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Psychiatrist cautions Mississippians about West Nile virus complacency

Ridgeland man, others on immunosuppressive drugs at greater risk for mosquito-borne illness
Lisa Uzzle Gates
Health and Research News Service
In his fourth week at Methodist Rehabilitation Center, Paul McGinnis has regained a lot of upper body strength and is working to regain control of his lower body. He spends three hours a day in physical and occupational therapy.

JACKSON, Miss.—Fewer cases of West Nile virus this year, combined with the coming of cold weather, caused Paul McGinnis to become complacent about the mosquito-borne illness.

Unfortunately, McGinnis, who is on immunosuppressive drugs for a donated kidney, is in a group that can’t afford complacency. Currently recovering from West Nile at Methodist Rehabilitation Center in Jackson, McGinnis urges everyone, especially those with weakened immune systems, to take precautions. “Don’t let your guard down. This disease is no fun,” he said.

Because the virus is so new, scientists are still learning about it and why it can produce such a range of symptoms—from a mild flu-like illness to various degrees of paralysis to death. There are a few things they know for certain—people with weakened immune systems, whether from age, illness or medications such as steroids and immunosuppressive therapies, are at risk of developing the most serious symptoms of the illness.

“A lot of times patients with rheumatoid arthritis, lung disease, liver disease—anyone on immunosuppressive therapy or steroids, such as Prednisone—are at substantial at risk,” said Dr. Michael Winkelmann, McGinnis’ doctor. Also at risk are those with HIV. People in all these categories need to take extra precautions to protect themselves from the virus, Winkelmann said.

McGinnis, of Ridgeland, doesn’t remember getting bitten, and speculates that it may have happened on a trip to Louisiana. McGinnis knew that his medical condition put him at a greater risk for developing harsh symptoms of the disease, but said with fewer reported cases this year and the lateness of the season, he had let his guard down. He said he was much more aware of the West Nile virus last year. A psychiatrist at Mississippi State Hospital, McGinnis said he even scouted around the hospital campus, on the lookout for standing water that could promote the mosquito population.

McGinnis, 38, has been in and out of the hospital since infancy for kidney problems, including three kidney transplants and a total of about 25 operations. When he began running a fever in September, he thought it was a sinus infection, something he had become accustomed to dealing with.

He went to the doctor on Sept. 11 and was immediately sent to the hospital. He realized it was something more than a sinus infection when he began experiencing weakness in his arms and legs. Two days later, he was in a coma that would last about a month.

After he came out of the coma, he began working his way back, faced with severe weakness that made it difficult to even lift his hand off the bed. Winkelmann said the combination of the virus attacking McGinnis’ nerves and the long stay in intensive care had a severe effect on his muscles.

In his fourth week at Methodist Rehab, McGinnis has regained a lot of upper body strength and is working to regain control of his lower body. He spends three hours a day in physical and occupational therapy. He uses a standing frame, which holds him up, so that his legs and organs will become accustomed to being upright after months of lying in a hospital bed and sitting in a wheelchair.

Winkelmann said McGinnis’ prognosis is very good, but it will take many months of rehabilitation to get the doctor back to his rounds.

McGinnis isn’t letting this most recent health scare get him down. His kidney, which he received in 1995, is doing well and he knows working with his medical team holds the key to his continued recovery.

While being a doctor helps him to understand many of the ramifications of the illness and its aftermath, McGinnis said that can sometimes make it more difficult, too, because he understands he will likely have limitations for the rest of his life.

“I’m probably looking at having a brace on this right foot and using a cane,” he said. “I have a sailboat and I really enjoy sailing, but I don’t know if that will be possible now.”

While the state has seen fewer West Nile virus cases and deaths this year—79 cases and two deaths, compared to 193 cases and 12 deaths last year—that doesn’t indicate the virus is leaving Mississippi, said Sally Slavinski, epidemiologist with the Mississippi State Department of Health.

“We only have four or five years worth of data, so we are not making any predictions for next year. New York had a big outbreak in 1999 and then it subsided, only to have more cases reported this year than the initial outbreak,” Slavinski said.

And while we are approaching the end of the mosquito season, it’s a good idea to continue to be cautious. The last case in 2002 was reported in December, Slavinski said.

Doctors and scientists at Methodist are playing a key role in unlocking the mysteries of the virus. Researchers at the Center for Neuroscience and Neurological Recovery at Methodist were the first to link the virus to the paralysis that has plagued many of the patients who have survived the illness. Their findings have been published in medical journals and publications around the world.

Researchers at the Jackson hospital are currently conducting follow-up studies on West Nile patients who have had the disease at least a year and continue to suffer residual symptoms. They hope to determine why the virus produces such a range of symptoms and outcomes. This study is being done in collaboration with the state Department of Health.

“The long-term outcome of people with muscle weakness has not been carefully studied, so we don’t know to what extent they recover,” said Dr. Dobrivoje Stokic, CNNR director. “We have seen some recover in longer periods and some are still paralyzed. We want to know what kind of recovery has taken place in the past year so that we can compare it to their evaluation soon after they were infected. We hope this will eventually tell us if they severity of initial impairment is related to long-term outcome.”