess the relationship between demographic, lifestyles and comorbidity factors on the severity of patients with SARS-CoV2 infection. Methods An observational study including data from the regional surveillance dataset on acute respiratory infections from September 2020 to February 2021 in one large tertiary hospital in Murcia, Spain. Demographic, clinical and lifestyle factors were collected. A descriptive analysis was carried out using SPSS. Chi-square tests were performed to assess the relationship between comorbidities and lifestyle factors. Binary logistic regression was calculated to estimate the probability of being admitted to ICU. Analysis were adjusted by sex, age, and lifestyle factors. Results Overall, 906 patients with COVID-19 were identified. The mean age was 64.3 years (SD = 16.5 years), and 523 of the patients were male (57.7%). A total of 104 (11.5%) patients required admission to ICU and 142 (15.7%) died during the hospitalisation process. The average length of stay at the hospital was 8 days (SD = 6). Acute renal failure (OR = 7.7;95% CI: 1.7-33.0), being a smoker (OR = 7.02;95% CI: 2.7-19, 0) and suffering from obesity (OR = 3.5;95% CI: 1.2-10.3) were the main risk factors associated with admission to ICU. Conclusions Acute renal failure, obesity, and smoking were strongly associated with both severity and admission to intensive care among patients with COVID-19 infection. More research needs to be done to assess the role of these underlying factors in the severity of COVID-19 infections. Key messages The design of predictive models for ICU admission during the COVID-19 pandemic should be promoted. Features associated to vulnerability in COVID-19 patients must be identified.