eMedicine Specialties > Physical Medicine and Rehabilitation > Medical Diseases

West Nile Virus: Follow-up

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
Coauthor(s): Monica L Steiner, MD, Clinical Assistant Professor, Program Director, Department of Orthopedics and Rehabilitation, Loyola University Medical Center
Contributor Information and Disclosures

Updated: Nov 6, 2009

Follow-up

Further Outpatient Care

  • Consultation with a psychologist or neuropsychologist may be helpful.16
  • The neuropsychologist's role includes developing behavioral treatment plans, assessing the patient's cognitive and emotional function, and providing individual, group, and family therapy.
  • The neuropsychologist also assesses the patient's attention, executive functions, personality, and memory, language, and visual-spatial abilities by using various specialized tests.
  • Although the literature concerning the neuropsychologic assessment and cognitive rehabilitation of patients with encephalitis is limited, neurocognitive testing may be useful in identifying deficits, and neurocognitive therapy to treat those deficits plays a significant part in the rehabilitation process.
  • The primary cognitive consequences of encephalitis involve attention, memory, information processing speed, and cognitive efficiency.
  • As a part of a rehabilitation team, the neuropsychologist also collaborates with the speech therapist and occupational therapist to maximize the interplay between cognitive rehabilitation and function.17

Deterrence

  • The Centers for Disease Control and Prevention (CDC) offer the following 3 major suggestions to help prevent West Nile virus infection18 :
    • Avoid mosquito bites.
    • Mosquito-proof the home.
    • Support community-based efforts in mosquito control and the prevention of West Nile virus infection.19,20
  • Avoiding mosquito bites
    • Individuals should apply insect repellent containing N,N -diethyl-meta-toluamide (DEET) to exposed skin whenever they go outdoors. In addition, using permethrin on clothing is very effective as an insecticide and as a repellent.
    • When possible, people should wear long sleeves, long pants, and socks when outdoors.
    • Mosquitoes can bite through thin clothing, so spraying clothes with repellent containing permethrin or DEET provides additional protection. However, repellents containing permethrin should not be applied directly to the skin, and repellent containing DEET should not be applied to skin under clothing.
    • The peak hours for mosquito bites are from dusk to dawn. Individuals are advised to use repellent and protective clothing in the evening and early morning or to consider avoiding outdoor activities during these times.
  • Mosquito-proofing homes
    • Because mosquitoes lay their eggs in standing water, containers or bodies of standing water should be drained if possible.
    • People can help prevent mosquitoes from entering their homes by repairing or installing screens on their doors and windows.
  • Supporting community-based efforts
    • Dead birds can indicate the presence of the West Nile virus in a community and should be reported to local health authorities.
    • Some communities have initiated mosquito-control programs. Local governments should have additional information about these programs.
    • Keeping the community clean by picking up garbage and draining standing water from vacant areas and parks can help to eliminate mosquito breeding grounds.

Prognosis

  • The prognosis is generally good.
  • However, the elderly and persons with multiple medical complications have a poorer prognosis.

Patient Education

 


More on West Nile Virus

Overview: West Nile Virus
Differential Diagnoses & Workup: West Nile Virus
Treatment & Medication: West Nile Virus
Follow-up: West Nile Virus
References
Further Reading
[ CLOSE WINDOW ]

References

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

  2. Brinton MA. Host factors involved in West Nile virus replication. Ann N Y Acad Sci. Dec 2001;951:207-19. [Medline].

  3. Kramer LD, Bernard KA. West Nile virus in the western hemisphere. Curr Opin Infect Dis. Oct 2001;14(5):519-25. [Medline].

  4. Centers for Disease Control and Prevention. Provisional surveillance summary of the West Nile virus epidemic--United States, January-November 2002. MMWR Morb Mortal Wkly Rep. Dec 20 2002;51(50):1129-33. [Medline].

  5. Centers for Disease Control and Prevention. West Nile virus update--United States, January 1-November 13, 2007. MMWR Morb Mortal Wkly Rep. Nov 16 2007;56(45):1191-2. [Medline].

  6. Asnis DS, Conetta R, Teixeira AA, et al. The West Nile Virus outbreak of 1999 in New York: the Flushing Hospital experience. Clin Infect Dis. Mar 2000;30(3):413-8. [Medline].

  7. Campbell GL, Marfin AA, Lanciotti RS, et al. West Nile virus. Lancet Infect Dis. Sep 2002;2(9):519-29. [Medline].

  8. 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]. [Full Text].

  9. Moorthi S, Schneider WN, Dombovy ML. Rehabilitation outcomes in encephalitis--a retrospective study 1990-1997. Brain Inj. Feb 1999;13(2):139-46. [Medline].

  10. Verma S, Lo Y, Chapagain M, Lum S, et al. West Nile virus infection modulates human brain microvascular endothelial cells tight junction proteins and cell adhesion molecules: Transmigration across the in vitro blood-brain barrier. Virology. Mar 15 2009;385(2):425-33. [Medline].

  11. Centers for Disease Control and Prevention. Acute flaccid paralysis syndrome associated with West Nile virus infection--Mississippi and Louisiana, July-August 2002. MMWR Morb Mortal Wkly Rep. Sep 20 2002;51(37):825-8. [Medline].

  12. Centers for Disease Control and Prevention. Update: Investigations of West Nile virus infections in recipients of organ transplantation and blood transfusion--Michigan, 2002. MMWR Morb Mortal Wkly Rep. Oct 4 2002;51(39):879. [Medline].

  13. Petzold A, Groves M, Leis AA, et al. Neuronal and glial cerebrospinal fluid protein biomarkers are elevated after West Nile Virus infection. Muscle Nerve. Sep 29 2009;[Medline].

  14. Zaayman D, Human S, Venter M. A highly sensitive method for the detection and genotyping of West Nile virus by real-time PCR. J Virol Methods. May 2009;157(2):155-60. [Medline].

  15. Sampson BA, Armbrustmacher V. West Nile encephalitis: the neuropathology of four fatalities. Ann N Y Acad Sci. Dec 2001;951:172-8. [Medline].

  16. Greve KW, Houston RJ, Adams D, et al. The neurobehavioural consequences of St. Louis encephalitis infection. Brain Inj. Oct 2002;16(10):917-27. [Medline].

  17. Sejvar JJ, Curns AT, Welburg L, et al. Neurocognitive and functional outcomes in persons recovering from West Nile virus illness. J Neuropsychol. Sep 2008;2:477-99. [Medline].

  18. West Nile Virus. Centers for Disease Control and Prevention; [Full Text].

  19. Harbison JE, Metzger ME, Allen V 2nd, et al. Evaluation of manhole inserts as structural barriers to mosquito entry into belowground stormwater systems using a simulated treatment device. J Am Mosq Control Assoc. Sep 2009;25(3):356-60. [Medline].

  20. LaBeaud AD, Glinka A, Kippes C, et al. School-based health promotion for mosquito-borne disease prevention in children. J Pediatr. Oct 2009;155(4):590-2. [Medline].

  21. Ahmed S, Libman R, Wesson K, et al. Guillain-Barre syndrome: an unusual presentation of West Nile virus infection. Neurology. Jul 12 2000;55(1):144-6. [Medline].

  22. Anderson JF, Main AJ, Ferrandino FJ, et al. Nocturnal activity of mosquitoes (Diptera: Culicidae) in a West Nile virus focus in Connecticut. J Med Entomol. Nov 2007;44(6):1102-8. [Medline].

  23. Centers for Disease Control and Prevention. Intrauterine West Nile virus infection--New York, 2002. MMWR Morb Mortal Wkly Rep. Dec 20 2002;51(50):1135-6. [Medline].

  24. Katz N, ed. Cognitive Rehabilitation: Models for Intervention in Occupational Therapy. Boston, Mass: Andover Medical Pubs; 1992.

  25. Craven RB, Roehrig JT. West Nile virus. JAMA. Aug 8 2001;286(6):651-3. [Medline].

  26. DeGroote J, Mercer DR, Fisher J, et al. Spatiotemporal investigation of adult mosquito (Diptera: Culicidae) populations in an eastern Iowa County, USA. J Med Entomol. Nov 2007;44(6):1139-50. [Medline].

  27. From the Centers for Disease Control and Prevention. Surveillance for West Nile virus in overwintering mosquitoes--New York, 2000. JAMA. May 10 2000;283(18):2380-1. [Medline]. [Full Text].

  28. Glass JD, Samuels O, Rich MM. Poliomyelitis due to West Nile virus. N Engl J Med. Oct 17 2002;347(16):1280-1. [Medline].

  29. Hubalek Z. Comparative symptomatology of West Nile fever. Lancet. Jul 28 2001;358(9278):254-5. [Medline].

  30. Nasci RS, Parise ME, Wirtz RA, et al. Pre- and post-travel general health recommendations. In: Arguin PM, Kozarsky PE, Reed C, eds. CDC Health Information for International Travel. Elsevier; 2007:[Full Text].

  31. Nichter CA, Pavlakis SG, Shaikh U, et al. Rhombencephalitis caused by West Nile fever virus. Neurology. Jul 12 2000;55(1):153. [Medline].

  32. Montgomery J, ed. Physical Therapy for Traumatic Brain Injury. New York, NY: Churchill Livingstone; 1995.

  33. Prigatano GP. Principles of Neuropsychological Rehabilitation. New York, NY: Oxford University Press; 1999.

  34. Samuel CE. Host genetic variability and West Nile virus susceptibility. Proc Natl Acad Sci U S A. Sep 3 2002;99(18):11555-7. [Medline]. [Full Text].

  35. Styer LM, Kent KA, Albright RG, et al. Mosquitoes inoculate high doses of West Nile virus as they probe and feed on live hosts. PLoS Pathog. Sep 14 2007;3(9):1262-70. [Medline]. [Full Text].

  36. Woo BH, Nesathurai S, eds. The Rehabilitation of People with Traumatic Brain Injury. Boston, Mass: Boston Medical Center/Blackwell Science; 2000.

  37. Wang T, Anderson JF, Magnarelli LA, et al. West Nile virus envelope protein: role in diagnosis and immunity. Ann N Y Acad Sci. Dec 2001;951:325-7. [Medline].

[ CLOSE WINDOW ]

Further Reading

Clinical guidelines:
Interim guidelines for the evaluation of infants born to mothers infected with West Nile virus during pregnancy. Centers for Disease Control and Prevention - Federal Government Agency [U.S.]. 2004 Feb 27. 4 pages. NGC:003471

The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Infectious Diseases Society of America - Medical Specialty Society. 2008 Aug 1. 25 pages. NGC:007083

Clinical trials:
Treatment of West Nile Virus With MGAWN1 (PARADIGM)

VRC 300: Screening of Healthy Volunteers for Clinical Trials of Investigational Vaccines to Prevent Infectious Diseases

[ CLOSE WINDOW ]

Keywords

West Nile virus, West Nile symptoms, West Nile virus symptoms, WNV, , West Nile fever, West Nile encephalitis, West Nile virus mosquitoes, West Nile fever, West Nile infection, mosquito bites, mosquitoes, mosquitoes, mosquitoes

[ CLOSE WINDOW ]

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.

Medical Editor

Elizabeth A Moberg-Wolff, MD, Associate Professor and Pediatric PM&R Fellowship Director, Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin; Program Director, Tone Management and Mobility, Department of Physical Medicine and Rehabilitation, Children's Hospital of Wisconsin
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 Grant/research funds Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, 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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.