Systemic and Ophthalmic Manifestations of West Nile Virus Infection

Yos Priestley; Marcia Thiel; Steven B. Koevary

Disclosures

Expert Rev Ophthalmol. 2008;3(3):279-292. 

In This Article

Differential Diagnosis of Systemic Disease

In light of its rise in incidence in the USA, it behooves clinicians to consider a diagnosis of WNV when patients display symptoms in common with Legionnaires disease, Mycoplasma meningeoencephalitis, listeria meningoencephalitis, rocky mountain spotted fever, ehrlichiosis, malaria, and herpes simplex virus 1.[57] As mentioned previously, WNP may be misdiagnosed as GBS, both of which share severe flaccid paralysis as their most important symptom. Rash, abdominal and back pain preceding a proximal asymmetric flaccid weakness along with fever may help to distinguish WNP from GBS.[20] Symptoms of WNV can often mimic common complications associated with other systemic diseases, resulting in its under- or misdiagnosis in immunocompromized patients. Thus, patients with HIV who are susceptible to a host of CNS complications may be misdiagnosed when they develop neuroinvasive symptoms of WNV.[58] The fact that paralysis is a generally uncommon symptom of viral infection makes a correct diagnosis of WNV especially difficult in patients who do not present with meningitis or encephalitis. WNV has even been shown to mimic herpes simplex encephalitis when a patient presented with a rare symptom of focal seizures in addition to meningoencephalitis. Only when a negative herpes test result was obtained did physicians consider other possibilities, including WNV - an epidemic of which was affecting patients in the area.[41] WNV can also affect other organs and may manifest itself as hepatitis, pancreatitis and myocarditis.[29] In one case, WNV was isolated from a patient who presented with hemorrhagic disease, highlighting the broadening clinical spectrum of the disease.[59] WNV should be considered in the differential diagnosis of patients that present with any of the aforementioned symptoms, especially if they do so during the summer and fall months.

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