Community-acquired West Nile virus infection in solid-organ transplant recipients
Bibliographic record
Abstract
BACKGROUND: West Nile virus (WNV) is rapidly spreading through North America. In the general population, the majority of WNV infections are asymptomatic. During 2002, an outbreak of WNV occurred in Toronto, Canada. We observed four cases of severe symptomatic community-acquired WNV infection in our organ-transplant population. METHODS: Patient data were obtained from chart review. WNV was diagnosed by acute and convalescent serology. Incidence was compared with data obtained from a population-based surveillance program. RESULTS: Four transplant patients had WNV encephalitis (n=3) or meningitis (n=1). Mean age was 44.5 (range 26-58) years and transplant type included kidney (n=2), liver (n=1), and heart (n=1). The mean time posttransplant was 3.8 years (range 2 months-8 years). The presenting symptoms were fever (4/4), confusion (3/4), headache (4/4), and weakness (2/4). Cerebrospinal fluid showed a pleocytosis in all patients and elevated protein in three of four. All patients had identifiable occupational or recreational risk factors. There was no evidence that the infection was acquired by transfusion or the transplanted organ. Outcomes were full recovery (2/4), lower limb paralysis (1/4), and death (1/4). On the basis of active population surveillance data, the rate of WNV meningoencephalitis in the general population in the Toronto area was approximately 5 per 100,000. This compares to four cases in a transplant population of 2,000 patients (rate 200 per 100,000) (P<0.001). CONCLUSIONS: Transplant patients are likely at greater risk of severe neurologic disease caused by community-acquired WNV compared with the general population. Prevention of transmission and patient education may be more important in this population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".