Acute confusional states and functional recovery after West Nile virus infection in hospitalized older adults.

The functional consequences of symptomatic West Nile virus (WNV) infection in hospitalized older adults remain poorly characterized. We aimed to describe the clinical presentation, acute confusional states, and six-month functional recovery trajectories of older adults hospitalized with symptomatic WNV infection. We conducted a retrospective case series of consecutive patients aged ≥65 years with laboratory-confirmed WNV infection admitted to a secondary-care hospital in Sardinia, Italy. Functional status was assessed using the Barthel Index at admission, discharge, and six-month follow-up. Seventeen patients were included (median age 76 years; 59% male), including 14 with non-neuroinvasive and 3 with neuroinvasive disease. Acute confusional states were documented in all patients at admission. At discharge, 13 patients (76%) exhibited at least one functional limitation. Median Barthel Index increased from 35 at admission to 60 at discharge and to 90 at six-month follow-up. Recovery trajectories were heterogeneous, with persistent severe disability in two of the three neuroinvasive cases. Symptomatic WNV infection in older adults was associated with acute confusional states and marked functional impairment during the acute phase, followed by substantial but heterogeneous recovery over six months. Functional recovery appeared less favorable in patients with neuroinvasive disease.