Uncovering the neurological effects of West Nile virus during a record-breaking southern Spain outbreak in 2020–2021

The 2020–21 West Nile Virus (WNV) outbreak in Andalusia, Spain, was the largest reported in the country, with eight cases of West Nile Neuroinvasive Disease (WNND) diagnosed in a tertiary hospital. Diagnosis of WNND is based on detecting WNV RNA, viral isolation, or demonstrating a specific immune response against the virus, with additional tests used to support the diagnosis. Treatment remains supportive, with variable outcomes. The potential efficacy of plasma exchange (PLEX) in select cases raises the possibility of an autoimmune component secondary to infectious pathology of the central nervous system. The influence of climate change on the expansion of WNV into new regions is a significant concern. It is crucial for physicians practicing in high-risk areas to be knowledgeable about the disease for early prevention and effective control measures. [Display omitted] •West Nile neuroinvasive disease (WNND) manifests in annual seasonal outbreaks.•Supportive care remains the mainstay of treatment for neuroinvasive WNV disease.•In the absence of an epidemiological alert, diagnosing Nile virus infection can be challenging.•Further research is needed to determine the potential utility of plasma exchange in West Nile neuroinvasive disease.