title: Use of Testing for West Nile Virus and Other Arboviruses.
abstract: In the United States, the most commonly diagnosed arboviral disease is West Nile virus (WNV) infection. Diagnosis is made by detecting WNV IgG or viral genomic sequences in serum or cerebrospinal fluid. To determine frequency of this testing in WNV-endemic areas, we examined the proportion of tests ordered for patients with meningitis and encephalitis at 9 hospitals in Houston, Texas, USA. We identified 751 patients (567 adults, 184 children), among whom 390 (52%) experienced illness onset during WNV season (June-October). WNV testing was ordered for 281 (37%) of the 751; results indicated acute infection for 32 (11%). Characteristics associated with WNV testing were acute focal neurologic deficits; older age; magnetic resonance imaging; empirically prescribed antiviral therapy; worse clinical outcomes: and concomitant testing for mycobacterial, fungal, or other viral infections. Testing for WNV is underutilized, and testing of patients with more severe disease raises the possibility of diagnostic bias in epidemiologic studies.
authors.forename: Jakapat
authors.initials: J
authors.lastname: Vanichanan
authors.forename: Lucrecia
authors.initials: L
authors.lastname: Salazar
authors.forename: Susan H
authors.initials: SH
authors.lastname: Wootton
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Aguilera
authors.forename: Melissa N
authors.initials: MN
authors.lastname: Garcia
authors.forename: Kristy O
authors.initials: KO
authors.lastname: Murray
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Hasbun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001102:Arbovirus Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D001103:Arboviruses / Q000235:genetics / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003955:Diagnostic Tests, Routine; D004671:Encephalitis, Arbovirus / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques; D007223:Infant; D008297:Male; D008587:Meningitis, Viral / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D063868:Patient Outcome Assessment; D016133:Polymerase Chain Reaction; D011159:Population Surveillance; D012621:Seasons; D013781:Texas / Q000453:epidemiology; D014901:West Nile Fever / Q000175:diagnosis* / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D014902:West Nile virus / Q000235:genetics / Q000276:immunology; D055815:Young Adult
keywords: WNV; West Nile virus testing; arboviral disease; arboviruses; community-acquired CNS infections; encephalitis; meningitis; vector-borne infections; viruses