A 6-year-old boy is brought to the emergency department due to confusion and lower extremity weakness. The symptoms began 2 days ago along with fever, headache, malaise, and myalgias. Today, the patient was noted to be confused and had difficulty ambulating due to left lower extremity weakness. he is visiting Texas for the summer and has never traveled outside the United States. Temperature is 38.3 C (101 F), blood pressure is 130/70 mm Hg, and pulse is 96/min. The patient is oriented to place and person only and has a coarse hand tremor. There is flaccid paralysis of the left lower extremity with preserved sensation. Cerebrospinal fluid analysis shows a leukocyte count of 200/mm³ with 20% neutrophils and 80% lymphocytes. Which of the following is the most likely pathogen responsible for this patient's condition?

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Eductional Objective: West Nile virus is harbored in birds and transmitted to humans by mosquitos.  Most patients are asymptomatic, but the virus can cause an influenza-like illness or neuroinvasive disease with meningitis, encephalitis, and flaccid paralysis.

A 6-Year-Old Boy Is Brought to the Emergency Department Due