Clinical Spectrum and Healthcare Burden of Autochthonous Neuroinvasive West Nile Virus: A Six-Case Series from a Tertiary Center in Western Romania (2024–2026)

Introduction: Western Romania, the Banat region, has emerged a significant endemic hub for West Nile Virus (WNV). The ecosystem, characterized by hot, humid summers and extensive river basins, provides a high-receptive environment for the Culex mosquito vector. As global thermal anomalies increase, the transmission window in these latitudes is expanding. This study analyzes the clinical trajectory and healthcare resource utilization of six confirmed cases, emphasizing the risk posed by shifting ecological dynamics in non-tropical region.
Methods: We performed a retrospective clinical audit of six laboratory-confirmed WNV patients admitted between October 2024-February 2026. Diagnosis was established via ELISA detection of WNV-specific IgM in serum and cerebrospinal fluid (CSF). Analysis focused on clinical phenotyping, therapeutic interventions and hospitalization duration.
Results: The cohort (median age: 57.5 years; 1:1 sex ratio) demonstrated a high prevalence of neuroinvasive syndromes (66.7%), specifically meningoencephalitis. All cases were autochthonous, with no recent history of travel, confirming active regional circulation. Clinical severity was high: 50% of patients required Intensive Care Unit admission and mechanical ventilation. Advanced interventions, including TPE and intravenous immunoglobulin were utilized to manage progressive neurological decline. The healthcare burden was characterized by extensively prolonged hospitalizations, with a median LOS of 38.5 days (range: 10–69 days). The case fatality rate was 16.7% (n=1), associated with multiorgan failure, while surviving WNND patients exhibited significant neurological sequelae.
Conclusions: Our series underscores the severe clinical impact of endemic WNV in Western Romania, characterized by high ICU utilization and prolonged recovery periods. The identification of cases outside the traditional summer window suggests shifting vector dynamics. Early clinical suspicion and a multimodal therapeutic approach are essential for managing autochthonous neuroinvasive disease in emerging European hotspots.