West Nile Virus: Symptoms, Diagnosis, and Transmission

West Nile Virus

• West Nile virus can infect humans, birds, mosquitoes, horses, and other animals.
• Human infection results from the bite of infected female mosquitoes.
• Mosquitoes contract the virus by feeding on infected birds.
• Most infected individuals are asymptomatic.
• Symptomatic individuals typically experience flu-like symptoms, including headache, fever, back pain, muscle aches, and anorexia.
• Less than 1% of those infected develop severe West Nile, such as meningitis or encephalitis.
• West Nile meningitis manifests with sudden fever, headache, chills, and neck pain.
• West Nile encephalitis involves fever, headache, altered consciousness, disorientation, behavioral changes, speech disturbances, neurological deficits (like hemiparesis), seizures, and possible coma.
• Diagnosis is confirmed through blood or cerebrospinal fluid tests, specifically an IgM test.
• The virus is not transmitted through casual contact like touching or kissing.
• Precautionary measures are crucial from April to October, during peak mosquito activity.
• Precautions include using insect repellent with DEET (for those older than two months), spraying clothing, covering exposed skin, reducing standing water, using screens, limiting outdoor activity at dusk and dawn, and using netting over strollers.
• Treatment focuses on supportive care.

Brain Abscess

• A brain abscess is an accumulation of pus within brain tissue.
• It can stem from local or systemic infections, commonly originating from ear, tooth, sinus, or mastoid infections.
• Common causative organisms include streptococci or staphylococci.
• Brain abscesses may also arise from septic venous thrombosis, pulmonary infections, infected endocarditis, skull fractures, and non-sterile neurological procedures.
• Symptoms resemble those of meningitis and encephalitis, including fever and headache.
• Additional symptoms can include increased intracranial pressure, drowsiness, confusion, seizures, and visual disturbances, depending on the abscess location in the brain.
• Medical management involves antimicrobial therapy, using antibiotics.
• Surgical removal might be necessary if the abscess is encapsulated and unresponsive to antibiotics.
• Nursing interventions mirror those for increased intracranial pressure and meningitis, emphasizing monitoring and supportive care.

Head Trauma (Traumatic Brain Injury - TBI)

• Head trauma is presently termed traumatic brain injury (TBI).
• Direct trauma refers to direct injury to the head, such as impact from an object.
• Indirect trauma involves tension, strain, and shearing forces from excessive head stretching, as seen in acceleration-deceleration injuries.
• These injuries can cause bruising or contusion of the occipital and frontal lobes, brainstem, and cerebellum.
• Open injuries involve skull fractures or penetrating wounds, like gunshot wounds.
• Injury severity is determined by the velocity, mass, shape, and duration of impact.
• Fractures at the skull base are particularly serious due to their proximity to the medulla, which regulates breathing.
• Closed head injuries include concussion (brain jarring), contusion (bruise), and scalp lacerations. Scalp lacerations bleed profusely.
• Epidural hematomas manifest as lethargy or unconsciousness following an initial period of regained consciousness, indicative of rapid arterial bleeding.
• Subdural hematomas develop more slowly, taking days to manifest, with patients remaining conscious for a period after the initial injury before losing consciousness or developing neurological symptoms; these are typically due to venous bleeding.
• Signs and symptoms include, but are not limited to:
  • Abnormal sensation
  • Abnormal consciousness
  • Signs of increased intracranial pressure
  • Nausea and vomiting
  • Headache
  • Loss of consciousness
  • Problems with orientation
  • Vertigo
  • Diplopia
  • Abnormal speech
  • Bleeding
• Monitor vital signs.
• Battle sign (hemorrhagic spots behind the ear) indicates a basilar skull fracture.
• Raccoon eyes (periorbital edema and ecchymosis) suggests a skull fracture.
• Cerebrospinal fluid (CSF) leakage from the nose or ears is a critical sign.
• A "halo" appearance on gauze indicates CSF.
• Advise patients not to blow their nose or insert anything into their nose or ears; wipe carefully without plugging.
• The ABCs (Airway, Breathing, Circulation) are the priority.
• Never suction through the nose if a skull fracture is possible.
• Stabilize the spine, assuming a neck injury until ruled out.
• Administer:
  • Corticosteroids (to decrease inflammation)
  • Osmotic diuretics like mannitol (to reduce cerebral edema)
  • Anticonvulsants (to manage brain irritability)
• Surgical intervention may be needed to relieve pressure or address bleeding.
• Monitor ABGs.
• Nursing interventions include avoiding insertion of anything into the nose or ears, carefully wiping any drainage, elevating the head of the bed (if no neck injury), and maintaining a neutral head position to promote venous drainage; also monitor for increasing intracranial pressure and prevent infection; emotional and personality changes are possible.

Spinal Cord Injuries (SCI)

• Accidents are the most common cause of spinal cord injuries.
• Symptoms depend on the level of injury.
  • Injuries above C4 result in no independent function, including respiration, and are often fatal.
  • C5 injuries affect arm and chest function.
  • C6 and C7 injuries affect arm and finger function and all below the chest.
  • Thoracic injuries affect trunk function and everything below the chest.
  • Lumbar/sacral injuries affect leg function.
• Spinal cord injuries can be complete (transection of cord, resulting in no function below the injury level) or incomplete.
  • Complete injuries lead to complete paralysis, with no hope of regaining function.
• Transitioning from Quadriplegic to Tetraplegic:
  • Tetraplegic is a cervical injury.
  • Paraplegic is a thoracic, lumbar, or sacral injury.
• Immobilization and stabilization of the neck are vital, potentially involving Crutchfield tongs with traction or a Halo vest.
• Pin care is necessary to prevent infection.

SCI Treatment

• Clean pin sites 2-3 times per day with prescribed solution.
• Use a mirror to inspect pin sites.
• Avoid bending at the waist.
• Always keep a wrench nearby to remove screws if needed in case of emergency.
• Never use the frame to move the person, as this can cause trauma.
• Nursing interventions include skin care (turning every two hours), range of motion exercises, anti-embolism stockings (Ted hose), and slow position changes.
• Bladder and bowel retraining programs are often needed.
• For patients lacking nervous innervation, stool softeners may be needed for bowel programs.
• Watch for signs of autonomic dysreflexia.

Autonomic Dysreflexia

• Autonomic dysreflexia is characterized by increased reflex actions.
• It occurs at or above the thoracic six vertebra (T6).
  • The sympathetic nervous system is stimulated by pain, but the patient cannot feel it due to paralysis.
  • Triggers include pain, bladder distention/issues, or impaction.
• Signs and symptoms are:
  • Skyrocketing blood pressure
  • Severe bradycardia
  • Severe headache
  • Diaphoresis
  • Restlessness
  • Goosebumps
  • A red face and skin from the injury up
  • Nausea
  • Cold and clammy skin below the level of the injury.
• Autonomic dysreflexia is a medical emergency.
• Interventions are:
  • Elevate the head of the bed to 90 degrees to promote venous return.
  • Remove the trigger by checking for bladder distention and impaction.
  • Administer potent IV blood pressure medication like Nipride as prescribed (administered by an RN).
• Raising the patient into a sitting position is useful
• Spinal cord injury can cause sexual dysfunction in males (impotence, ejaculation difficulties, fertility problems) and altered sensation in females.

West Nile virus spreads through infected mosquitoes. Most people show no symptoms, but some experience flu-like symptoms. Severe cases can lead to meningitis or encephalitis, diagnosed through blood or cerebrospinal fluid tests.