neuroinvasive west nile virus

Seven months ago I contracted severe west nile encephalitis. Although I have made some progress in recovery I still have eye problems. One of my first symptoms were several floaters in each eye. I went to an opthomologist and was told some people just get floaters and to learn to live with it. This was before my west nile diagnosis as it took six month and tons of bloodwork to figure out why I was so sick. I spoke with a retinal doctor who is a friend of the family in another state who told me that the floaters will go away because she believes that they are inflamed cells from the west nile and has seen this in other west nile patients. Is she correct that the floaters will go away over time. I have so many in each eye I feel like I am in a constant swarm of flies. Also I do not blame my opthomologist as he has been very understanding and has tried to be supportive as much as possible. I saw him several time over the first few month before my diagnosis due to injected conjunctiva and very sore eyes as well. I have not seen him since because I am scheduled to see an neuro optho in march. Your thoughts on the floaters would be appreciated. Before the west nile I had perfect vision and no visual issues what sos ever.

[Michael J Kutryb, MD]

I thank you for bringing to light some of the ophthalmic manifestations of West Nile Virus - which fortunately seems to be decreasing in incidence in the US.  I have to say that I have never seen a case of West Nile but from what I've read, only about half of those infected ever see a doctor and I suspect many cases are not diagnosed.  I  will definitely keep a higher suspicion of it after hearing your story.  West Nile can cause inflammation in the vitreous (vitritis) and in the retina and choroid (chorioretinitis.)  Regarding your situation, I don't think anyone can say whether or not your floater or vision will improve.  The fact that you are only 7 months out, leads me to believe that you likely are still on the road to complete recovery - if you ever fully recover?  Some articles I read suggested that if you had significant choroiretinal lesions (which you didn't mention.)  there could be a risk of choroidal neovascularization many years down the road, similar to what we sometimes see with ocular histoplasmosis syndrome.  It doesn't sound like that is the case in your situation though.  My best guess is that if you still have significant floaters after a year or so that they might not get much better after that.  That's pure speculation though - since I don't think anyone really knows how  you will respond, and what floaters are from the west nile and what floaters are just there naturally.  God bless you after all you have been through.  Thanks for sharing your story.

Michael Kutryb, MD

[Baker096]

A related discussion, insephilitus was started.