West nile virus natural history

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]

Natural history

West nile virus is spread by the bite of Culex mosquito. Birds are the natural reservoir of the virus and the disease is transmitted when a mosquito that bite the bird bites a human being. It can infect horses also

Incubation period

The incubation period for WNV disease is typically 2 to 6 days but ranges from 2 to 14 days and can be several weeks in immunocompromised people. An estimated 70-80% of human WNV infections are subclinical or asymptomatic. Less than 1% of infected persons develop neuroinvasive disease, which typically manifests as meningitis, encephalitis, or acute flaccid paralysis. Most patients with non-neuroinvasive WNV disease or WNV meningitis recover completely, but fatigue, malaise, and weakness can linger for weeks or months. Patients who recover from WNV encephalitis or poliomyelitis often have residual neurologic deficits. Among patients with neuroinvasive disease, the overall case-fatality ratio is approximately 10%, but it is significantly higher for patients with WNV encephalitis and poliomyelitis than WNV meningitis.

Possible Complications

Complications from mild West Nile virus infection are very rare.

Complications from severe West Nile virus infection include:

• Brain damage
• Permanent muscle weakness (sometimes similar to polio)
• Death
• Dysphagia
• Deep venous thrombosis
• Pressure ulcers

Prognosis

In general, the outcome of a mild West Nile virus infection is excellent.

For patients with severe cases of West Nile virus infection, the outlook is more uncertain. West Nile encephalitis or meningitis may lead to brain damage and death. Approximately 10% of patients with brain inflammation do not survive.