West nile virus: A primer for the otolaryngologist

Abstract

Objectives: Since recognition in the United States with a 1999 New York City epidemic, West Nile virus has enduringly migrated westward, leaving few states unaffected. Infection rates are rising at an alarming rate, doubling every year since introduction, with over 8000 cases in 2003 alone and nearly 200 deaths. Patients may present with myriad symptoms; though common to the presenting signs is a maculopapular rash that affects the face and trunk and diffuse lymphadenopathy, both of which may result in the initial consultation of the otolaryngologist. We review the clinical history of West Nile virus, its epidemiology, laboratory findings, and variable clinical presentation, with an emphasis on otolaryngologic manifestations. Methods: We did a comprehensive review of the literature over the past 50 years with an emphasis on what the present day otolaryngologist needs to know concerning West Nile virus. Clinical manifestations of the head and neck such as encephalitis, meningitis, maculopapular rash, lymphadenopathy, and dysphagia are discussed. Results: There are no articles in the otolaryngology literature discussing West Nile virus. These patients may present initially to multiple providers with diverse specialties due to multifarious initial signs and symptoms. The otolaryngologist must be educated on this quickly growing affliction and practice with a high index of suspicion. Conclusions: In this paper we describe the clinical manifestations of West Nile virus with an emphasis on the otolaryngologic manifestations. The otolaryngologist must become educated about this entity in order to facilitate preventative measures, adequately treat, and assist other providers in hopeful control and potential eradication of this infectious threat.