eMedicine Specialties > Physical Medicine and Rehabilitation > Medical Diseases

West Nile Virus: Treatment & Medication

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

Treatment

Rehabilitation Program

Physical Therapy

Brain injury from West Nile virus encephalitis or meningitis can result in cognitive, gross motor, and fine motor delays. Because infected patients have varying degrees of functional deficits, treatment programs must be individualized. Comprehensive rehabilitation using a team consisting of a physiatrist, nurse, physical therapist, occupational therapist, speech therapist, social worker/case manager, and neuropsychologist achieves best outcomes.

The physical therapist can partially address the problems of increased muscle tone, weakness, decreased sensation, and poor endurance. Mobility training, transfer training, and gait training are usually implemented, with range of motion and proper positioning attended to as well. Physical therapists are also important in providing exercises for muscle reeducation and for the improvement of strength, endurance, coordination, and balance, with the goal of returning the patient to independent function.

Occupational Therapy

Occupational therapy focuses on the activities of daily living (ADLs), including bathing, dressing, feeding, and hygiene maintenance. Occupational therapists provide a program to maximize the use of the arms and hands with functional activities; they also address the cognitive issues that affect daily independent function. (See also Further Outpatient Care.)

Speech Therapy

Patients may develop dysarthria, dysphagia, or aphasia. A structured speech therapy program may improve their ability to swallow, help them recover speech and language function, and prevent complications, such as aspiration pneumonia. (See also Further Outpatient Care.)

Medical Issues/Complications

  • Pressure ulcers
    • The development and progression of a pressure ulcer can deeply affect the type, length, and cost of a patient's rehabilitation.
    • Pressure ulcers are caused by prolonged pressure, shear forces, friction, and maceration.
    • Means of preventing this complication include close monitoring of potential ulcer sites, frequent repositioning to reduce pressure on vulnerable areas, ensuring that adequate nutrition is provided, and cleaning and drying sites of perspiration, urine, or feces.
    • Once a pressure ulcer develops and progresses, more severe complications (eg, wound infection, bacteremia, osteomyelitis) may enter the clinical picture.
  • Deep venous thrombosis
    • Elderly patients who are severely deconditioned because of West Nile virus encephalitis may be predisposed to deep venous thrombosis (DVT). The inherent risk of having DVT is the development of a pulmonary embolus that can cause death.
    • Risk factors for DVT may include, among others, decreased mobilization, a history of smoking, and a history of premorbid medical conditions, such as coronary artery disease, diabetes mellitus, hypercoagulopathy, and peripheral vascular disease.
    • Prevention strategies include the use of thigh-high compression stockings, pneumatic compression devices, and subcutaneous, unfractionated or low – molecular weight heparins. Early mobilization and ambulation also may decrease the risk of DVT.
    • Doppler ultrasonography may be used to monitor for DVT, but its accuracy is limited, as has been shown in many studies.
  • Pulmonary complications
    • Individuals with severe illness secondary to West Nile virus infection are at increased risk of pulmonary complications in the rehabilitation setting. Individuals with encephalitis may have a decreased level of consciousness, or they may suffer from dysphagia related to their neurologic injury, predisposing them to aspiration pneumonia.
    • Swallow evaluation can be performed to identify the problem and to help in implementing the appropriate diet and feeding techniques to decrease the risk of aspiration.
    • Phrenic nerve palsy has been described. This complication could lead to decreased expansion of the lungs, further increasing the risk of atelectasis and nosocomial pneumonia.
    • Deep-breathing exercises, use of an inspiratory spirometer, and early mobilization and ambulation help to decrease the risk of these complications occurring.

Surgical Intervention

No surgical indications are reported at this time.

Consultations

  • Physiatrist
  • Neurologist
  • Infectious disease specialist
  • Psychologist or neuropsychologist

Medication

Ongoing research is being pursued into the direct treatment of West Nile virus meningoencephalitis with interferon alpha and intravenous immunoglobulin G (Omr-IgG-am).

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
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References

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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

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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

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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.

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.

 
 
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