Medscape is available in 5 Language Editions – Choose your Edition here.


West Nile Virus Treatment & Management

  • Author: Jess D Salinas, Jr, MD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
Updated: Jun 17, 2016

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.


A study by Greco et al suggested that West Nile virus infection could, in predisposed persons, contribute to the development of myasthenia gravis. In a study of 29 patients with myasthenia gravis, the investigators found that 17% of subjects demonstrated anti–West Nile virus immunoglobulin G (IgG), although none of the patients apparently had clinical signs or symptoms of the virus.[24]


Surgical Intervention

No surgical indications are reported at this time.



See the list below:

  • Physiatrist (physical medicine and rehabilitation specialist)
  • Neurologist
  • Infectious disease specialist
  • Psychologist or neuropsychologist
Contributor Information and Disclosures

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 Medicine, American Academy of Physical Medicine and Rehabilitation, American Medical Association, Physiatric Association of Spine, Sports and Occupational Rehabilitation, American Society of Interventional Pain Physicians, American Academy of Pain Management

Disclosure: Nothing to disclose.


Monica L Steiner, MD 

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

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Chief Editor

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, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

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, American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

  1. Chancey C, Grinev A, Volkova E, Rios M. The global ecology and epidemiology of West Nile virus. Biomed Res Int. 2015. 2015:376230. [Medline]. [Full Text].

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

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

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

  5. West Nile virus and other arboviral diseases--United States, 2012. MMWR Morb Mortal Wkly Rep. 2013 Jun 28. 62(25):513-7. [Medline].

  6. Hackethal V. West Nile Virus, Arborviruses Still Source of Severe Illness. Medscape Medical News. Jun 26 2014. [Full Text].

  7. Lindsey NP, Lehman JA, Staples JE, et al. West nile virus and other arboviral diseases - United States, 2013. MMWR Morb Mortal Wkly Rep. 2014 Jun 20. 63(24):521-6. [Medline].

  8. CDC. West Nile Virus Disease Cases and Presumptive Viremic Blood Donors by State – United States, 2014. Centers for Disease Control and Prevention. Available at Accessed: Jul 14, 2015.

  9. CDC. West Nile Virus: Peliminary Maps & Data for 2015. Centers for Disease Control and Prevention. Available at Jan 12, 2016; Accessed: May 24, 2016.

  10. 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. 2000 Mar. 30(3):413-8. [Medline].

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

  12. 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. 2001 Jun 14. 344(24):1807-14. [Medline]. [Full Text].

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

  14. Hadler JL, Patel D, Nasci RS, et al. Assessment of arbovirus surveillance 13 years after introduction of West Nile virus, United States(1). Emerg Infect Dis. 2015 Jul. 21 (7):1159-66. [Medline].

  15. 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. 2009 Mar 15. 385(2):425-33. [Medline]. [Full Text].

  16. CDC. West Nile virus disease cases and deaths reported to CDC by year and clinical presentation, 1999‐2014. Centers for Disease Control and Prevention. Available at Accessed: Jul 14, 2015.

  17. World Health Organization. West Nile Virus. WHO. Available at Accessed: Jun 21 2014.

  18. 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. 2002 Sep 20. 51(37):825-8. [Medline].

  19. 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. 2002 Oct 4. 51(39):879. [Medline].

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

  21. 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. 2009 May. 157(2):155-60. [Medline].

  22. Hirota J, Shimoji Y, Shimizu S. New Sensitive Competitive ELISA using Monoclonal Antibody against Non-structural Protein 1 of West Nile Virus NY99. Clin Vaccine Immunol. 2011 Dec 21. [Medline].

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

  24. Greco M, Cofano P, Lobreglio G. Seropositivity for West Nile Virus Antibodies in Patients Affected by Myasthenia Gravis. J Clin Med Res. 2016 Mar. 8 (3):196-201. [Medline].

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

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

  27. West Nile Virus. Centers for Disease Control and Prevention. Available at

  28. 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. 2009 Sep. 25(3):356-60. [Medline].

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

  30. Centers for Disease Control and Prevention. West Nile Virus: Final Cumulative Maps & Data for 1999-2013. CDC. Available at Accessed: Jul 20 2014.

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

  32. 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. 2007 Nov. 44(6):1102-8. [Medline].

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

  34. 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. 2002 Dec 20. 51(50):1129-33. [Medline].

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

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

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

  38. 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. 2007 Nov. 44(6):1139-50. [Medline].

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

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

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

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

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

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

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

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

  47. 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. 2007 Sep 14. 3(9):1262-70. [Medline]. [Full Text].

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

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

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.