West nile virus history and symptoms: Difference between revisions

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{{West nile virus}}
{{West nile virus}}
{{CMG}}
{{CMG}}; {{AE}} {{Ammu}}; {{Rim}}


==Overview==
==Overview==
The presentation of patients with West Nile fever infection is variable as it can be completely asymptomatic, mild, or very severe. When symptoms are present, the manifestation of West Nile fever infection can range from mild fever, to severe encephalitis, meningitis, coma, and death.
WNV infection is considered a clinical spectrum. Infection due to WNV may have any of 3 different clinical presentations: Asymptomatic (~70-80%), mild [[febrile]] syndrome termed West Nile fever (~20%), and neuroinvasive disease termed West Nile [[meningitis]] or [[encephalitis]] (<1%). Patients who are suspected to have WNV infection should specifically be inquired about recent mosquito bites.


==History==
==History==
 
Patients who are suspected to have West Nile virus infection should be inquired about recent mosquito bites. In addition, important clues in the history include the time of the year, geographical location, recent travel, and outdoor activities. Patients should also be asked about virus-associated symptoms and their progression.


==Symptoms==
==Symptoms==
West Nile fever infection can present with a variety of manifestation according to the severity of the diseases. West Nile fever infection has three different clinical presentations in humans: asymtomatic, mild febrile syndrome termed West Nile fever, and Neuroinvasive disease termed West Nile meningitis or encephalitis.
===Asymptomatic===
===Asymptomatic===
Absence of symptoms is present in approximately 80% of subjects infected with the West Nile virus.
An asymptomatic course of the disease is observed among approximately 80% of individuals infected with WNV.


===West Nile Fever===
===West Nile fever===
====Constitutional Symptoms====
====Constitutional symptoms====
* [[Fever]]
* [[Fever]]
* [[Chills]]
* [[Chills]]
* [[Headache]]
* [[Ache|Body aches]]
* [[Ache|Body aches]]
* [[Fatigue]]
* [[Fatigue]]
* [[Back pain]]
* [[Arthralgia]]
* [[Diaphoresis]]
* [[Diaphoresis]]
* [[Drowsiness]]
* [[Drowsiness]]
* [[Eye pain]]
* [[Anorexia]]
*[[ Insomnia]]


====Skin Symptoms====
====HEENT symptoms====
* Skin [[rash]] on the trunk of the body
* [[Headache]]
* [[Swelling of lymph nodes]]
* [[Ocular pain]]
* [[Hearing impairment]]
* [[Cough]]


====Gastrointestinal Symptoms====
====Gastrointestinal symptoms====
* [[Nausea]]
* [[Nausea]]
* [[Vomiting]]
* [[Vomiting]]
* [[Loss of appetite]]
* [[Diarrhea]]
* [[Diarrhea]]


===Neurovascular Disease===
====Genitourinary symptoms====
West Nile encephalitis
* [[Bladder urgency]]
* [[Urinary incontinence]]


West Nile meningitis
====Cutaneous manifestations====
====Constitutional Symptoms====
* Macular or papular skin [[rash]] on the trunk
* [[Lymphadenopathy]]
 
===Neuroinvasive disease===
Neuroinvasive disease is the most severe form of WNV infection. Patients can present with fever associated with a wide range of neurological manifestations, such as flaccid paralysis, symptoms of meningitis or encephelatitis, or a combination of these conditions.
 
====Constitutional symptoms====
* High [[fever]]
* High [[fever]]
* [[Body aches]]
* [[Diffuse body aches]]


====Neurological====
====Neurological symptoms====
 
Shown below is a table of the most common neurological symptoms of neuroinvasive WNV disease with their corresponding frequencies.<ref name="Neurologic Complications of West Nile Virus">{{Cite web  | last =  | first =  | title = Neurologic Complications of West Nile Virus |  url = http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/neurology/neurologic-complications-west-nile-virus/ }}</ref>
It is the most severe form of the disease. They can present with a variety of manifestation in conjunction with fever like meningitis, flaccid paralysis, encephalitis or a combination of these .
The most common neurological symptoms with their corresponding frequencies are tabulated below.
{|style=" border: 0px; font-size: 90%; margin: 3px;"
{|style=" border: 0px; font-size: 90%; margin: 3px;"
! style="padding: 0 5px; width: 150px; background: #4479BA; font-weight: bold;"| {{fontcolor|#FFFFFF|Symptom}}
! style="padding: 0 5px; width: 150px; background: #4479BA; font-weight: bold;"| {{fontcolor|#FFFFFF|Symptom}}
! style="padding: 0 5px; width: 50px; background: #4479BA; font-weight: bold;" | {{fontcolor|#FFFFFF|Percentage}}
! style="padding: 0 5px; width: 50px; background: #4479BA; font-weight: bold;" | {{fontcolor|#FFFFFF|Percentage}}
|-
|-
| style="padding: 0 5px; background: #DCDCDC;" | [[Facial Palsy]]
| style="padding: 0 5px; background: #DCDCDC;" | [[Facial palsy]]
| style="padding: 0 5px; background: #F5F5F5;" | 13%
| style="padding: 0 5px; background: #F5F5F5;" | 13%
|-
|-
| style="padding: 0 5px; background: #DCDCDC;" | [[ Dhyphagia]]
| style="padding: 0 5px; background: #DCDCDC;" | [[ Dysphagia]]
| style="padding: 0 5px; background: #F5F5F5;" | 33%
| style="padding: 0 5px; background: #F5F5F5;" | 33%
|-
|-
Line 79: Line 83:
| style="padding: 0 5px; background: #F5F5F5;" | 31%
| style="padding: 0 5px; background: #F5F5F5;" | 31%
|}
|}
* Deep tendon reflexes are hyperactive at first, later diminished. There are also [[extrapyramidal disorder]]s. Recovery is marked by a long convalescence with fatigue. More recent outbreaks have resulted in a deeper study of the disease and other, rarer, outcomes have been identified.The spinal cord may be infected, marked by [[anterior myelitis]] with or without encephalitis.<ref>Sejvar J J, Haddad M B, Tierney B C, Campbell G L, Marfin A A, VanGerpen J A, Fleischauer A, Leis A A, Stokic D S, Petersen L R. "Neurologic manifestations and outcome of West Nile virus infection." ''JAMA'' 2003; 290: 511-515.</ref> WNV-associated [[Guillain-Barré syndrome]] has been identified<ref>Ahmed S, Libman R, Wesson K, Ahmed F, Einberg K. "Guillain-Barre syndrome: an unusual presentation of West Nile virus infection." ''Neurology'' 2000; 55: 144-146.</ref>
====West nile meningitis====
The main signs and symptoms  are back pain, myalgia, rash , photophobia. Usually it is aseptic meningitis and resolves without major complications.
====West nile meningoencephalitis====
It is the most common form of severe disease presenting as behavioual changes like confusion, irritability, disorientation along with focal signs like tremor, ataxia , bulbar dysfunction, or focal weakness.
====Acute flaccid paralysis====
It usually occurs in the subclinical phase presenting as lower limb weakness  with flaccid tone, areflexia or hyporeflexia.


====Multiorgan abnormality====
=====West Nile meningitis=====
* [[Headache]]
* [[Photophobia]]
* [[Neck stiffness]]
* [[Tremor]]
* [[Seizure]]
* [[Paralysis]]
* [[Rash]]


* [[Chorioretinitis]] (which has 100% specificity for identifying WNV infection in patients with possible WNV encephalitis)<ref>Abroug F, Ouanes-Besbes L, Letaief M, Ben Romdhane F, Khairallah M, Triki H, Bouzouiaia N. "A cluster study of predictors of severe West Nile virus infection." ''Mayo Clinic Proceedings'' 2006; 81: 12-16.</ref>
=====West Nile meningoencephalitis=====
* [[Confusion]]
* [[Irritability]]
* [[Disorientation]]
* [[Tremor]]
* [[Ataxia]]
* [[Bulbar dysfunction]]
* Focal weakness
* [[Sensory loss]]
* [[Memory loss]]
* [[Diplopia]]
* [[Cranial nerve palsy]]
 
=====Acute flaccid paralysis=====
* Lower limb weakness
 
====Multiorgan involvement====
* [[Chorioretinitis]]: Very specific for identifying WNV virus infection among patients with high pre-test probability<ref>Abroug F, Ouanes-Besbes L, Letaief M, Ben Romdhane F, Khairallah M, Triki H, Bouzouiaia N. "A cluster study of predictors of severe West Nile virus infection." ''Mayo Clinic Proceedings'' 2006; 81: 12-16.</ref>
* [[Hepatitis]]
* [[Hepatitis]]
* [[Myocarditis]]
* [[Myocarditis]]
* [[Nephritis]]
* [[Nephritis]]
* [[Pancreatitis]]
* [[Pancreatitis]]
* [[Splenomegaly]].<ref>Perelman A, Stern J. "Acute pancreatitis in West Nile Fever." ''American Journal of Tropical Medicine and Hygiene'' 1974; 23: 1150-1152.</ref><ref>Omalu B I, Shakir A A, Wang G, Lipkin W I, Wiley C A. "Fatal fulminant pan-meningo-polioencephalitis due to West Nile virus." ''Brain Pathology'' 2003; 13: 465-472</ref><ref>Mathiot C C, Georges A J, Deubel V. "Comparative analysis of West Nile virus strains isolated from human and animal hosts using monoclonal antibodies and cDNA restriction digest profiles." ''Res Virol'' 1990; 141: 533-543.</ref>
* [[Splenomegaly]]<ref>Perelman A, Stern J. "Acute pancreatitis in West Nile Fever." ''American Journal of Tropical Medicine and Hygiene'' 1974; 23: 1150-1152.</ref><ref>Omalu B I, Shakir A A, Wang G, Lipkin W I, Wiley C A. "Fatal fulminant pan-meningo-polioencephalitis due to West Nile virus." ''Brain Pathology'' 2003; 13: 465-472</ref><ref>Mathiot C C, Georges A J, Deubel V. "Comparative analysis of West Nile virus strains isolated from human and animal hosts using monoclonal antibodies and cDNA restriction digest profiles." ''Res Virol'' 1990; 141: 533-543.</ref>


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Infectious disease]]
 
[[Category:Neurology]]
[[Category:Neurology]]

Latest revision as of 19:11, 18 September 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]; Rim Halaby, M.D. [3]

Overview

WNV infection is considered a clinical spectrum. Infection due to WNV may have any of 3 different clinical presentations: Asymptomatic (~70-80%), mild febrile syndrome termed West Nile fever (~20%), and neuroinvasive disease termed West Nile meningitis or encephalitis (<1%). Patients who are suspected to have WNV infection should specifically be inquired about recent mosquito bites.

History

Patients who are suspected to have West Nile virus infection should be inquired about recent mosquito bites. In addition, important clues in the history include the time of the year, geographical location, recent travel, and outdoor activities. Patients should also be asked about virus-associated symptoms and their progression.

Symptoms

Asymptomatic

An asymptomatic course of the disease is observed among approximately 80% of individuals infected with WNV.

West Nile fever

Constitutional symptoms

HEENT symptoms

Gastrointestinal symptoms

Genitourinary symptoms

Cutaneous manifestations

Neuroinvasive disease

Neuroinvasive disease is the most severe form of WNV infection. Patients can present with fever associated with a wide range of neurological manifestations, such as flaccid paralysis, symptoms of meningitis or encephelatitis, or a combination of these conditions.

Constitutional symptoms

Neurological symptoms

Shown below is a table of the most common neurological symptoms of neuroinvasive WNV disease with their corresponding frequencies.[1]

Symptom Percentage
Facial palsy 13%
Dysphagia 33%
Dysarthria 33%
Diplopia 33%
Tremor 22%
Parkinsonism 16%
Ataxia 31%
Motor seizures 5%
Myoclonus 31%
West Nile meningitis
West Nile meningoencephalitis
Acute flaccid paralysis
  • Lower limb weakness

Multiorgan involvement

References

  1. ↑ "Neurologic Complications of West Nile Virus".
  2. ↑ Abroug F, Ouanes-Besbes L, Letaief M, Ben Romdhane F, Khairallah M, Triki H, Bouzouiaia N. "A cluster study of predictors of severe West Nile virus infection." Mayo Clinic Proceedings 2006; 81: 12-16.
  3. ↑ Perelman A, Stern J. "Acute pancreatitis in West Nile Fever." American Journal of Tropical Medicine and Hygiene 1974; 23: 1150-1152.
  4. ↑ Omalu B I, Shakir A A, Wang G, Lipkin W I, Wiley C A. "Fatal fulminant pan-meningo-polioencephalitis due to West Nile virus." Brain Pathology 2003; 13: 465-472
  5. ↑ Mathiot C C, Georges A J, Deubel V. "Comparative analysis of West Nile virus strains isolated from human and animal hosts using monoclonal antibodies and cDNA restriction digest profiles." Res Virol 1990; 141: 533-543.


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