First Isolation of West Nile Virus From a Patient With Encephalitis in the United States

Emerg Infect Dis. 2002 Dec;8(12):1367-71. doi: 10.3201/eid0812.020532.


West Nile virus (WNV) was isolated from a patient who developed encephalitis while undergoing treatment with CHOP (cyclophosphamide, hydroxydoxorubicin, vincristine [Oncovin], predisone) and rituximab for a non-Hodgkin B-cell lymphoma. Both standard reverse transcription-polymerase chain reaction (RT-PCR) and Taqman RT-PCR established the diagnosis of WNV infection from cerebrospinal fluid (CSF). Several whole blood samples and one serum sample underwent further testing. CSF and serum samples were negative for WNV antibody; however, all samples were positive by both RT-PCR assays. Infectious virus was recovered from a blood sample, and its identity was confirmed by using a WNV-specific immunofluorescence assay. The complete WNV genomes determined from CSF and from the virus isolate adapted from cell culture were the same. The results represent the first complete WNV genome sequence obtained directly from human CSF and the first time that infectious WNV has been recovered from a patient with encephalitis in North America.

Publication types

  • Case Reports
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Cyclophosphamide / therapeutic use
  • Doxorubicin / therapeutic use
  • Fatal Outcome
  • Female
  • Humans
  • Lymphoma, B-Cell / drug therapy
  • New York
  • Prednisone / therapeutic use
  • Reverse Transcriptase Polymerase Chain Reaction
  • Vincristine / therapeutic use
  • West Nile Fever / diagnosis
  • West Nile Fever / drug therapy
  • West Nile Fever / physiopathology*
  • West Nile virus / isolation & purification*


  • Vincristine
  • Doxorubicin
  • Cyclophosphamide
  • Prednisone

Supplementary concepts

  • CHOP protocol