West Nile Information for Clinicians

Diagnosis:  Please remember to consider WNV in the differential diagnosis of:

  • Encephalitis
  • Acute Flaccid Paralysis
  • Aseptic Meningitis (especially in adults)

Reporting:  For cases of either encephalitis or acute flaccid paralysis, or for lab results which are preliminarily positive for WNV, please immediately notify San Mateo County Public Health by phone at (650) 573-2346 or by fax at (650) 573-2919. After hours, please call County Communications at (650) 363-4981 and ask for the on-call Public Health Officer.

Lab Testing: The San Mateo Public Health Laboratory will be performing rapid IFA serum testing on suspect cases.  We would like to screen as many cases of the above-mentioned diseases as possible for WNV.  Please click here to go to our lab testing protocol.

Links

Overview of West Nile Virus for Clinicians from CDC (PDF)
West Nile Virus and Breastfeeding from CDC
CDC WNV Homepage
West Nile Virus and Nursing Homes (PDF) [from the California Department of Health Services, August 2003]

Referring Cases for West Nile Virus Testing

1. Refer hospitalized patients with any of the following clinical symptoms:

A. Viral Encephalitis (patients ≥ 6 months of age) characterized by:

- Encephalopathy (depressed or altered level of consciousness, lethargy, or personality change), and one or more of the following

- Fever (T≥38C), seizure(s), focal neurologic findings, CSF pleocytosis, abnormal EEG, abnormal neuroimaging.

B. Aseptic meningitis (patients ≥ 17 years of age) characterized by:

-Fever (T≥38C)

-Headache, stiff neck and/or other meningeal signs

-CSF pleocytosis

C. Atypical Guillain-Barré Syndrome characterized by:

-Fever (T≥38C), altered mental status, and/or CSF pleocytosis

2. How to Arrange Testing

clinicians must first notify their local health department.

San Mateo county Health DeptARTMENT:

650-573-2346 (During Business hours)

650-363-4981 (After hours)

specimens will not be tested if the case has not been reported

Then, contact the California Encephalitis Project at the California Department of Health Services (DHS). Because of limited laboratory capacity, testing for WN virus at the State is being prioritized for hospitalized patients with the above syndromes. Testing will also be done on patients in the Emergency Room. When you call DHS, we will help determine whether testing is necessary. We will help arrange the shipment of specimens. Please call us to discuss the case and the need for testing before directing your laboratory to submit specimens.

 

3.What Specimens to Send

·CSF: ~2cc. Store specimen frozen, not at room temperature

·Serum: 3-5cc in a red top tube.


Label specimens with: patient's name, date of birth, date of specimen collection, and specimen type.

All specimens must be accompanied by “Viral and Rickettsial Disease Laboratory Specimen Submittal Form” and by “West Nile Surveillance Case History Form.”


SPECIMENS WITHOUT COMPLETED FORMS WILL NOT BE TESTED


To refer suspected cases, call:

Evelyn Tu / West Nile Virus Surveillance

CA Department of Health Services

(510) 307-8606 / (510) 639-8667 (pager) / (510) 307-8599 (fax)

 

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