Dianne Fluty - Cara Keilman - Roger Wilkins MO

Posted on Thu, Jul. 14, 2005
West Nile virus can disable for months, years
BY ALAN BAVLEY
Knight Ridder Newspapers

KANSAS CITY, Mo. - (KRT) - Two summers ago, West Nile virus invaded Cara Keilman's brain and likely caused a stroke that the 11-year-old Ness City, Kan., girl is still striving to overcome.

After mosquitoes swarmed Roger Wilkins of Bucyrus, Kan., in 2003, he spent a month in the hospital feverish, dizzy and delirious with a West Nile infection. Months of physical therapy later, he still feels weak and less steady on his feet.

Dianne Fluty suffered through the summer of 2002 with headaches, insomnia and tremors. The Sedalia, Mo., woman spent a year recovering from the West Nile virus infection that caused her symptoms. But even now, the tremors and headaches make regular visits.

As hundreds of its victims have discovered, West Nile virus is a ferocious enemy. Once thought to be a serious threat mainly to the elderly and infirm, researchers have found that the virus can cause months of debilitating illness, and even poliolike paralysis, in healthy people of all ages.

And even relatively mild cases of West Nile illness that doctors used to compare to a weeklong bout of flu have turned out to have serious lingering symptoms.

"West Nile is a frightening disease," said Daniel Hinthorn, an infectious disease specialist and West Nile researcher at the University of Kansas Medical Center.

Scientists estimate that less than 1 percent of mosquitoes carry the virus. Only small percentages of people become infected.
About one in five people who are infected with the virus become ill, Hinthorn said. "Most people who are infected won't know they have it. But if they do get the disease, it can be devastating."
Among the most serious cases are infections that attack the spinal cord and cause paralysis.

Investigators at the Centers for Disease Control and Prevention have been reporting these cases for several years. In 2003 they tracked West Nile virus illnesses in three Colorado counties and identified 27 such serious cases.

That translated into a paralysis rate of 3.7 cases per 100,000 people, a level comparable to what is seen during polio epidemics.
"A surprising number of people who develop this syndrome can be in their 30s or 40s and otherwise healthy," said James Sejvar, a CDC medical epidemiologist who is studying these West Nile paralysis cases. "You don't have to be a frail old person to become severely ill from West Nile."

West Nile typically is passed to people by mosquitoes that pick up the virus from infected birds. Since West Nile made its first North American appearance in New York City in 1999, it has spread across the continent.

The results: Nearly 17,000 cases of West Nile virus illnesses and more than 650 deaths nationwide.

Doctors used to describe West Nile fever as a flulike illness with nausea and headaches lasting three to six days. But that hasn't turned out to be the case.

When researchers with the Chicago Department of Public Health surveyed 98 persons who developed West Nile fever in 2002, they found that large numbers suffered from fatigue, muscle weakness and difficulty concentrating for a month or longer. On average, it took these patients two months to feel they were back to normal.The patients' age had no bearing on the length of their illness, the researchers found.

"Adults of any age can get West Nile fever, which can put them on their backs for a long time," said William Paul, deputy commissioner of the Chicago health department. "We were surprised at the duration of symptoms and the degree of symptoms people had. The common knowledge of West Nile fever previously was that it was a mild illness that lasted a few days."

Still more serious infections occur where West Nile virus attacks the central nervous system. These infections can inflame membranes covering the brain and spinal cord, a condition called meningitis; or inflame the brain itself, causing encephalitis.

The New York City Department of Health came up with some disturbing findings when it followed the progress of people hospitalized with West Nile meningitis, encephalitis or fever in 1999.

A year after their illness, 37 percent of these patients had fully recovered. Nearly half required physical therapy.

Even after 18 months, more than 40 percent still suffered from some combination of muscle weakness, fatigue, insomnia and difficulty walking; 30 percent still experienced memory loss, confusion, depression and irritability.

A lot of these people were significantly impaired down the road. It had a significant impact on their lives for a long time," said Annie Fine, an epidemiologist who participated in the study.
Patients under 65 were nearly three times as likely as older patients to make a full recovery. But even so, more than a third of the younger patients still had lingering problems after a year.
"Even among young people it can be a serious infection and have a long-lasting impact," Fine said.

Cara Keilman felt the full force of West Nile virus two years ago, when she was just 9.
She was riding her bike when her right foot slipped off the pedal and her right hand couldn't grasp the handlebar. Paralyzed on her right side, she struggled for 20 minutes to finish the short ride to her Ness City home.

Doctors in Hays diagnosed a massive stroke. Cara was flown to Children's Mercy Hospital in Kansas City.
"They did brain scans. They did every test you could do. You name it, they did it," Cara's mother, Faye Keilman, recalled.

A blood test for West Nile virus turned up positive. Doctors told Faye Keilman that the virus probably inflamed blood vessels in Cara's brain. That led to her stroke and to the seizures.

Cara needed months of drug treatment to bring down the inflammation and physical therapy to regain the use of the right side of her body.
She can write again with her right hand, although with her limited muscle control she clenches the pen too hard. And she's even resumed playing a full roster of sports –– basketball, volleyball, track and softball.
"She's not going to let it slow her down," her mother said.

Dianne Fluty knew there were plenty of mosquitoes buzzing around her Sedalia home three years ago, but she didn't take precautions to avoid bites.
"I took it lightly," she said. "Oh, this is crazy, West Nile."

But through the summer she had headaches. She couldn't sleep. Tremors shook her body. She was hospitalized several times with meningitis and encephalitis caused by West Nile virus.

"It was a really rough time and it was a long recovery," said Fluty, 55. "Once in a while I still get tremors. I'm better than I was, but I am not right. I don't have the memory or mind I used to have."

Roger Wilkins, 65, recalled sitting on the deck of his Bucyrus home when mosquitoes attacked. It wasn't long after that Wilkins was feverish, dizzy and too tired to do anything but sleep or watch television.

A trip to the St. Luke's South emergency room turned into a four-week hospital stay for meningitis and encephalitis.
"He was in and out of reality," said Wilkins' wife, Melanie. "A nurse found him standing on his bed acting as if he was trying to change a light bulb."

Wilkins went through five months of physical, occupational and speech therapy. He's back at his job supervising work sites for home builders. But West Nile has taken its toll.
Wilkins said he tires easily. He's less steady on his feet. His muscles ache constantly.
"People say West Nile, they think it's something you get over. I'm sorry. I think they're wrong," Wilkins said.
"A lot of this, I think, is a problem that will stay with me until I leave this earth."

Insect repellents containing the chemical DEET have long been considered the most effective protection against mosquitoes.
But this year, the Centers for Disease Control and Prevention added two alternatives to their list. The chemical picaridin has been used successfully in repellents for years in other countries. CDC officials say its effectiveness often is comparable to that of DEET.

The other newly recommended ingredient is oil of lemon eucalyptus, a plant-based product. It appears to be as effective as low concentrations of DEET, the CDC said.

Consumer Reports recently tested Cutter Advanced, a new spray repellent with picaridin, and found its effectiveness comparable to a spray containing 10 percent DEET. The picaridin spray didn't have the chemical odor or greasy feel of DEET sprays.

The University of Kansas Medical Center is participating in a nationwide study of whether immune globulin collected from donors in Israel is an effective treatment for West Nile virus illnesses.
West Nile is common in Israel, so the immune globulin collected there contains high levels of antibodies against the virus.

The immune globulin, called Omr-IgG-am, has to be given soon after an infection to be effective. Persons with West Nile fever symptoms who want to participate in the study should come to the medical center within a week after symptoms appear. Patients may seek help through the medical center's emergency room or ask their personal physician to contact the center's infectious disease division.
---
© 2005, The Kansas City Star.
Visit The Star Web edition on the World Wide Web at http://www.kcstar.com/
Distributed by Knight Ridder/Tribune Information Services.