Introduction

Overview of western equine encephalitis (WEE)

Western Equine Encephalitis (WEE) mosquito-born disease primarily transmitted by the Culex tarsalis mosquito, found in cities as well as agricultural areas.¹ Upon biting a host, the Western Equine Encephalitis virus (WEEV) enters the bloodstream, and can subsequently reach the brain, leading to neurological damage to the central and peripheral nervous systems. WEEV affects both equine and humans.²

Clinical presentations of WEE can vary widely, from mild flu-like symptoms to more complicated conditions such as encephalitis, meningitis, comas and even death.³

Complications 

Neurological complications

• Encephalitis: In severe cases, WEE can lead to inflammation, swelling, and damage to nervous tissue of the brain
• Meningitis: The membranes surrounding the brain and spinal cord can also become inflamed, resulting in headaches, fevers, a stiff neck, and nausea and even death
• Seizures: Inflammation of the brain can lead to seizures, ranging from mild to severe and potentially life-threatening⁴
• Cognitive impairment and confusion: cognitive defects, including memory problems, difficulty concentrating, and impaired decision-making abilities, may occur
• Paralysis: In some cases, WEE can result in paralysis or weakness in certain muscle groups (e.g. in the limbs), by affecting the central or peripheral nervous systems. Survivors can sometimes suffer permanent brain damage

Physical complications 

• Muscle weakness: Individuals recovering from WEE may suffer residual muscle weakness or diminished muscle control
• Fatigue: Persistent fatigue and lack of energy are common after-effects of WEE, often lasting for several months or longer⁵
• Chronic pain: Some individuals may experience chronic pain, such as headaches, muscle aches, or neuropathic pain, caused by the infection

Psychological complications 

• Depression: The physical and neurological impacts of WEE, combined with stress, can contribute to the development of depression in survivors
• Anxiety: Experiencing a severe illness like WEE can lead to anxiety disorders, specifically related to health concerns or fear of recurrence⁶

How to diagnose western equine encephalitis

Diagnosis of WEE begins with a thorough assessment of symptoms and potential exposure to mosquitoes. Common signs of WEE include fever, headache, nausea, vomiting, confusion, seizures, weakness, and paralysis.

Laboratory tests are essential for confirming the diagnosis. One option is a blood test that looks for antibodies - proteins made by the body to fight off the WEE virus. Another is a test on blood or spinal fluid samples to directly detect the virus's genetic material.

Imaging studies, such as MRI or CT may also be done to check for inflammation or other problems in the brain from the infection.

Since WEE is pretty rare, ruling out other causes of brain inflammation and infections is important too, such as other viruses, bacteria, fungi, or autoimmune conditions that could have similar symptoms. Putting all the pieces together - the symptoms, exposure risks, lab tests, and brain imaging - helps doctors make an accurate WEE diagnosis. However, this may require consulting infectious disease experts, especially in areas where WEE isn't common.

Coping strategies

While there is no specific antiviral treatment for (WEEV), modern medicine offers support to manage patient's specific symptoms and complications:

• Physical therapy: To improve strength, balance, and mobility, as well as provide assistive devices or equipment when needed⁷
• Speech therapy: WEEV can impact speech, language, and one's ability to swallow. Speech therapists can help to improve communication skills and develop alternative communication methods (if needed)⁸
• Medications:
  • Anti-inflammatory medications: Corticosteroids or other anti-inflammatory medications are the standard treatment to reduce inflammation in the brain and alleviate symptoms such as headaches, seizures, or cognitive impairment and confusion
  • Antiseizure medications: If WEEV causes seizures, antiseizure medications (anticonvulsants) may be prescribed to control and prevent seizure activity⁹
• Supportive Care: In severe cases, patients may require supportive care, such as intravenous fluids, respiratory support, or management of other complications

Public awareness and mosquito control

Public awareness campaigns also play a crucial role as part of coping strategy in controlling WEEV by educating the public about WEE virus, transmission, symptoms, and prevention as well as guidelines for healthcare providers.¹⁰

Mosquito control organisations educate people on mosquito-borne diseases, including WEE, and their prevention methods, including using insect repellents and advice on how to avoid mosquito bites. To protect yourself and your loved ones, we recommend taking the following preventive measures: 

• Apply an EPA-registered insect repellent when spending time outdoors to deter mosquitoes from biting.
• Diligently eliminate any sources of standing water around your property, as these stagnant areas serve as breeding grounds for mosquitoes.
•  Avoid being outside during the peak mosquito feeding hours around dawn and dusk when mosquito activity is highest. Remaining indoors provides a simple way to reduce exposure.¹¹

FAQs

What are the long-term effects of WEE?

Cognitive impairments

Are there any new treatments or therapies for WEE complications?

Currently, there is no treatment however, medical professionals can help you to recover from this rare but brutal viral infection.

Summary

Western equine encephalitis is a serious viral infection with potentially devastating neurological issues - seizures, paralysis, and long-term brain damage. Effective management requires a multidisciplinary approach, involving doctors, therapists, neurologists, infectious disease specialists, physical, occupational therapists, and speech therapists. It takes a village to properly tackle a case this complex. Supportive care, including respiratory support and seizure management, is life-saving for patients to stabilise and rehabilitate through physical, occupational, and speech therapy to help regain function and improve their quality of life. 

It is vital to not overlook the mental and emotional toll either - having access to counselling is huge for patients and families alike. It's a long road, but staying on top of follow-ups and letting your medical team guide you the way gives you the best shot at overcoming this virus's brutal complications.