- WASHINGTON -- Patricia Heller
was super-healthy, an avid skier and competitive bicyclist. So when she
collapsed in the street after a daylong bike ride, she first shrugged off
the weakness as cramps.
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- By the next morning, Ms. Heller's left leg was completely
paralyzed. It was West Nile virus, from a mosquito bite the Colorado woman
doesn't even remember. She would need months of gruelling therapy to walk
again and today, almost two years later, still isn't fully
recovered.
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- West Nile was long considered a serious problem only
for the elderly and frail, and more of a nuisance illness for everyone
else. Now a surprising number of patients like Ms. Heller shows the virus
is more threatening than widely believed - and new research finds that
even so-called mild cases of West Nile fever can impair people for weeks
or months.
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- It's sobering news as North America gears up for a
seventh
season of the mosquito-borne virus.
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- "West Nile is fading a little bit from the public
consciousness," worries Dr. Henry Masur of the National Institutes
of Health. "Still, there are more cases of paralysis (from West Nile)
than there were in many years of polio."
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- West Nile virus had stricken abroad for decades, from
the tip of Africa up to Europe and throughout Asia, before it appeared
in New York City in 1999 and began an inexorable march across this country.
Since then, the Centers for Disease Control and Prevention have counted
more than 16,600 human cases and 654 deaths.
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- Severe illness still is rare, considering that 80 per
cent of people infected never show symptoms.
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- But last year, about a third of the West Nile cases
reported
to CDC had neurologic complications like meningitis or encephalitis. Those
are most common in older adults.
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- Then there are patients like the athletic Ms. Heller,
who came down with West Nile's most perplexing complication: polio-like
paralysis or severe muscle weakness that often strikes healthy people in
their 30s, 40s and 50s. They may show no other symptoms before a limb
suddenly
quits working. Sometimes, the paralysis leads to respiratory
failure.
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- There are no good counts of this West Nile complication,
and some doctors believe it's frequently mistaken for a stroke or other
paralyzing ailment.
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- In a study to be published in July, CDC's Dr. Jim Sejvar
estimates that 10 per cent of people who develop the most severe West Nile
disease may have some degree of the polio-like complication, and many don't
recover muscle function.
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- Even the less serious form of illness, West Nile fever,
is turning out to be harder to kick than doctors initially described, so
much so that the CDC has largely abandoned its earlier characterization
as a "mild disease."
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- A study by Chicago's health department last fall found
that West Nile fever was bad enough to keep half of sufferers out of school
or work for 10 days, fatigue lasted a month - and the median time to get
back to normal was a stunning 60 days.
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- What's happening? In much of the world, West Nile is
a fairly mild illness. But the form working its way through the United
States appears similar to a more virulent Israeli strain, something not
initially apparent to health workers.
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- "There was no recognition that it could paralyze
and kill people that were healthy and relatively young," says Ms.
Heller, now 56, a physician's assistant who shared rehabilitation with
a 40-year-old also paralyzed in late 2003. "We were really caught
off guard."
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- There is no vaccine yet, or approved West Nile treatment.
The best protection is to avoid mosquitoes, using repellent whenever you're
outdoors and not letting puddles collect in flower pots, wading pools or
other spots where mosquitoes can breed.
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- Anyone with symptoms of serious illness should see a
doctor right away: high fever, severe headache, confusion or difficulty
thinking, stiff neck, severe muscle weakness, or tremors.
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- Studies of potential West Nile therapies - including
infusions of West Nile-fighting antibodies from the blood of survivors
- are poised to begin as soon as this year's first patients appear.
California
especially is putting doctors and residents on notice to seek out these
research studies, as that state braces for what it expects to be a large
outbreak.
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- "If new symptoms develop at any age, don't assume
that it is an innocuous, transient viral infection," says Dr. Patrick
Joseph, a San Francisco physician and member of the National Foundation
of Infectious Diseases. "Seek help so diagnostic testing can be
done."
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- For those who suffer paralysis, prompt physical therapy
is crucial, too, advises Dr. Mazen Dimachkie of the University of Texas
Medical School in Houston.
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- That therapy is what Ms. Heller credits with her ability
to walk again, and she's keeping it up in hopes of one day also being able
to run again. Meanwhile, she advises everyone she meets to slather on the
bug spray.
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