West Nile Virus
WNV causes over 95% of neuroinvasive arboviral infections in the US. It is transmitted by Culex mosquitoes. Infections peak in late summer and early fall.
DIAGNOSIS
Clinical Presentation
• Most infections are asymptomatic.
Symptomatic cases range from a mild febrile illness to aseptic meningitis, fulminant encephalitis, or a poliomyelitis-like presentation with flaccid paralysis. Extrapyramidal symptoms can occur. Long-term neurologic sequelae are common with severe disease.• Risk factors for neuroinvasive disease include age older than 60 years, malignancy, diabetes, organ transplantation, and genetic factors.
Diagnostic Testing
Diagnosis is usually clinical or by CSF and serum WNV-specific IgM. Serum WNV IgG antibodies persist for years and suggest previous infection. Cross-reactivity with the less common St. Louis encephalitis virus occurs.
TREATMENT
Treatment for arboviral meningoencephalitides is mostly supportive.48
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