Summary
Definition
History and exam
Key diagnostic factors
- fever of sudden onset
- malaise
- myalgia
- arthralgia
- pharyngitis
- anorexia
- abdominal pain
- visual disturbances
- headache
- rash
- lymphadenopathy
- conjunctival injection
- multi-focal chorioretinal lesions
- chorioretinitis and inflammatory vitritis
- seizures
- respiratory distress
- jaundice
- epigastric tenderness
- 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
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
Treatment algorithm
Contributors
Authors VIEW ALL
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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