Clinical Scorecard: Documenting Wisconsin's Initial Neuroinvasive Oropouche Virus Case: A Case Study

At a Glance

Key Highlights

• First documented neuroinvasive OROV case in Wisconsin and the United States (2025), associated with travel to Panama.
• Presentation included biphasic meningitis symptoms with headache, neck stiffness, blurry vision, dizziness, and unsteadiness.
• No disease-specific treatment or vaccine exists; diagnosis relies on clinical suspicion and laboratory confirmation.

Guideline-Based Recommendations

Diagnosis

• Consider OROV in patients with compatible travel history and neuroinvasive symptoms.
• Perform lumbar puncture showing lymphocytic pleocytosis, elevated protein, and normal glucose in CSF.
• Use serologic testing and PCR for arboviruses to differentiate OROV from other infections like chikungunya, dengue, and Zika.

Management

• Provide supportive care and symptomatic management as no specific antiviral therapy is available.
• Empiric treatment for other causes of meningitis may be initiated pending diagnostic results but can be discontinued if OROV is confirmed.

Monitoring & Follow-up

• Monitor neurological symptoms and vital signs during hospitalization.
• Follow up outpatient visits to assess symptom resolution and detect recurrence.

Risks

• Potential for spread to new geographic regions due to climate change and international travel.
• Risk of misdiagnosis due to overlapping symptoms with other arboviral infections.

Patient & Prescribing Data

Immunocompetent young adults with recent travel to endemic areas

Symptomatic treatment effective; empiric antimicrobials may be stopped after negative pathogen testing and clinical improvement

Clinical Best Practices

• Obtain detailed travel history in patients presenting with febrile or neuroinvasive syndromes.
• Consider OROV in differential diagnosis of aseptic meningitis in travelers from endemic regions.
• Coordinate with public health laboratories and CDC for confirmatory testing.
• Educate patients on vector avoidance to reduce risk of arboviral infections.

References

• Pan American Health Organization/World Health Organization Oropouche virus information
• Centers for Disease Control and Prevention Arboviral Diseases Branch