Correspondence

Increased Serum Lipase in West Nile Virus Infection

N Engl J Med 2005; 352:420-421January 27, 2005

Article

To the Editor:

West Nile virus is a flavivirus that has caused seasonal outbreaks of disease in humans since its introduction into the United States in 1999. The clinical presentation is highly variable, ranging from asymptomatic disease to mild influenza-like symptoms to permanent flaccid paralysis and death.1 Study and clinical observation are complicated by the fact that areas hardest hit by the disease during one year may have only sporadic cases in the following years.

Colorado had 2943 reported cases of West Nile virus infection in 2003.2 There was a spectrum of clinical presentations among patients hospitalized with the disease, and elevated serum lipase levels were incidentally noted in a majority of patients hospitalized at three facilities in Aurora, Colorado. Patients with elevated lipase levels had few clinical signs or symptoms of pancreatitis, other than nonspecific symptoms such as nausea and vomiting. Serum lipase assays were initially ordered to follow up on abnormal liver aminotransferase values on admission.

Table 1Table 1Maximal Measured Serum Lipase Levels in 17 Patients with a Diagnosis of West Nile Virus Infection. lists the maximal measured serum lipase levels in 17 patients admitted to the three facilities in Aurora between July 1 and November 30, 2003. West Nile virus infection was diagnosed with the use of the enzyme-linked immunosorbent assay for the West Nile virus antibody. The prevalence of elevated serum lipase levels in this small series of patients was 65 percent (11 of the 17 patients had elevated values); the prevalence of lipase levels that were more than twice the upper limit of the normal range was 24 percent (4 of 17). The elevations tended to be transient, with normalization within 7 to 10 days.

The lipase levels in these 17 patients were not measured with respect to any specific signs or symptoms of pancreatitis. It is possible that the incidence of elevated lipase levels in patients with West Nile virus infection is higher than reported here and that the elevations are greater than those shown in Table 1. None of the 17 patients had any identified complications or morbidity related to pancreatitis.

The clinical significance of lipase levels in patients with West Nile virus infection is unclear. However, since therapy for West Nile virus infection is being developed, clinicians should be aware that abnormal lipase values may be related to the infection, rather than to empirical or novel therapies.

Joseph T. Batuello, M.D., J.D.
Specialized Complex Care Hospital, Aurora, CO 80012

Jeanie Youngwerth, M.D.
University of Colorado Health Sciences Center, Denver, CO 80262

Ron Gabel, B.S., P.A.-C.
Specialized Complex Care Hospital, Aurora, CO 80012

2 References

1. 1

   Sampathkumar P. West Nile virus: epidemiology, clinical presentation, diagnosis, and prevention. Mayo Clin Proc 2003;78:1137-1143
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2. 2

   Human West Nile virus infections: Colorado, 2003. (Accessed January 6, 2005, at http://www.cdphe.state.co.us/dc/zoonosis/wnv/HUMAN_WNV_03.HTML.)
   

Citing Articles (3)

Citing Articles

1. 1

   Jonathan Buber, Noam Fink, Hanna Bin, Meir Mouallem. (2008) West Nile virus-induced pancreatitis. Travel Medicine and Infectious Disease 6:6, 373-375
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2. 2

   Larry E. Davis, Roberta DeBiasi, Diane E. Goade, Kathleen Y. Haaland, Jennifer A. Harrington, JoAnn B. Harnar, Steven A. Pergam, Molly K. King, B. K. DeMasters, Kenneth L. Tyler. (2006) West Nile virus neuroinvasive disease. Annals of Neurology 60:3, 286-300
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3. 3

   C. D. Paddock, W. L. Nicholson, J. Bhatnagar, C. S. Goldsmith, P. W. Greer, E. B. Hayes, J. A. Risko, C. Henderson, C. G. Blackmore, R. S. Lanciotti, G. L. Campbell, S. R. Zaki. (2006) Fatal Hemorrhagic Fever Caused by West Nile Virus in the United States. Clinical Infectious Diseases 42:11, 1527-1535
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