West nile virus medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Overview

There is currently no specific antiviral pharmacologic therapy indicated for patients with WNV infection, but interferon-alpha-2b or ribavirin have been used. Patients with mild disease may be followed-up as outpatients; whereas patients with severe disease require hospitalization and close monitoring. Current management of infected patients is based on supportive care aimed at symptom relief and prevention of complications.

Medical therapy

Supportive care

• There is no specific antiviral therapy indicated for patients with WNV infection.
• Treatment is aimed at supportive measurements and prevention of complications.
• In mild cases, patients may be followed-up as out-patients. On the other hand, severe cases often require hospitalization to receive supportive treatment, such as intravenous fluids, analgesics, and nursing care.
• Patients with severe meningeal symptoms often require pain control for headaches, along with antiemetic therapy and rehydration for associated nausea and vomiting.
• Patients with encephalitis require close monitoring for possible development of elevated intracranial pressure and seizures. They should also be closely monitored for possible mechanical ventilation in cases where patients are unable to protect their airways.
• Acute neuromuscular respiratory failure may rapidly develop and ventilatory support may be required.

Pharmacologic therapy

• Although various drugs have been evaluated or empirically administered to patients with WNV disease, none has shown specific benefit.
• Despite common practice, there are no guidelines that recommend the use of ribavirin or interferon alfa-2b for the treatment of WNV encephalitis or meningitis.