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Volume 25, Number 2—February 2019
Research Letter

West Nile Virus Infection in Travelers Returning to United Kingdom from South Africa

Vivak ParkashComments to Author , Kate Woods, Liana Kafetzopoulou, Jane Osborne, Emma Aarons, and Katharine Cartwright
Author affiliations: Royal Hallamshire Hospital, Sheffield, UK (V. Parkash, K. Cartwright); Public Health England, Porton Down, UK (K. Woods, L. Kafetzopoulou, J. Osborne, E. Aarons)

Main Article


Diagnostic investigations for the index case of West Nile virus infection in a woman from the United Kingdom who traveled to South Africa*

Test Result Reference range Day of testing†
Blood tests
White cell count 12.2 × 109 cells/L 3.5–9.5 × 109/L 1
C-reactive protein 81 mg/L 0–5 mg/L 1
Creatine kinase 593 U/L 25–200 U/L 1
7 mmol/L
3–6 mmol/L
Liver function tests
Alkaline phosphatase 60 IU/L 30–130 IU/L 3
Aspartate aminotransferase 33 IU/L 0–32 IU/L 3
Gamma glutamyl transferase 78 IU/L 0–40 IU/L 3
Gamma glutamyl transferase 155 IU/L 0–40 IU/L 11
Alanine aminotransferase 35 IU/L 0–33 IU/L 3
Alanine aminotransferase
37 IU/L
0–33 IU/L
Malaria testing
Rapid antigen detection‡ Negative 1
Thick/thin blood films

1, 2, 3
Lumbar puncture
Visual appearances Clear, colorless CSF 2
Opening pressure 22 cm H2O 5–18 cm H2O 2
Leukocyte count 102 × 106 cells/L <5 × 106 cells/L 2
Leukocyte differential 80% polymorphonuclear cells; 20% lymphocytes
CSF protein 1.24 g/L 0.15–0.45 g/L 2
CSF glucose
3 mmol/L
3.3–4.4 mmol/L
CSF molecular assays
Herpes simplex virus DNA Not detected 2
Varicella zoster virus DNA Not detected 2
Enterovirus RNA Not detected 2
Meningococcus DNA Not detected 2
Pneumococcus DNA Not detected 2
Listeria DNA
Not detected

Serology and blood cultures
Blood cultures No growth after 5 d 1, 3, 5
HIV screen Negative 3
Syphilis screen

Imaging and EEG
Chest radiograph Unremarkable 1
Contrast MRI of the brain No leptomeningeal enhancement; established right cerebellar infarct 5
EEG Rhythmic irregular delta slow-wave activity (suggestive of encephalopathy) 11

*CSF, cerebrospinal fluid; EEG, electroencephalogram; MRI, magnetic resonance imaging.
†After hospital admission.
Plasmodium lactate dehydrogenase (pLDH) test (OptiMAL-IT, Bio-Rad,

Main Article

Page created: January 18, 2019
Page updated: January 18, 2019
Page reviewed: January 18, 2019
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.