West Nile Encephalitis Treatment & Management

  • Author: Burke A Cunha, MD; Chief Editor: Michael Stuart Bronze, MD   more...
 
Updated: Jun 17, 2011
 

Approach Considerations

Provide supportive care to minimize the potential for cerebral edema. In comatose patients, pay special attention to maintaining a clear airway.

Replace fluids and electrolytes, as they are lost through insensible losses due to fever and decreased or absent intake. Patients who are unconscious may need ventilation support in an intensive care unit (ICU) until consciousness is restored.

A normal diet and normal activity, as tolerated by the patient, are acceptable. Many patients recover quickly, but some experience prolonged malaise.[13, 14, 15]

West Nile encephalopathy (WNE) is prevented through avoidance of mosquitoes.

Consult an infectious disease specialist and a neurologist. In patients with WNE, repeat testing for lymphopenia or increased serum transaminases until levels return to normal. A repeat lumbar puncture is usually unnecessary. Further outpatient care is usually unnecessary.

Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Wesley W Emmons, MD, FACP  Assistant Professor, Department of Medicine, Thomas Jefferson University; Consulting Staff, Infectious Diseases Section, Department of Internal Medicine, Christiana Care, Newark, DE

Wesley W Emmons, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International AIDS Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

John L Brusch, MD, FACP  Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD  Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

  1. Cunha BA. Alexander the Great and West Nile virus encephalitis. Emerg Infect Dis. Jul 2004;10(7):1328-9; author reply 1332-3. [Medline].

  2. Oldach D, Benitez RM, Mackowiak PA. Alexander the Great and West Nile virus encephalitis. Emerg Infect Dis. Jul 2004;10(7):1329-30; author reply 1332-3. [Medline].

  3. MacDonald RD, Krym VF. West Nile virus. Primer for family physicians. Can Fam Physician. Jun 2005;51:833-7. [Medline]. [Full Text].

  4. Petersen LR, Marfin AA. West Nile virus: a primer for the clinician. Ann Intern Med. Aug 6 2002;137(3):173-9. [Medline].

  5. Murray K, Baraniuk S, Resnick M, Arafat R, Kilborn C, Cain K, et al. Risk factors for encephalitis and death from West Nile virus infection. Epidemiol Infect. Dec 2006;134(6):1325-32. [Medline]. [Full Text].

  6. Wadei H, Alangaden GJ, Sillix DH, et al. West Nile virus encephalitis: an emerging disease in renal transplant recipients. Clin Transplant. Dec 2004;18(6):753-8. [Medline].

  7. Zou S, Foster GA, Dodd RY, Petersen LR, Stramer SL. West Nile fever characteristics among viremic persons identified through blood donor screening. J Infect Dis. Nov 1 2010;202(9):1354-61. [Medline].

  8. Abroug F, Ouanes-Besbes L, Letaief M, et al. A cluster study of predictors of severe West Nile virus infection. Mayo Clin Proc. Jan 2006;81(1):12-6. [Medline]. [Full Text].

  9. Nash D, Mostashari F, Fine A, et al. The outbreak of West Nile virus infection in the New York City area in 1999. N Engl J Med. Jun 14 2001;344(24):1807-14. [Medline].

  10. Rodriguez AJ, Westmoreland BF. Electroencephalographic characteristics of patients infected with west nile virus. J Clin Neurophysiol. Oct 2007;24(5):386-9. [Medline].

  11. Rawal A, Gavin PJ, Sturgis CD. Cerebrospinal fluid cytology in seasonal epidemic West Nile virus meningo-encephalitis. Diagn Cytopathol. Feb 2006;34(2):127-9. [Medline].

  12. Tyler KL, Pape J, Goody RJ, et al. CSF findings in 250 patients with serologically confirmed West Nile virus meningitis and encephalitis. Neurology. Feb 14 2006;66(3):361-5. [Medline].

  13. Murray KO, Resnick M, Miller V. Depression after infection with West Nile virus. Emerg Infect Dis. Mar 2007;13(3):479-81. [Medline]. [Full Text].

  14. Ou AC, Ratard RC. One-year sequelae in patients with West Nile Virus encephalitis and meningitis in Louisiana. J La State Med Soc. Jan-Feb 2005;157(1):42-6. [Medline].

  15. Sejvar JJ. The long-term outcomes of human West Nile virus infection. Clin Infect Dis. Jun 15 2007;44(12):1617-24. [Medline].

  16. Cunha BA. Differential diagnosis of West Nile encephalitis. Curr Opin Infect Dis. Oct 2004;17(5):413-20. [Medline].

  17. Cunha BA, Minnaganti V, Johnson DH, Klein NC. Profound and prolonged lymphocytopenia with West Nile encephalitis. Clin Infect Dis. Oct 2000;31(4):1116-7. [Medline].

  18. Cunha BA, Sachdev B, Canario D. Serum ferritin levels in West Nile encephalitis. Clin Microbiol Infect. Feb 2004;10(2):184-6. [Medline].

 
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Common encephalitis associations.
Clinical features of arboviral encephalitis.
Differential diagnoses of meningoencephalitis.
The Culex mosquito, common in the eastern United States, is the primary vector responsible for infecting humans with West Nile virus. Prevention of West Nile virus is primarily directed at reducing the mosquito population from May to October and by taking precautions to limit human exposure during these months of high mosquito activity. Image courtesy of the Centers for Disease Control and Prevention.
The geographic distribution of the Japanese encephalitis servocomplex of the family Flaviridae, 2000. Image courtesy of the Centers for Disease Control and Prevention.
States reporting laboratory-positive West Nile virus infection in birds, mosquitoes, animals, or humans between January 1 and August 28, 2002. Image courtesy of the Centers for Disease Control and Prevention.
 
 
 
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