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Last reviewed: 20 Mar 2025
Last updated: 07 Jan 2025

Summary

Definition

History and exam

Key diagnostic factors

  • fever of sudden onset
  • malaise
  • myalgia
  • arthralgia
  • pharyngitis
  • anorexia
  • abdominal pain
  • visual disturbances
  • headache
  • rash
  • lymphadenopathy
  • conjunctival injection
  • multi-focal chorioretinal lesions
  • chorioretinitis and inflammatory vitritis
  • seizures
  • respiratory distress
  • jaundice
  • epigastric tenderness
  • mild confusion
  • disorientation
  • stupor/coma
  • neck stiffness
  • Kernig's sign
  • Brudzinski's sign
  • muscle paralysis
  • parkinsonism
  • ataxia
  • myoclonus
  • tremors

Other diagnostic factors

  • nausea/vomiting
  • generalised muscle weakness
  • splenomegaly
  • retinal haemorrhages
  • chest pain, dyspnoea, palpitations
  • photophobia
  • depression
  • loss of memory
  • bowel and bladder dysfunction
  • cranial nerve palsies

Risk factors

  • living in/visiting areas with high West Nile virus activity
  • mosquito bites
  • blood transfusion
  • organ transplant
  • needle-stick injuries

Diagnostic investigations

1st investigations to order

  • serology
  • plaque reduction neutralisation test
  • cerebrospinal fluid (CSF) analysis
  • full blood count
  • serum electrolytes
  • liver function tests
  • serum amylase/lipase

Investigations to consider

  • MRI brain
  • CT head
  • reverse transcriptase-polymerase chain reaction (RT-PCR)

Treatment algorithm

Contributors

Authors

Bruce Y. Lee, MD, MBA
Bruce Y. Lee

Professor of Health Policy and Management

Executive Director

Center for Advanced Technology and Communication for Health (CATCH)

Public Health Informatics Computational and Operation Research (PHICOR)

City University of New York (CUNY)

New York

NY

Disclosures

BYL declares that he has no competing interests.

Peer reviewers

Susan Stramer, PhD

Executive Scientific Officer

American Red Cross

Gaithersburg

MD

Disclosures

SS declares that she has no competing interests.

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