West nile: Difference between revisions
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==Overview== | ==Overview== | ||
==History and Symptoms== | |||
WNV has three different effects on humans. The first is an [[asymptomatic]] infection; the second is a mild [[febrile]] syndrome termed West Nile Fever;<ref>Olejnik E. "Infectious adenitis transmitted by ''Culex molestus''." ''Bull. Res. Counc. Isr.'' 1952; 2: | |||
210-211.</ref> the third is a neuroinvasive disease termed West Nile [[meningitis]] or [[encephalitis]].<ref>Smithburn K C, Jacobs H R. "Neutralization-tests against neurotropic viruses with sera collected in central Africa." ''Journal of Immunology'' 1942; 44: 923.</ref> In infected individuals the ratio between the three states is roughly 110:30:1.<ref>Tsai T F, Popovici F, Cernescu C, Campbell G L, Nedelcu N I. "West Nile encephalitis epidemic in south eastern Romania." ''Lancet'' 1998; 352: 767-771</ref> | |||
The second, febrile stage has an incubation period of 3-8 days followed by fever, headache, chills, [[diaphoresis]], weakness, [[lymphadenopathy]], and drowsiness. Occasionally there is a short-lived truncal rash and some patients experience gastrointestinal symptoms including nausea, vomiting, loss of appetite, or diarrhea. All symptoms are resolved within 7-10 days, although fatigue can last for some weeks and lymphadenopathy can take up to two months to resolve. | |||
The more dangerous encephalitis is characterized by similar early symptoms but also a decreased level of consciousness, sometimes approaching near-coma. Deep tendon reflexes are hyperactive at first, later diminished. There are also [[extrapyramidal disorder]]s. Recovery is marked by a long convalescence with fatigue. | |||
More recent outbreaks have resulted in a deeper study of the disease and other, rarer, outcomes have been identified.The spinal cord may be infected, marked by [[anterior myelitis]] with or without encephalitis.<ref>Sejvar J J, Haddad M B, Tierney B C, Campbell G L, Marfin A A, VanGerpen J A, Fleischauer A, Leis A A, Stokic D S, Petersen L R. "Neurologic manifestations and outcome of West Nile virus infection." ''JAMA'' 2003; 290: 511-515.</ref> WNV-associated [[Guillain-Barré syndrome]] has been identified<ref>Ahmed S, Libman R, Wesson K, Ahmed F, Einberg K. "Guillain-Barre syndrome: an unusual presentation of West Nile virus infection." ''Neurology'' 2000; 55: 144-146.</ref> and other rare effects include multifocal [[chorioretinitis]] (which has 100% specificity for identifying WNV infection in patients with possible WNV encephalitis)<ref>Abroug F, Ouanes-Besbes L, Letaief M, Ben Romdhane F, Khairallah M, Triki H, Bouzouiaia N. "A cluster study of predictors of severe West Nile virus infection." ''Mayo Clinic Proceedings'' 2006; 81: 12-16.</ref> [[hepatitis]], [[myocarditis]], [[nephritis]], [[pancreatitis]], and [[splenomegaly]].<ref>Perelman A, Stern J. "Acute pancreatitis in West Nile Fever." ''American Journal of Tropical Medicine and Hygiene'' 1974; 23: 1150-1152.</ref><ref>Omalu B I, Shakir A A, Wang G, Lipkin W I, Wiley C A. "Fatal fulminant pan-meningo-polioencephalitis due to West Nile virus." ''Brain Pathology'' 2003; 13: 465-472</ref><ref>Mathiot C C, Georges A J, Deubel V. "Comparative analysis of West Nile virus strains isolated from human and animal hosts using monoclonal antibodies and cDNA restriction digest profiles." ''Res Virol'' 1990; 141: 533-543.</ref> | |||
==References== | ==References== | ||
Revision as of 19:27, 2 February 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
History and Symptoms
WNV has three different effects on humans. The first is an asymptomatic infection; the second is a mild febrile syndrome termed West Nile Fever;[1] the third is a neuroinvasive disease termed West Nile meningitis or encephalitis.[2] In infected individuals the ratio between the three states is roughly 110:30:1.[3]
The second, febrile stage has an incubation period of 3-8 days followed by fever, headache, chills, diaphoresis, weakness, lymphadenopathy, and drowsiness. Occasionally there is a short-lived truncal rash and some patients experience gastrointestinal symptoms including nausea, vomiting, loss of appetite, or diarrhea. All symptoms are resolved within 7-10 days, although fatigue can last for some weeks and lymphadenopathy can take up to two months to resolve.
The more dangerous encephalitis is characterized by similar early symptoms but also a decreased level of consciousness, sometimes approaching near-coma. Deep tendon reflexes are hyperactive at first, later diminished. There are also extrapyramidal disorders. Recovery is marked by a long convalescence with fatigue.
More recent outbreaks have resulted in a deeper study of the disease and other, rarer, outcomes have been identified.The spinal cord may be infected, marked by anterior myelitis with or without encephalitis.[4] WNV-associated Guillain-Barré syndrome has been identified[5] and other rare effects include multifocal chorioretinitis (which has 100% specificity for identifying WNV infection in patients with possible WNV encephalitis)[6] hepatitis, myocarditis, nephritis, pancreatitis, and splenomegaly.[7][8][9]
References
- ↑ Olejnik E. "Infectious adenitis transmitted by Culex molestus." Bull. Res. Counc. Isr. 1952; 2: 210-211.
- ↑ Smithburn K C, Jacobs H R. "Neutralization-tests against neurotropic viruses with sera collected in central Africa." Journal of Immunology 1942; 44: 923.
- ↑ Tsai T F, Popovici F, Cernescu C, Campbell G L, Nedelcu N I. "West Nile encephalitis epidemic in south eastern Romania." Lancet 1998; 352: 767-771
- ↑ Sejvar J J, Haddad M B, Tierney B C, Campbell G L, Marfin A A, VanGerpen J A, Fleischauer A, Leis A A, Stokic D S, Petersen L R. "Neurologic manifestations and outcome of West Nile virus infection." JAMA 2003; 290: 511-515.
- ↑ Ahmed S, Libman R, Wesson K, Ahmed F, Einberg K. "Guillain-Barre syndrome: an unusual presentation of West Nile virus infection." Neurology 2000; 55: 144-146.
- ↑ Abroug F, Ouanes-Besbes L, Letaief M, Ben Romdhane F, Khairallah M, Triki H, Bouzouiaia N. "A cluster study of predictors of severe West Nile virus infection." Mayo Clinic Proceedings 2006; 81: 12-16.
- ↑ Perelman A, Stern J. "Acute pancreatitis in West Nile Fever." American Journal of Tropical Medicine and Hygiene 1974; 23: 1150-1152.
- ↑ Omalu B I, Shakir A A, Wang G, Lipkin W I, Wiley C A. "Fatal fulminant pan-meningo-polioencephalitis due to West Nile virus." Brain Pathology 2003; 13: 465-472
- ↑ Mathiot C C, Georges A J, Deubel V. "Comparative analysis of West Nile virus strains isolated from human and animal hosts using monoclonal antibodies and cDNA restriction digest profiles." Res Virol 1990; 141: 533-543.