September 2, 2004
Rankin County man learns even healthy people can succumb to severe West Nile virus infection
By Susan Christensen
Health and Research News Service
BRANDON, Miss.—Charles Goldsmith of Brandon has only a hazy recall of the days he spent fighting to survive a severe case of West Nile virus encephalitis.
But there is one memory he won’t soon forget. “All my family was marching in and getting in my face and telling me they loved me,” remembered Goldsmith. “I thought: Maybe I’m dying and they’re saying their last good-byes.”
Goldsmith is among Mississippi’s first reported human cases of West Nile virus this year. And despite having been in intensive care for 10 days, Goldsmith knows his fate could have been much worse. Another virus victim in Rankin County died of the mosquito-borne disease.
Goldsmith was initially left seriously debilitated by the disease, and immediately checked into Methodist Rehabilitation Center in Jackson to begin therapy to improve his strength, endurance and mobility.
“I couldn’t walk when I first came to Methodist and it scared me to death,” he said. “But I was told if I did what the therapist told me to do they would have me up pretty quickly. They have you working all day long.”
Goldsmith is already seeing the fruits of that labor. While he is continuing therapy at Methodist’s outpatient clinic in Flowood, he has made great strides, said Dr. Michael Winkelmann, a rehabilitation medicine physician at Methodist.
“He did have some difficulties with walking and balance and he recovered very rapidly,” Winkelmann said. “He was very fortunate because I have a few West Nile patients that I treated a year ago who are still not walking.”
Dr. Winkelmann said many people who are infected with West Nile never have any symptoms, while others experience only a flu-like illness. In a small number of people, infection can cause encephalitis or meningitis and may result in paralysis, coma or death.
In 2000, Methodist researchers were the first to report that West Nile virus can attack the motor cells of the spinal cord, causing fatigue, muscle weakness and a polio-like paralysis. They recently wrapped up a federally funded study that looked at the long-term outcome of 33 West Nile virus cases from 2002 and 2003.
Dr. Dobrivoje Stokic, director of Methodist’s Center for Neuroscience and Neurological Recovery (CNNR), said preliminary results of the study reveal that lasting fatigue affected about half of the study participants. About 1 in 5 said fatigue was severe enough to impact their daily lives. Overall, 20 to 30 percent of participants said that aftereffects of their West Nile virus infection were causing “big problems,” including limiting their outdoor activities and affecting their ability to fulfill family roles. On the positive side, muscle recovery was evident in almost all cases, and the majority of participants remained functionally independent.
CNNR senior scientist Dr. Art Leis said the study has helped identify a number of symptoms not previously associated with West Nile virus, including facial weakness, difficulty swallowing and vision problems.
“Our initial discoveries showed the virus attacking the anterior horn cells of the spinal cord, which controls muscle function in the limbs and leads to paralysis,” Dr. Leis said. “Now we know the virus also can attack other nerves and muscles, causing additional loss of motor control in the body.”
Dr. Leis said that alerting other health care professionals to these more rare manifestations of the virus should help reduce what has been a common problem—doctors mistaking a patient's muscle weakness and paralysis for symptoms of stroke or Guillain Barre Syndrome. “Treatments for those conditions are completely ineffective for West Nile virus and can cause injurious side effects,” Dr. Leis said.
Study results also have underscored the need for West Nile patients to undergo a comprehensive battery of electro-diagnostic tests to determine the extent of damage to the spinal cord. “A complete neurological electromyography and nerve conduction studies are essential for a prognosis,” Dr. Leis said. “If the virus destroys a majority of cell bodies in the spinal cord, the patient will likely have permanent profound weakness.”
At greatest risk for severe infections are people with compromised immune systems. “A lot of times patients with rheumatoid arthritis, lung disease, liver disease—anyone on immunosuppressive therapy or steroids, such as Prednisone—are at substantial risk,” said Dr. Winkelmann. Also at heightened risk are those with HIV.
But as Goldsmith’s case bears out, “anyone can become ill,” Winkelmann said. “He was healthy. The message should be we are all at risk.”
After being bitten by an infected mosquito, Goldsmith quickly went from being a regular at the gym to a resident of an ICU unit.
His symptoms began on a Saturday with burning ears and dizziness, and quickly progressed to double vision and hallucinations. “By Wednesday, he was having violent convulsions and talking jibberish,” said his wife Mary Ann.
As often is the case with West Nile virus, doctors spent days trying to pinpoint the source of Goldsmith’s suffering. “When I asked the doctor if he was going to get better, he would just say: ‘He’s very, very sick,’” Mary Ann said. “They were concerned he had herpes encephalitis, which destroys the brain.”
When news came that Goldsmith had tested positive for West Nile, Mary Ann said she felt relieved. “I knew West Nile carried a pretty good possibility for recovery.”
When Goldsmith arrived at Methodist, he was unable to stand and therapists immediately began working on his balance and endurance. By the time he left, he could stand for 15 minutes, walk short distances unassisted and be totally independent with his self-care.
Goldsmith said he’s looking forward to getting back to work as director of manufacturing for Trilogy Communications in Pearl and Flowood. And he and his family say they’re grateful to all who played a role in his recovery—from the many who prayed for him to those who answered his medical needs.
“I think miracles happen,” Mary Ann said. “I think we have excellent doctors in this state and it’s wonderful to find a facility like Methodist Rehab that has a wonderful reputation. I was so impressed with the respect Charles was given. They’re very focused on everyone up there. They’ve seen so many miracles and feel privileged to be in a situation where they can correct something.”
Measures to reduce mosquito population in and around your home include:
- Drain or dump any source of standing water around the home;
- Dispose of containers and debris which can collect or hold water;
- Remove all leaf debris;
- Dispose of used tires;
- Clean rain gutters and swimming pools;
- Change the water in bird baths weekly;
- Reduce the mosquito population by using over-the-counter larvaciding products that can be purchased at home improvement stores;
- Eliminate pools of standing, stagnant water, especially with organic debris;
- Repair damaged or torn window and door screens that stay open;
- Remove outdoor pet food and water dishes that are not being used;
- Close garbage can lids and be sure water does not collect in the bottom of the cans;
- Check around construction sites to ensure that proper backfilling and grading prevent drainage problems
Measures to protect yourself include:
- Wear long-sleeved, long-legged clothing with socks and shoes outdoor when practical;
- Use mosquito repellant with DEET, follow label instructions, products with up to 35 percent DEET will provide adequate protection under most conditions; Use repellant with 10 percent or less concentration of DEET on children as recommended by the Academy of Pediatrics, follow label directions;
- Avoid mosquitoes whenever possible, stay indoors or take personal protective measures, especially between dusk and dawn.
Source: Mississippi State Health Department