West nile virus history and symptoms: Difference between revisions
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{{West nile virus}} | {{West nile virus}} | ||
{{CMG}}; {{AE}} {{Ammu}} | {{CMG}}; {{AE}} {{Ammu}}; {{Rim}} | ||
==Overview== | ==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== | ==History== | ||
Patients who are suspected to have West Nile virus infection should be inquired about | 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== | ||
===Asymptomatic=== | ===Asymptomatic=== | ||
An asymptomatic course of the disease is observed among approximately 80% of individuals infected with WNV. | |||
===West Nile | ===West Nile fever=== | ||
====Constitutional | ====Constitutional symptoms==== | ||
* [[Fever]] | * [[Fever]] | ||
* [[Chills]] | * [[Chills]] | ||
* [[Ache|Body aches]] | * [[Ache|Body aches]] | ||
* [[Fatigue]] | * [[Fatigue]] | ||
* [[ | * [[Arthralgia]] | ||
* [[Diaphoresis]] | * [[Diaphoresis]] | ||
* [[Drowsiness]] | * [[Drowsiness]] | ||
* [[ | * [[Anorexia]] | ||
*[[ Insomnia]] | |||
==== | ====HEENT symptoms==== | ||
* | * [[Headache]] | ||
* [[ | * [[Ocular pain]] | ||
* [[Hearing impairment]] | |||
* [[Cough]] | |||
====Gastrointestinal | ====Gastrointestinal symptoms==== | ||
* [[Nausea]] | * [[Nausea]] | ||
* [[Vomiting]] | * [[Vomiting]] | ||
* [[Diarrhea]] | * [[Diarrhea]] | ||
=== | ====Genitourinary symptoms==== | ||
* [[Bladder urgency]] | |||
* [[Urinary incontinence]] | |||
====Constitutional | ====Cutaneous manifestations==== | ||
* 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]] | ||
* [[ | * [[Diffuse body aches]] | ||
====Neurological | ====Neurological symptoms==== | ||
Shown below is a table of the most common neurological symptoms with their corresponding frequencies. | 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> | ||
{|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}} | ||
| Line 75: | Line 84: | ||
|} | |} | ||
=====West Nile | =====West Nile meningitis===== | ||
* [[Headache]] | * [[Headache]] | ||
* [[Photophobia]] | * [[Photophobia]] | ||
| Line 84: | Line 93: | ||
* [[Rash]] | * [[Rash]] | ||
=====West Nile | =====West Nile meningoencephalitis===== | ||
* [[Confusion]] | * [[Confusion]] | ||
* [[Irritability]] | * [[Irritability]] | ||
| Line 92: | Line 101: | ||
* [[Bulbar dysfunction]] | * [[Bulbar dysfunction]] | ||
* Focal weakness | * Focal weakness | ||
* [[Sensory loss]] | |||
* [[Memory loss]] | |||
* [[Diplopia]] | |||
* [[Cranial nerve palsy]] | |||
=====Acute | =====Acute flaccid paralysis===== | ||
* Lower limb weakness | * Lower limb weakness | ||
====Multiorgan | ====Multiorgan involvement==== | ||
* [[Chorioretinitis]] | * [[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]] | ||
| Line 111: | Line 124: | ||
[[Category:Disease]] | [[Category: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
- 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
- Diffuse body aches
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
- 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[2]
- Hepatitis
- Myocarditis
- Nephritis
- Pancreatitis
- Splenomegaly[3][4][5]
References
- ↑ "Neurologic Complications of West Nile Virus".
- ↑ 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.
- ↑ Perelman A, Stern J. "Acute pancreatitis in West Nile Fever." American Journal of Tropical Medicine and Hygiene 1974; 23: 1150-1152.
- ↑ 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
- ↑ 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.