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A Fatal Neuroinvasive West Nile Virus Infection in a Traveler Returning from Madagascar: Clinical, Epidemiological and Veterinary Investigations

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  • Cellule Interrégionale d'Épidémiologie Océan Indien (Cire OI), Institut de Veille Sanitaire, Saint Denis, La Réunion, France; CIRAD UMR, Contrôle des Maladies Animales Exotiques et Émergentes, Saint Denis, La Réunion, France; Centre de Recherche et de Veille de l'Océan Indien (CRVOI), Saint Denis, La Réunion, France; Service de Réanimation Neurologique Groupe Hospitalier Sud Réunion (GHSR), Centre Hospitalier Réunion (CHR), Saint Pierre, La Réunion, France; Commission de l'Océan Indien (COI), Quatre Bornes, Mauritius; Institut de Recherche et de Développement (IRD), Marseille, France; Service Maladies Infectieuses Groupe Hospitalier Sud Réunion (GHSR), Centre Hospitalier Réunion (CHR), Saint Pierre, La Réunion, France; Centre National de Référence(CNR) des Arbovirus, Institut Pasteur, Paris, France; Service de Neurologie Groupe Hospitalier Sud Réunion (GHSR), Centre Hospitalier Réunion (CHR), Saint Pierre, La Réunion, France; Laboratoire de Bactériologie-Parasitologie-Virologie-Hygiène, Groupe Hospitalier Sud Réunion (GHSR), Centre Hospitalier Réunion (CHR), Saint Pierre, La Réunion, France

A 58-year-old woman living in Reunion Island and returning from Madagascar was hospitalized for neuroinvasive encephalitis and died 1 month later. West Nile virus (WNV) infection was biologically confirmed by detection of immunoglobulin M (IgM) reactive with WNV antigens in both cerebrospinal fluid and serum, and weak neutralizing activity was also detected. A veterinary survey performed in her traveling area showed a seroprevalence of WNV of 28.7% (95% confidence interval [CI] = 21.1–36.3) in adult poultry, confirming an active circulation of the virus. Development of a severe form could be related to a weak antibody response, because the patient presented low IgM and IgG titers. This case report underlines the constant risk of emergence of West Nile in Indian Ocean territories, including Reunion Island where competent vectors are widely present during the whole year.

Author Notes

* Address correspondence to Sophie Larrieu, 2 bis avenue Georges Brassens, BP50, Saint Denis 97408, La Réunion, France. E-mail: sophie.larrieu@ars.sante.fr

Authors' addresses: Sophie Larrieu and Elise Brottet, Cellule Interrégionale d'Épidémiologie Océan Indien (Cire OI), Institut de Veille Sanitaire, Saint Denis, La Réunion, France, E-mails: sophie.larrieu@ars.sante.fr and Elise.brottet@ars.sante.fr. Eric Cardinale and Matthieu Roger, CIRAD-UMR, Saint Denis, Réunion, Centre de Recherche et de Veille de l'Océan Indien - Santé Animale, Saint Denis, Réunion, E-mails: eric.cardinale@cirad.fr and roger.matthieu@cirad.fr. Philippe Ocquidant, Centre Hospitalier Réunion, Groupe Hospitalier Sud Réunion (GHSR) - Neuroréanimation, Saint Pierre, Réunion, E-mail: philippe.ocquidant@chr-reunion.fr. Richard Lepec, Commission de l'Océan Indien - (COI), Quatre Bornes, Mauritius, E-mail: richard.lepec@coi-ioc.org. Hélène Delatte, Institut de Recherche et de Développement - Entomologie, Marseille, France, E-mail: Helene.delatte@ird.fr. Guillaume Camuset, Centre Hospitalier Réunion, Groupe Hospitalier Sud Réunion (GHSR) - Maladies Infectieuses, Saint Pierre, Réunion, E-mail: guillaume.camuset@chr-reunion.fr. Philippe Desprès, Institut Pasteur - CNR des Arbovirus, Paris, France, E-mail: philippe.despres@ip.fr. Cyril Charlin, Centre Hospitalier Réunion, Groupe Hospitalier Sud Réunion (GHSR) - Neurologie, Saint Pierre Réunion, E-mail: cyril.charlin@chr-reunion.fr. Alain Michault, Centre Hospitalier Réunion, Groupe Hospitalier Sud Réunion (GHSR) - Laboratoire de Bactériologie-Parasitologie-Virologie-Hygiène Saint Pierre, Réunion, E-mail: alain.michault@chr-reunion.fr.

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