West Nile Fever

Dr.Ali Alhumood
aliabh2006@hotmail.com
 Definition:
West Nile virus (WNV) causes West
Nile fever and West Nile meningitis,
encephalitis and West Nile
poliomyelitis. It can infect people,
birds, mosquitoes, horses and other
animals. In Washington State the virus
was first found in horses and birds in
2002. The first human infection by
WNV in Washington State occurred in
2006.
 Etiolgy:
The disease is caused by flaviviruses. It is a single
stranded RNA. Morphological it is enveloped,
spherical viruses, 40-60nm diameter.
- Family: Flaviviridae.
- Genus:
1. Flavivirus => Type of species is Yellow fever virus.
2. Pestivirus => Type of species is Bovine diarrhea
virus 1.
3. Hepacivirus => Type of species is Hepatitis C
virus.
- Host:
Vertebrae (Human, mammals and birds)
 Epidemiology:
• Most severe illness occurs in older patients
– Over age 50: Twenty fold risk of severe illness
• Timing
– Temperate climate: Late summer and early fall
• Range of infections: Mid-July to early December
• Peaks in late August to early September
– Southern climate: Year round transmission
– Most favorable weather conditions
• Hot,dry summer with brief unseasonably cool weather
• Distribution
– Africa
– West Asia
– Eastern Europe
– Middle East
– United States
 Incubation Period:

3-14 days after a bite from

an infected mosquito
 Transmission& live cycle
• West Nile virus is spread to people
mainly by the bite of an infected
mosquito. Mosquitoes become infected
after feeding on birds that carry the
virus. WNV is not spread by direct
contact with infected animals or people.
WNV may be spread via blood
transfusion and organ transplantation.
The virus has also been found in breast
milk and passed to a child during
pregnancy
Many mosquito species able to transmit
a disease. The genus of mosquito is
Culex .
- C pipiens and C restuans:
They major vector species in most of the
United States.
- C quinquefasciatus:
Plays an important role in the southern
portion of this country.
 Bird Identification, Family
Corvidae(crows and jays)

American Crow Common Raven

 Stellar's Jay Western
Scrub Jay

Yellow-billed
Magpie
 Clinical Signs:
In Human: In more sever more
infections there is:
The clinical signs are not 1. headache.
systematic, in most of the
cases there is only mild 2. High fever.
infection with an influenza- 3. Neck stiffness.
like illness that includes: 4. Stupor.
1. Fever. 5. Nisorientation.
2. Headache. 6. Comma.
3. body aches. 7. Tremors.
4. skin rash. 8. Convulsions.
5. swollen lymph glands. 9. Paralysis.
In some individuals, especially
the elderly, West Nile Virus
cause aseptic meningitis
and encephalitis which are
often fatal.
In dogs and cat:

Rarely exhibit clinical illness

•Fever, depression
•Muscle weakness, spasms
•Seizures, paralysis, myocarditis
•Wolf-1 case–3 months old, zoo animal, CNS
signs
•Suspect WNV in animals exhibiting
neurological and cardiac symptoms
In horses:

• Paralysis of lips, facial muscle, or tongue.

• Head tilt.
• Difficulty swallowing.
• Blindness.
• Drowsiness.
• Flu-like , anaroxia , depression.
• Muscle and skin twitching.
• Weakness, ataxia, recumbeny.
• Propulsive in walking.
 WNV Aseptic Meningitis

• Fever, headache, nuchal rigidity (100%).

• Nausea, vomiting, neck pain, myalgia (80%).
• Symptoms with variable frequency:
1. Low back pain.
2. Tremors.
3. Parkinsonism.
4. Myoclonus.
5. Flaccid paralysis of limb.
6. Cranial nerve palsies .
7. Cerebellar signs.
 WNV Encephalitis

• Most common symptoms:

Fever, headache, altered mental status.
• Variable symptoms:
1. Tremors.
2. Weakness.
3. Cerebellar signs/symptoms.
4. Nystagmus, dysphagia, decreased gag.
5. “Locked-in”syndrome.
 Diagnosis:
Specimens required for diagnosis: Whole blood, serum,
and cerebrospinal fluid (if collected) samples that are
processed by PCR and immuno-histochemistry.
A. Serology:
1. Fluorescent antibody.
2. Virus neutralizing antibodies.
3. IgM capture ELIZA.
B. RT-PCR:
• Blood – negative.
• CSF – negative.
• Brain\cord – positive.
C. Virus isolation:
• Blood – negative.
• Brain\cord – positive.
 Differential Diagnosis:
• Estern, western, venezuelan equine
encephalomyelitis.
• Equine herpes virus 1.
• Rabies.
• Equine protozoal myelitis.
• Leukoencephalomacia.
• Stenotic cervical myelopathy.
• Hepatic, intestinal or renal
encephalopathies.
 Post mortem:
• No lesions are pathognomonic for West Nile Virus
infection.
• Only nervous tissue involvement
1. Few gross lesions within the brain – occasional
hemorrhages.
• Prominent rhombencephalic lesions
1. Multifocal perivascular lymphocytic
rhombencephalitis.
2. Ring hemorrhages, neutrophils and multifocal
microgliosis.
• Peroxidase immunohistochemical staining
1. West Nile virus antigen in cytoplasm.
2. Few neurons, nerve fibers, glial cells, neutrophils.
 Treatment:
1. Supportive therapy.
2. 2 .IV fluids.
3. Analgesia and antipyretics may be useful in milder
cases of illness.
4. Preventive of secondary infection.
5. Respiratory support.
6. Preventing self-inflicted injury.
7. Interferon therapy.
8. Nutritional support.
9. In severe neurologic disease use anti-WNV
intravenous immunoglobulin.
 Vaccination for horses:
• Fully licensed vaccine
- Killed produc.
- 2 doses, 3-6 weeks apart.
- Annual booster.
- Restricted use to veterinarians only.
 Prevention:
• Use mosquito repellant when
necessary, and carefully follow the
directions on the label. Effective
repellents contain DEET, picaridin,
or oil of lemon eucalyptus.
• Prevention of Vector-borne Infection.
• Control the migrating birds.
• Eliminate areas of standing water
The end