Last reviewed: November 2017
Last updated: May  2017

Summary

Definition

History and exam

Key diagnostic factors

  • fever of sudden onset
  • malaise
  • myalgia
  • arthralgia
  • pharyngitis
  • anorexia
  • abdominal pain
  • visual disturbances
  • headache
  • seizures
  • respiratory distress
  • rash
  • lymphadenopathy
  • jaundice
  • epigastric tenderness
  • conjunctival injection
  • multi-focal chorioretinal lesions
  • chorioretinitis and inflammatory vitritis
  • mild confusion
  • disorientation
  • stupor/coma
  • neck stiffness
  • Kernig's sign
  • Brudzinski's sign
  • muscle paralysis
  • parkinsonism
  • ataxia
  • myoclonus
  • tremors

Other diagnostic factors

  • nausea/vomiting
  • generalised muscle weakness
  • splenomegaly
  • retinal haemorrhages
  • chest pain, dyspnoea, palpitations
  • photophobia
  • depression
  • loss of memory
  • bowel and bladder dysfunction
  • cranial nerve palsies

Risk factors

  • significant vegetation
  • exposed skin while outdoors
  • stagnant water
  • blood transfusion
  • needle-stick injuries
  • organ transplant
  • living in/visiting areas with high WNV activity
  • late spring/early autumn
  • outdoor activities between dusk and dawn

Diagnostic investigations

1st investigations to order

  • CSF WNV-specific IgM using IgM antibody capture ELISA (MAC-ELISA)
  • serum WNV-specific IgM using MAC-ELISA
  • CSF protein
  • CSF cell count
  • CSF glucose
  • FBC
  • serum electrolytes
  • LFTs
  • serum amylase/lipase
  • CT head
Full details

Investigations to consider

  • serum or CSF WNV-specific IgM using plaque-reduction neutralisation test (PRNT)
  • WNV isolation from serum, CSF, or body tissue using culture or PCR
  • MRI brain
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Bruce Y. Lee

Associate Professor of International Health

Director

Global Obesity Prevention Center

Director of Operations Research

International Vaccine Access Center (IVAC)

Johns Hopkins School of Public Health

Baltimore

MD

Disclosures

BYL declares that he has no competing interests.

Peer reviewers VIEW ALL

Executive Scientific Officer

American Red Cross

Gaithersburg

MD

Disclosures

SS declares that she has no competing interests.

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