Preliminary diagnosis is often based on the patient's clinical features, places and dates of travel (if patient is from a non-endemic country or area), activities, and epidemiologic history of the location where infection occurred.
Laboratory diagnosis of West Nile Virus infections is generally accomplished by testing of serum or cerebrospinal fluid (CSF) to detect virus-specific IgM and neutralizing antibodies.
Four FDA-cleared WNV IgM ELISA kits from different manufacturers are commercially available in the U.S. According to the package inserts, each of these kits is indicated for use on serum to aid in the presumptive laboratory diagnosis of WNV infection in patients with clinical symptoms of meningitis or encephalitis. The package inserts also state that all positive results obtained with any of the commercially-available WNV test kits should be confirmed by additional testing at a state health department laboratory or CDC.
In fatal cases, nucleic acid amplification, histopathology with immunohistochemistry and virus culture of autopsy tissues can also be useful. Only a few state laboratories or other specialized laboratories, including those at CDC, are capable of doing this specialized testing.
Instructions for sending diagnostic specimens to the DVBID Arbovirus Diagnostic Laboratory can be found at the following site: http://www.cdc.gov/ncidod/dvbid/misc/specimen-submission.htm. Test results are normally available 4 to 14 days after specimen receipt. Reporting times for test results may be longer during summer months when arbovirus activity increases. Receipt of a hard copy of the results will take at least 2 weeks after testing is completed. Initial serological testing will be performed using IgM capture ELISA, MIA (Microsphere-Based Immunoassay) and IgG ELISA. If the initial results are positive, further confirmatory testing may delay the reporting of final results. ALL RESULTS WILL BE SENT TO THE APPROPRIATE STATE HEALTH DEPARTMENT. Notify your state health department of any submissions to CDC.