A 67-year-old woman is brought to the emergency department due to fever, headache, vomiting, and confusion. Today, the patient was noted to be confused and had difficulty ambulating due to left lower extremity weakness. The patient has a history of lymphoma in remission, hypertension, and type 2 diabetes mellitus. She is visiting her family in Texas for the summer and has never traveled outside the United States. Physical examination shows neck rigidity and left lower extremity weakness with fasciculations. CT scan of the head shows no abnormalities. Lumbar puncture is performed, and cerebrospinal fluid analysis shows lymphocytic pleocytosis and elevated protein. Cerebrospinal fluid polymerase chain reaction testing yields viral RNA. The agent infecting this patient most likely uses which of the following modes of transmission?

Question

A 67-year-old woman is brought to the emergency department due to fever, headache, vomiting, and confusion. Today, the patient was noted to be confused and had difficulty ambulating due to left lower extremity weakness.  The patient has a history of lymphoma in remission, hypertension, and type 2 diabetes mellitus.  She is visiting her family in Texas for the summer and has never traveled outside the United States. Physical examination shows neck rigidity and left lower extremity weakness with fasciculations. CT scan of the head shows no abnormalities.  Lumbar puncture is performed, and cerebrospinal fluid analysis shows lymphocytic pleocytosis and elevated protein.  Cerebrospinal fluid polymerase chain reaction testing yields viral RNA.  The agent infecting this patient most likely uses which of the following modes of transmission?

Quizplus · Accepted Answer

Eductional Objective: West Nile virus is a single-strand flavivirus transmitted by mosquitoes, most commonly in the summer.  Most infections are asymptomatic or may present with a flu-like illness (West Nile fever), often with a maculopapular or morbilliform rash.  Neuroinvasive disease manifests as meningitis, encephalitis, or asymmetric flaccid paralysis; patients may have parkinsonian features.

A 67-Year-Old Woman Is Brought to the Emergency Department Due