Friday, January 19, 2018

West Nile virus symptoms can linger for life

FORT WORTH, Texas — Claire McCall says that a mosquito bite changed her life.

On Aug. 8, 2008, she entered a Dallas emergency room with a 103.4-degree fever. She would be diagnosed with West Nile virus.

"I went into a coma immediately," she said. "I was paralyzed. I couldn't swallow, couldn't talk and was being fed through a tube."

Four years later, McCall, 60, is on disability and still suffers with balance issues, has mild cognitive impairment, tremors and short-term memory loss. Fatigue, depression and chronic pain are a constant problem, she said.

Many people who catch West Nile feel like they have an extended form of the flu, with low-grade fever and fatigue that can last for weeks. But for others like McCall, the virus can attack the brain and nervous system, paralyze the body and leave life-changing impairments.

And in some cases, it can kill.

In Tarrant County, about a third of the reported West Nile cases have been neuro-invasive, the most severe form of the disease, public health officials report. Those who are 50 and over, diabetics, transplant recipients, others with weakened immune systems, chronic alcoholics and those with high blood pressure are most susceptible to the more severe effects. Some people may be genetically predisposed to contract the neuro-invasive infection.

But every case is different.

McCall, who is a nurse practitioner, said she considered herself very healthy before catching the virus. She had been taking a medication for psoriasis that has since been taken off the market due to adverse reactions reported by other patients. Her treating physicians suspect that the medication may have weakened her immune system, McCall said.

Don Read, 70, a Dallas physician who was bitten in 2005, said he had a clean bill of health when he caught the virus. Read, who suffered through the worst symptoms the disease can cause, is serving on a committee that recommended aerial spraying for Dallas County.

Before he got sick, Read typically spent 88 hours a week as a surgeon with Texas Colon and Rectal Specialists. Now it's a strain for him to put in 35 hours a week, he said. He was paralyzed, had the brain swelling of encephalitis and also suffered from meningitis, the swelling of the membrane around the brain and spinal cord, all due to the West Nile virus.

"West Nile affected my stamina," Read said. "I have to wear braces on both legs. I can no longer do the abdominal surgeries because they require me to stand for long hours at the surgery table. And after standing awhile, I tend to fall down."

He had to have physical therapy to learn how to walk and talk again, Read said. He has to take a nap every day to get through his part-time schedule. Even people who suffer from West Nile fever, the disease's milder form, can have long-term problems, he said.

"They may only get sick for a few weeks and then get better," he said. "But others will have decreased stamina for a week or two or even a year or for life because of West Nile fever."

Weakness, cognitive difficulties and behavioral changes are all pretty common residual effects for people diagnosed with West Nile encephalitis, said Richard Fulbright, a neuropsychologist who practices in North Texas.

"They go through an amazingly difficult period of unexpected physical difficulty," he said. "Then they go through long periods of rehabilitation."

The recovery process can grind down the will of some caregivers, and children often have a difficult time reconnecting with a parent who has been diminished by the disease, Fulbright said.

"You can have a lot of behavioral changes," Fulbright said. "The patients can be irritable, it may look like they are being rude and inconsiderate, but it's the disease."

Kristy Murray, an associate professor of pediatrics at the National School of Tropical Medicine at the Baylor College of Medicine, questions whether West Nile disease ever goes away. The 200 West Nile virus sufferers she has followed for 10 years have experienced significant declines in kidney function years after their initial infection, Murray said. More than half of the people who suffer from neuro-invasive disease never return to their pre-infection health status, Murray said.

"It may be that it's a little like getting over the chicken pox," said William Schaffner, infectious disease specialist at Vanderbilt Medical School in Nashville. "We know that chicken pox can last in our bodies for decades and then resurrect itself as shingles later on. Every patient, it seems, does not eliminate the virus completely."

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