Rx in WN virus

Q: Which of the following has not shown any benefit in the treatment of West Nile (WN) infection?

A) Corticosteroids 

B) Intravenous immunoglobulin

C) Interferon

D) Ribavirin 

Answer: D

The mainstay of treatment in WN virus infection is supportive care.

WN virus is known to cause acute flaccidity, paralysis, and opsoclonus-myoclonus-ataxia. Despite weak evidence, corticosteroids (choice A) inhibit the proinflammatory mediators that may contribute to the nervous system's clinical signs. 

Intravenous immunoglobulin (IVIG) - choice B - is particularly effective in patients with humoral deficiencies.

Similarly, interferon therapy (choice C), despite limited data, has shown a trend toward benefit in WN infection when other modalities fail and can be used as a last resort.

Although Ribavirin (choice D) has demonstrated in vitro activity against the WN virus, it has failed to show any benefit in vivo and, in fact, has shown to cause harm.

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References:

1. Pyrgos V, Younus F. High-dose steroids in the management of acute flaccid paralysis due to West Nile virus infection. Scand J Infect Dis 2004; 36:509.

2. Leis AA, Sinclair DJ. Lazarus Effect of High Dose Corticosteroids in a Patient With West Nile Virus Encephalitis: A Coincidence or a Clue? Front Med (Lausanne) 2019; 6:81.

3. Colaneri M, Lissandrin R, Calia M, et al. The WEST Study: A Retrospective and Multicentric Study on the Impact of Steroid Therapy in West Nile Encephalitis. Open Forum Infect Dis 2023; 10:ofad092.

4. Planitzer CB, Modrof J, Kreil TR. West Nile virus neutralization by US plasma-derived immunoglobulin products. J Infect Dis 2007; 196:435.

5. Kalil AC, Devetten MP, Singh S, et al. Use of interferon-alpha in patients with West Nile encephalitis: report of 2 cases. Clin Infect Dis 2005; 40:764.

6. Chowers MY, Lang R, Nassar F, et al. Clinical characteristics of the West Nile fever outbreak, Israel, 2000. Emerg Infect Dis 2001; 7:675.