West Nile Virus

West Nile Virus. Yes, it is still around however it is clearly dependent on rainfall and reproduction of this mosquito. It should always be on the differential diagnosis list with outdoor activity and presentation of fever and body aches in the summer time

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Survive Outdoors first reported on West Nile Virus in August of 2002. At that time it covered the East coast and had move to the Central United States. Currently in 2021 It is in all 50 states. It has progressed to the point of being endemic. IN 1999 on the East coast of the United States there were 62 patients with encephalitis, 7 deaths in Queens, New York. In 2000 there were 14 patients diagnosed and two were fatal.  By November of 2002 a total of 3,737 cases, with 202 fatalities were noted in 39 states. Evidence of birds ( crows mainly were found in 43 states. The virus has a higher morbidity and mortality in older individuals.

In 2013 West Nile virus incidence had the highest percentage of infections in the western states with an incidence of greater than 1.0 per 100,000, Montana down to New Mexico and North Dakota down to Oklahoma, the second highest, .50- .99/100,000 were the California, Idaho, Arizona, Minnesota, Iowa , Illinois, Arkansas, Mississippi, and Louisiana.

Case Presentation

In 2018 I had a 62 year old male come into our northern Illinois Urgent Care with fever 101 F, diaphoresis (sweating, muscle aches, fine macular rash throughout his body, not pruritic (itchy) and nausea. No cough or shortness of breath. No known exposures. He did get his influenza vaccine in November of the previous year. He came into our clinic in May of 2018. He had no cough but did complain of a headache that was minimal relieved with Tylenol and one of the worse he has had ( could be from the fever ). He had a history of hypertension which was controlled on medication and was compliant with his primary care provider with routine check ups. This guy was sick. He looked sick and he was concerned.

Exam: Mildly diaphoretic, in no severe distress, Head, eyes, ears and throat negative, no swollen lymph nodes, Lungs clear to auscultation, cardiac  tachycardia at 124/minute ( could be from fever).

Chest x-ray negative

In going back in the room and exploring the history more I asked where he has been or what has he done the last three weeks as well as any hobbies. I am thinking now ticks, and insects. He stated 21/2 weeks ago went camping and fishing in northern Minnesota for four days. Had a great time and denied any tick bites that he was aware of. He did then state that a couple nights the mosquitos were very bad and he and his buddies commented on the insane amount of mosquitos. BINGO! Labs needed to be drawn. This could be the beginning of any mosquito Bourne vector illness. St Louis encephalopathy, West Nile, etc

He was sent to the hospital and admitted and his labs came back pos for West Nile Antibodies. He was admitted for one week and did well.

This was my second case in ten years.

Facts and general Information West Nile Virus

West Nile Virus Treatment

Treatment is primarily supportive. Fluids and fever reducing agents and time are the best bet. There is no vaccine at this time for this virus.