"Most of the people have a condition almost identical to that caused by the polio virus,'' said Dr. James Sejvar, an epidemiologist for the CDC and on

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Rare form of West Nile worries California
Athlete suffered polio-like symptoms after Colorado event
- Sabin Russell, Chronicle Medical Writer
Wednesday, August 25, 2004



At a lake in Colorado last summer, 47-year-old Pleasanton water skier Richelle Matli was in such good form that she knew she had a shot at the national championships, only two weeks away in Texas.

Then a mosquito bite intervened.

Instead of taking a trip to Houston, Matli lay for five days in intensive care at UC San Francisco Medical Center with a mysterious, polio-like paralysis in her left leg.

The diagnosis: West Nile virus.

But this was not an ordinary case of West Nile. Matli appears to have come down with a rare form of the disease doctors now call acute flaccid paralysis, or West Nile poliomyelitis. Frighteningly, it tends to strike otherwise healthy adults in their 30s and 40s. Some patients who've contracted it can no longer breathe without a ventilator.

"I went into the hospital under my own power and came out in a wheelchair, '' said Matli, who is the mother of two teenage girls and is an X-ray technician at California Pacific Medical Center in San Francisco.

Matli started water skiing when she was 8 and competing when she was 20. She describes herself as "hooked" on slalom competition. Before her illness, she was ranked 5th nationally in her event.

A roomful of trophies at her Pleasanton townhouse attests to her success. Since 1980, she has competed in every National Championship but two. "One was to have a child, the other was for West Nile,'' she said.

The sport requires a skier on a single ski to weave through six buoys at progressively faster speeds, with set times for completing the course. Skiers attain their maximum speed -- Matli covers the course in 16.95 seconds -- and then are scored on a variety of skills as they fly around the buoys.

"It's very addicting because you can measure your improvement immediately, '' said Matli, who was raised in San Francisco and graduated from Lincoln High School and City College.

She returned to work in April and, remarkably, has returned to the water as well. Now 48, she skied in a tournament on July 22 for the first time since her illness, drawing cheers from fans on shore as she left the dock.

West Nile virus was rampant last summer in Colorado, ultimately striking 3,000 residents and killing 67. Nationwide, the outbreak killed 264.

The summer of 2004 appears to be California's turn for a major West Nile virus outbreak. Spared in previous years as the virus moved across the country, the state now has logged 277 cases and seven deaths. While most cases are in Southern California, where the disease first appeared last fall, single cases have been reported as far north as Lassen, Butte and Yolo counties.

Researchers at the Centers for Disease Control and Prevention in Atlanta are following the cases of 32 Colorado residents who came down with this polio- like syndrome during last summer's West Nile outbreak. All live in the three counties hardest hit by the virus.

"Most of the people have a condition almost identical to that caused by the polio virus,'' said Dr. James Sejvar, an epidemiologist for the CDC and one of the nation's leading experts on the phenomenon.

Unlike polio, West Nile virus is spread only by the bite of an infected mosquito and cannot be transferred from person to person.

At least 80 percent of people infected with the virus show no symptoms, while most of the remaining 20 percent experience a flu-like illness and often break out in a rash.

One in 150 of those infected with West Nile virus develop serious symptoms such as encephalitis -- a life-threatening swelling of the brain. Most of them are well over the age of 50.

The polio-like syndrome is less common -- and in some ways, more ominous. "Those developing West Nile poliomyelitis tend to be younger and otherwise healthy,'' said Sejvar.

Doctors also do not know if such patients will ever recover full use of their limbs. "In the short term, pretty much everyone continues to have some functional difficulties,'' said Sejvar.

Dr. Carol Glaser, chief of the California Department of Health Services viral lab in Richmond, said no cases of the polio-like syndrome have been confirmed in the state, although several suspicious case histories are being reviewed. "We're very familiar with the syndrome. We've been looking for it,'' she said.

Glaser said she is skeptical that the syndrome strikes only younger, healthier patients. It is possible, she said, that some of the elderly victims who died of West Nile virus encephalitis or meningitis also had the limb paralysis, but their symptoms went unnoticed as they battled for their lives.

Last year, at the 2003 Western Regional Water Ski Championships outside Fort Collins, Colo., Matli and her competitors had heard the news on television of a local West Nile virus outbreak. They joked about catching West Nile. Fortunately, the lake area itself had been sprayed and seemed mosquito- free.

On the final day of that tournament, the skiers celebrated at a banquet on a golf course. The mosquito situation there was different. "I felt like we were getting eaten alive,'' she said. There were more West Nile jokes.

Five days later, while training for the nationals at a private lake for water skiers in Southern California, Matli began to feel poorly. "I felt like I'd had a few too many cocktails. I had a rash. I assumed it was a heat rash, '' she said.

When she returned to Pleasanton, her condition was worsening. "But I still had high hopes of winning the nationals,'' she said.

The day before she was to leave for the tournament, Matli found she could not climb the stairs to the second floor of her home. There would be no flight to Houston. She was hospitalized the following day and spent five days in intensive care. Months of rehab followed.

Today the wheelchair and cane are history. "I limp,'' she said. "If I get tired, I limp more.''

But this onetime water ski champion is relentlessly working her way back to the life she used to know. "For my level, I am about 60 percent of where I used to be,'' she said.

The slalom requires a smooth combination of strength, agility and grace. Matli still has all three -- plus a dry wit and an unflappable disposition - - to take her along.

She doesn't claim to have an iron will or the extreme discipline of many athletes. But she marks her return to health with the same relentless attention that made her a nationally ranked water skier.

"There was a time when I could not lift my foot,'' she said. "A month ago, I still could not walk up a stair. I still can't stand on my toes. But I see little improvements almost every day.''



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CHART:BV:

THE SPREAD OF WEST NILE VIRUS
State health officials have identified 277 people infected with West Nile virus this year in California. Seven people have died. In all of 2003, only 3 cases were found in humans and 96 in birds. It was first detected in the state in 2002.

West Nile virus is spread when an infected bird is bitten by a mosquito. The mosquito then bites another bird, a horse or a human, passing along the infection. .

People

Fatalities Infected Dead Birds

Alameda 6

Butte 1 96

Calaveras 2

Contra Costa 2

El Dorado 5

Fresno 3 34

Glenn 29

Humboldt 1

Imperial 1 1

Kern 4 30

Kings 1

Lake 2

Lassen 1 3

Los Angeles 4 100 741

Madera 1

Marin 2

Mariposa 1

Mendocino 4

Merced 1

Napa 1

Nevada 2

Orange 1 11 115

Placer 4

Plumas 3

Riverside 54 129

Sacramento 37

San Bernardino 2 98 284

San Diego 10

San Joaquin 10

San Luis Obispo 1

San Mateo 5

Santa Barbara 3

Santa Clara 13

Shasta 13

Sierra 3

Siskiyou 4

Solano 3

Sonoma 12

Stanislaus 12

Sutter 3

Tehama 55

Trinity 2

Tulare 1 7

Ventura 1 9

Yolo 1 1

Yuba 3

State totals 7 277 1,705

Source: California Department of Health Services

More information is available at westnile.ca.gov/maps.htm

The Chronicle

EC:
E-mail Sabin Russell at srussell@sfchronicle.com.

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