Last reviewed: 22 Dec 2024
Last updated: 07 Jan 2025
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
Full details
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
Full details
Risk factors
- living in/visiting areas with high West Nile virus activity
- mosquito bites
- blood transfusion
- organ transplant
- needle-stick injuries
Full details
Diagnostic investigations
1st investigations to order
- serology
- plaque reduction neutralisation test
- cerebrospinal fluid (CSF) analysis
- full blood count
- serum electrolytes
- liver function tests
- serum amylase/lipase
Full details
Investigations to consider
- MRI brain
- CT head
- reverse transcriptase-polymerase chain reaction (RT-PCR)
Full details
Treatment algorithm
ACUTE
West Nile fever
West Nile neuroinvasive disease
Contributors
Authors
Bruce Y. Lee, MD, MBA
Professor of Health Policy and Management
Executive Director
Center for Advanced Technology and Communication for Health (CATCH)
Public Health Informatics Computational and Operation Research (PHICOR)
City University of New York (CUNY)
New York
NY
Disclosures
BYL declares that he has no competing interests.
Peer reviewers
Susan Stramer, PhD
Executive Scientific Officer
American Red Cross
Gaithersburg
MD
Disclosures
SS declares that she has no competing interests.
Differentials
- Herpes simplex encephalitis
- St. Louis encephalitis
- Eastern equine encephalitis
More DifferentialsGuidelines
- Guidelines for West Nile virus surveillance and control
- Treatment and prevention of West Nile virus disease
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