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Confusion beyond the usual suspects.
Lucia Colavolpe1, Piero Tarantini1, Aldo Fici1
1Department of Cardiovascular Medicine, Ospedale di Circolo, Busto Arsizio, VA, Italy.
Journal of Infection and Public Health
|March 24, 2026
Summary
West Nile virus (WNV) encephalitis can cause acute confusion in older adults, mimicking systemic infections. Early diagnosis is crucial, especially during mosquito season in Europe.
Area of Science:
- Neurology
- Infectious Diseases
- Public Health
Background:
- Acute confusion in older adults is often misdiagnosed as systemic infection.
- West Nile virus (WNV) is an emerging cause of viral encephalitis in Europe.
Purpose of the Study:
- To report a case of WNV neuroinvasive disease in an elderly patient.
- To emphasize the importance of considering WNV in differential diagnosis of acute confusion in older adults.
Main Methods:
- Case report of an 82-year-old man with fever, agitation, and confusion.
- Diagnostic workup included blood tests, CSF analysis, and WNV serology/RT-PCR.
- Epidemiological history including mosquito bite was crucial.
Main Results:
- Initial investigations suggested systemic infection; antibacterial therapy was initiated.
- Lumbar puncture revealed lymphocytic pleocytosis and elevated protein, indicating viral meningoencephalitis.
- WNV-specific antibodies and RNA confirmed WNV neuroinvasive disease.
Conclusions:
- WNV encephalitis should be considered in older adults with acute confusion and fever during mosquito season.
- Epidemiological history, particularly mosquito exposure, is vital for prompt diagnosis.
- Timely diagnosis and supportive care can lead to recovery.
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