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West Nile virus (WNV), alongside other endemic arboviruses including St Louis encephalitis, Lacrosse encephalitis, and California encephalitis viruses, can cause CNS infections. Laboratory diagnosis of WNV, and most other arboviruses, is typically accomplished by detecting virus-specific IgM- and/or IgG-class antibodies in serum and/or CSF [ 284 ] ( Table 67 ). IgM antibodies to WNV are detectable 3–8 days after symptom onset and often taper off 2–3 months later, though seropersistence in serum for up to 12 months has been documented. Seroconversion to anti-WNV IgM and/or IgG positivity between acute and convalescent sera (collected 7–10 days apart) is strongly suggestive of a recent WNV infection. The presence of anti-WNV IgG alone at the time of presentation is indicative of prior WNV infection, and evaluation for an alternative etiology is recommended. Serologic diagnosis of WNV CNS infection may be established by detection of IgM antibodies to WNV in CSF as antibodies in this class do not naturally cross the blood–brain barrier. However, introduction of blood into the CSF during a traumatic lumbar puncture or defective permeability of the blood–brain barrier may lead to falsely elevated IgM levels in the CSF. False-positive results for both anti-WNV IgM and IgG antibodies may occur in patients who have been vaccinated against yellow fever virus or following natural infection with other flaviviruses (eg, dengue, St Louis encephalitis viruses). To rule out cross-reactivity, it is recommended that specimens reactive for WNV antibodies be tested by PRNT.

Table 67.

Laboratory Diagnosis of Infection With West Nile Virus and Other Endemic Arboviruses

Abbreviations: CSF, cerebrospinal fluid; EDTA, ethylenediaminetetraacetic acid; NAAT, nucleic acid amplification test; PPT, plasma preparation tube; RT, room temperature; SST, serum separator tube.

NAATs for uncommon arboviruses (eg, California encephalitis viruses, LaCrosse encephalitis, St Louis encephalitis virus, Eastern equine encephalitis virus) are available through the Centers for Disease Control and Prevention or select public health laboratories.

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Table 67.

Laboratory Diagnosis of Infection With West Nile Virus and Other Endemic Arboviruses

Abbreviations: CSF, cerebrospinal fluid; EDTA, ethylenediaminetetraacetic acid; NAAT, nucleic acid amplification test; PPT, plasma preparation tube; RT, room temperature; SST, serum separator tube.

NAATs for uncommon arboviruses (eg, California encephalitis viruses, LaCrosse encephalitis, St Louis encephalitis virus, Eastern equine encephalitis virus) are available through the Centers for Disease Control and Prevention or select public health laboratories.

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Detection of WNV RNA by NAAT in serum and CSF is associated with higher sensitivity in immunosuppressed patients due to the delayed immune response and thus prolonged WNV viremia in this population. Viral culture, while possible, is insensitive and not routinely offered at local or reference laboratories.

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Ranking the Elite 11 QBs after Monday's action

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How the Elite 11 QBs ranked Sunday at The Opening Finals

By Mike Fisher
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The Dallas Mavericks aren't juggling any gigantic pieces of their salary-cap pie anymore, having secured the services of free-agent center DeAndre Jordan for a one-year deal in the neighborhood of the $24.1 million he was due for 2018-19 before opting out of the Clippers.

But the smaller pieces can still add up -- especially if Dallas alters DeAndre's neighborhood just a bit.

The final step here -- though an obviously important step -- involves the re-signing of temporary free agent Dirk Nowitzki. One option, we're told, is to give Dirk a $5 million deal for this year (along with a possible second-year option). That seems tight -- except an NBA source tells DallasBasketball.com just after the noon hour on Sunday that Jordan's reported "one-year, $24.1-million deal'' is actually under $24 million ... which sets the wheels in motion for that sort of deal for Dirk.

Another option, however, is to use that "slightly under'' to chase a replacement for the planned boomerang of shooter Doug McDermott, who spurred Dallas' request for patience, and an offer that was going to be nowhere near three years and $22 million, to take that deal from the Pacers.

Who around here is a viable catch-and-shoot guy? Free agent Seth Curry qualifies. There is a way to have holds on both Yogi Ferrell and Curry if Jordan settles in at about $23.9 million. Dallas could r enounce its Bird rights on Salah Mejri and waive Kyle Collinsworth and boost its spending room from about $2.5 million to about $3.8 million, and offer that leftover money of about $3.5 million (and EB rights) to Curry.

Does Dallas want another combo guard? Roster-wise, does Dallas really need Luka Doncic, Dennis Smith Jr., JJ Barea, Yogi Ferrell and Jalen Brunson, plus Seth, plus old pal Devin Harris? Not so much. How about is the post-McDermott shooter is, like McDermott, a bigger body, someone like Mario Hezonja, the 6-8 Orlando shooter? (Now that we think of it, maybe the Magic, in need of point guard depth, ought to be talking to the Mavs ...)

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