Second epidemic of West Nile virus meningoencephalitis in Tunisia
Abstract
The West Nile virus (WNV) re-emerged in Tunisia in 2003, causing an outbreak of meningoencephalitis. Objective. - The authors studied the epidemiological, clinical, biological, and imaging features of WNV-associated neurological disease observed in central eastern Tunisia. Design. - A retrospective descriptive study was made on patients with West Nile meningitis and/or encephalitis observed in the Sousse area, from August 15 to November 15, 2003. Screening for specific anti-WNV antibodies in serum was performed with Elisa. Results. - Recent central nervous system infection due to WNV was confirmed in 21 patients with a mean age of 53 years and a sex ratio of 3.2. The clinical presentation was meningitis in 11 cases, meningoencephalitis in seven cases, and encephalitis in three cases. Patients with encephalitis were older than those with meningitis. An acute flaccid limb paralysis was observed in three patients. The CSF assay showed lymphocytosis, high protein (67 %), and normal glucose levels (83 %). Brain CT scan and MRI were normal. Three patients died, the remaining evolved uneventfully. Conclusions. - These first cases of WNV meningoencephalitis in Sousse area suggest a possibility of reemergence of this infection. Preventives measures and epidemiological surveillance are necessary. (C) 2009 Elsevier Masson SAS. All rights reserved.