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Singin' the West Nile BluesSTORY BY

Sonora Hudson

West Nile Virus (WNV) does not always make people seriously ill, but it can cause some long-term effects: A high percentage of people infected with the virus have reported depression as late as one year after their initial diagnosis, according to a study by researchers at The University of Texas School of Public Health at Houston.

“In the general population, about six percent of women and three percent of men are depressed,” says Kristy O. Murray, DVM, PhD, assistant professor of epidemiology and lead researcher in the ongoing study evaluating patients recuperating from WNV. “Using a scale to evaluate depression, our study found that a high percentage of those who had severe disease from WNV also had evidence of depression at one-year follow-up: 30 percent had mild-to-moderate depression, and 45 percent had major depression. Our results validate what these people tell us they are feeling.”

Although depression has been noted before in patients recuperating from WNV, this study was the first to measure objectively the psychological state of patients and scientifically analyze the results. Murray and fellow researchers Melissa Resnick, DVM, MPH, and Vicki Miller, MD, MPH, reported results of their study in a recent article in the journal, Emerging Infectious Diseases.

The researchers interviewed 65 patients with various manifestations of WNV: 38 had encephalitis; 19 had meningitis; and eight had fever at first evaluation. One year later, 26 patients reported experiencing depression (six reported having depression before the onset of WNV). When the 20 participants with new-onset depression completed a psychological questionnaire used to assess for depression, results showed that 15 could be diagnosed as depressed. In addition, four patients who did not report being depressed could also be determined to have depression on the basis of this test.

There was no statistically meaningful difference between the type of WNV illness and presence of depression.

Another scale also showed no relation between depression and level of physical functioning. Personality changes (including short temper and irritability, reduced desire to socialize, sensitivity, sense of hopelessness) were also reported by 29 patients.

No one knows for sure why people who have had WNV would be affected by depression, but researchers have some ideas and are continuing their research.

“It is likely related to changes in the brain resulting from inflammation,” Murray explains. “Our results confirm that doctors need to look for mental, as well as physical complications from infection. Antidepressants might be helpful for these patients.”

2007: An early rise in cases

According to a Centers for Disease Control and Prevention report released last week, WNV cases are up nearly four times what they were this time a year ago. Government researchers consider this a prediction that cases will continue to rise through summer and early fall, calling for vigilant prevention measures.

Last year almost 4300 cases were reported (though some public health experts calculate the actual numbers of infections to be up to nine times this number). Nearly 1500 brain infections were reported and 177 people died. Last year at this time, there were 33 cases nationwide. This year, there are 122 reported cases in 17 states, with three deaths (as of July).

Pay attention to symptoms

Symptoms and manifestations of WNV range from the unnoticeable to the fatal. Though 80 percent of persons infected will show no symptoms at all, one out of every 150 will develop serious, life-threatening disease or complications. Severe symptoms can include high fever, stiff neck, headache, confusion, coma, numbness and paralysis, tremors, convulsions, weakness and loss of vision. These symptoms may last several weeks, and in some cases, neurological damage may be permanent.

Milder symptoms include fever, headache, nausea and vomiting, rash and swollen lymph glands. Up to 20 percent of infected persons have these milder symptoms and may feel better in a few days or may be symptomatic for several weeks. Persons over age 50 are at highest risk for complications.

Contact your physician if you exhibit any of these symptoms.

Serotonin dip may be to blame

Depression is often found in patients who have been ill from encephalitis and conditions such as Lyme disease. Although the reason behind this is not clear, it may be that levels of the neurotransmitter serotonin may be lower than usual, which can result in conditions such as aggressive and angry behavior, depression, obsessive-compulsive disorder, migraine and anxiety.

The long-term effects of West Nile Virus need to be further studied, say Murray and her fellow researchers, to determine whether treatments such as physical therapy, counseling and antidepressant drug therapy can improve recovery.

Fighting off the bug

There still is no curative treatment for WNV, only good deterrents:

This study was funded by a grant from the National Institutes of Health, National Institute of Allergy and Infectious Diseases. It is ongoing and continues to evaluate patients.

Last Updated: 8-01-2007