%0 Journal Article
%T West Nile Virus Infection in Pregnancy
%A Robert D. Stewart
%A Stefanie N. Bryant
%A Jeanne S. Sheffield
%J Case Reports in Infectious Diseases
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/351872
%X A recent outbreak of West Nile virus has allowed for observations as to the clinical course of this emerging pathogen during pregnancy. We present three cases of West Nile virus infection during pregnancy. Case 1 presented at term with focal subjective weakness and fever. With supportive care, her symptoms were resolved within 7 days, and she subsequently delivered an unaffected term infant. Case 2 presented in the first trimester with fever and headache. Her symptoms were resolved in 8 days with supportive care. Case 3 was diagnosed during the first trimester during workup of nonspecific respiratory symptoms, with resolution of all symptoms in 24 days. Obstetricians need to be aware of the varied clinical presentation of West Nile virus during pregnancy. 1. Background Since it was first detected in New York in 1999 [1], West Nile virus (WNV) has become an increasingly important pathogen in the United States. Most cases of WNV are asymptomatic; however, infection can result in febrile illness, encephalitis, meningitis, or poliomyelitis. The first case of intrauterine-acquired WNV was reported in 2002 [2], and in 2003 a case of maternal WNV encephalitis was reported [3]. In the summer of 2012, the United States experienced an epidemic of WNV, with 5,245 cases and 236 deaths reported to the Centers for Disease Control and Prevention. Texas has reported 1714 cases with 76 deaths thus far, with Dallas County being the most severely affected. According to the Texas Department of State Health Services, 400 cases of WNV illness and 18 WNV deaths have occurred in Dallas County to date. Here we report our experience with 3 cases of maternal WNV illness during pregnancy at Parkland Hospital. 2. Case 1 A 41-year-old G6P4A1 Hispanic female at 37-week gestation was presented to Labor and Delivery complaining of two days of bilateral lower extremity weakness with difficulty walking, fevers, and chills. She denied headaches, nuchal rigidity, nausea, vomiting, other weakness, or loss of sensation. Her prenatal care was complicated by diet controlled gestational diabetes. On arrival, she was febrile to 38.2ˇăC with a pulse of 120. Her initial physical examination was otherwise benign with a normal neurological examination without any focal deficits. Strength was normal (5/5) in all extremities. Fetal heart tones were reassuring. Initial labs were negative for any obvious signs of infection and without leukocytosis. West Nile virus antibodies were drawn on admission. She became afebrile with acetaminophen and was admitted to the antepartum unit for further observation. On
%U http://www.hindawi.com/journals/criid/2013/351872/