West Nile Virus Clinical Presentation

  • Author: Jess D Salinas Jr, MD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Jan 18, 2012
 

History

Mosquito bites may or may not be present in an infected person. A history of travel to or from an area that is known to harbor the virus is common.

The incubation period for the West Nile virus is postulated to be approximately 5-15 days. Symptoms of mild infection may last 3-6 days and include fever in 20% of cases. Other symptoms include nausea, anorexia, malaise, myalgia, headache, backache, rash, eye pain, and vomiting.[1]

Symptoms of more severe illness include severe muscle weakness, flaccid paralysis, photophobia, seizures, mental status changes, respiratory symptoms, and an erythematous, maculopapular, or morbilliform rash involving the neck, trunk, arms, or legs.[6, 11] The severity of the illness is related to the degree of central nervous system invasion by the virus.

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Physical

Signs of encephalitis and meningoencephalitis may be seen. These include mental status changes, such as confusion, stupor, or coma. Other findings include positive Brudzinski and Kernig signs, papilledema, cranial nerve involvement (eg, facial weakness, double vision, visual loss, decreased taste sensation), motor strength weakness, decreased sensation, hyperreflexia, and positive pathologic reflexes (eg, Babinski sign, Hoffman sign).

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Causes

The West Nile virus is transmitted to humans by the bite of an infected mosquito. Typically, warm climates and the summer months provide an ideal environment for mosquitoes to breed.[1] Multiple mosquito bites and greater exposure to environments with a large mosquito population increase the risk of infection. However, some cases have been linked to organ transplantation, breastfeeding, and (possibly) blood transfusions.[12]

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Contributor Information and Disclosures
Author

Jess D Salinas Jr, MD  Medical Director, Lake Mary Clinic, National Pain Institute, LLC; Associate Medical Director, Winter Park Clinic, National Pain Institute, LLC

Jess D Salinas Jr, MD is a member of the following medical societies: American Academy of Pain Management, American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Society of Interventional Pain Physicians, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Emedicine Honoraria Other

Coauthor(s)

Monica L Steiner, MD  Clinical Assistant Professor, Program Director, Department of Orthopedics and Rehabilitation, Loyola University Medical Center

Monica L Steiner, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Elizabeth A Moberg-Wolff, MD  Medical Director, Pediatric Rehabilitation Medicine Associates

Elizabeth A Moberg-Wolff, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Physical Medicine and Rehabilitation

Disclosure: Medtronic Neurological None Speaking and teaching

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

Kat Kolaski, MD  Assistant Professor, Departments of Orthopedic Surgery and Pediatrics, Wake Forest University School of Medicine

Kat Kolaski, MD is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine and American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

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