Treatment

There are no specific treatments for WNV. A number of treatment strategies have been investigated and several are currently in clinical trials. These strategies include: vaccines, antivirals and antibody products.

Until an effective WNV treatment is developed, medical care will consist of supportive care directed toward alleviating disease symptoms. Symptoms and care can be organized into three levels of severity:

• Asymptomatic WNV positive patients require no medical treatment. Patients should be counseled regarding the natural course of the disease, to seek medical advice if more severe symptoms appear and to avoid blood donation.
• Mild symptoms West Nile Fever resembles the flu. Acetaminophen may be prescribed to control fever and myalgia. Aspirin should be avoided to reduce risk of Reyes syndrome. Fever and vomiting may require fluid or electrolyte replacement. Patients should be counseled as to the natural course of the disease and to seek medical advice if symptoms persist or escalate.
• Severe neurologic symptoms indicates viral invasion of the nervous system.
  • Acute flaccid paralysis is characterized by asymmetric weakness or paralysis without sensory loss, potentially progressing to life threatening respiratory paralysis. It is thought to be a polio-like condition due to viral infection of the anterior horn of the spinal cord.
    Intensive inpatient care may require:
    • Airway, Breathing, Circulatory monitoring and support
    • Ongoing neuro checks
    • Pain control
    • Antipyretic
    • Psycho-social support
    • Fluid/electrolyte/nutrition management
    • Elimination management
    • ROM
    • Hygiene
  • Viral meningitis, WNV infection of the pia mater and arachnoid layers is serious but rarely fatal. It rarely results in permanent disability and symptoms usually improve in a few days to weeks. Common symptoms of viral meningitis are: fever, headache, neck stiffness, photophobia, drowsiness or confusion, and nausea and vomiting (N/V).
    • Emergent testing may include:
      • CBC
      • CT/MRI
      • LP
    • Suppotive care may include:
      
      • Airway, Breathing, Circulatory monitoring
        • Fluid & electrolyes management
      • Antibiotic therapy until bacterial meningitis can be ruled out
      • Ongoing neuro checks
        • Increased risk of elevated ICP
        • Anticipate: intubation, hyperventilation, mannitol
      • Seizure precautions
        • Anticonvulsant medications
      • Pain control
      • Antipyretic
      • Psycho-social support
  • Encephalitis, WNV infection of the brain tissue often begins with non-specific symptoms consistent with the Flu. Patients diagnosed with viral encephalitis who present symptoms of: malaise, N/V, myalgia, mild headache, photophobia, and low-grade fever should be admitted to a skilled nursing facility. More severe symptoms require ICU admission for close observation. Severe symptoms include: Cognitive & behavioral changes, seizures, and depression of consciousness, stupor and coma.
    
    • Intensive care includes:
      
      • Airway & Breathing monitoring and support
        • Incapacited and intubated patients are at risk for
          • Pneumonia
          • Pulmonary embolism
      • Circulatory monitoring
        • Arrhythmia risk due to electrolyte imbalance or brainstem damage
          • ECG monitoring
      • Fluid & electrolyes monitoring
        • Avoid hypotonic solutions, risk of cerebral edema
      • Antidiuretic hormone (ADH) abnormalities are common in viral encephalitis
      • Antibiotic therapy
        • When bacterial meningitis/encephalitis can not be ruled out
        • Indwelling lines and catheters increase risk
      • Ongoing neuro checks
        • Elevated ICP due to cerebral edema
          • Intubate and hyperventilate to reduce PCO2
          • IV mannitol
      • Seizure precautions
        • Anticonvulsant medications
      • Pain control
      • Skin care
      • Range of motion
      • Antipyretic
      • Psycho-social support