How is West Nile virus infection diagnosed and treated?

Updated: Apr 23, 2020
  • Author: Jess D Salinas, Jr, MD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Serologic testing to detect immunoglobulin M (IgM) antibodies is currently the best means [4] of diagnosing West Nile virus infection.

In an estimated one third of infected individuals, magnetic resonance imaging (MRI) scans show notable enhancement in the leptomeninges and periventricular areas.

Brain injury from West Nile virus encephalitis or meningitis can result in cognitive, gross motor, and fine motor delays. Because infected patients have varying degrees of functional deficits, treatment programs must be individualized. Comprehensive rehabilitation using a team consisting of a physiatrist, nurse, physical therapist, occupational therapist, speech therapist, social worker/case manager, and neuropsychologist achieves best outcomes.

Elderly patients who are severely deconditioned because of West Nile virus encephalitis may be predisposed to deep venous thrombosis (DVT). The inherent risk of having DVT is the development of a pulmonary embolus that can cause death. Prevention strategies include the use of thigh-high compression stockings, pneumatic compression devices, and subcutaneous, unfractionated or low–molecular weight heparins. Early mobilization and ambulation also may decrease the risk of DVT.

Individuals with severe illness secondary to West Nile virus infection are at increased risk of pulmonary complications in the rehabilitation setting. Individuals with encephalitis may have a decreased level of consciousness, or they may suffer from dysphagia related to their neurologic injury, predisposing them to aspiration pneumonia. Swallow evaluation can be performed to identify the problem and to help in implementing the appropriate diet and feeding techniques to decrease the risk of aspiration. Phrenic nerve palsy has been described; this complication could lead to decreased expansion of the lungs, further increasing the risk of atelectasis and nosocomial pneumonia. Deep-breathing exercises, use of an inspiratory spirometer, and early mobilization and ambulation help to decrease the risk of these complications occurring.

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