(news) West Nile Virus & Polio symptoms 
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 (news) West Nile Virus & Polio symptoms

Doctors link polio to West Nile virus

 By Stephen Smith, Globe Staff, 9/24/2002

Mosquito-borne West Nile virus is causing a medical condition rarely seen
by US physicians since the 1950s: polio.

In case reports released yesterday, stunned neurologists in Mississippi
and Georgia describe the conditions of four patients suffering from the
hobbled limbs, impaired breathing, and fevers that are the hallmark of
polio, a disease essentially eradicated in the United States.

Just like the polio patients of the first half of the 20th century, the
West Nile victims seen this summer by the Southern doctors are also
enduring prolonged muscle weakness and respiratory ailments that will
require months of treatment and probably will disable some of the patients

''I teach this as a historical thing to the residents,'' said Dr. Jonathan
D. Glass, director of the neuromuscular program at Emory University in
Atlanta and one of the physicians who treated the polio patients. ''We
simply don't see it today. That's why I didn't believe it at first.''

The strain of polio that was so widely feared in the 20th century, and now
prevented by vaccines, is caused by a different virus than West Nile. In
fact, West Nile comes from a different family than viruses known to cause
the disease. However, the devastating effects are the same.

In polio, the virus attacks the gray matter of the patients' spinal cord,
which contains the neurons responsible for carrying information to the
muscles. As the attack frays the neuron fibers, muscles turn limp, often
producing uneven results - a leg gone weak on the right side, an arm on
the left. It also results in bladder and bowel dysfunction, along with
respiratory complications that can leave patients tethered to breathing

According to the Centers for Disease Control, the West Nile virus has
killed 94 people nationwide this year, including two in Massachusetts, and
sickened 1,963, by far the largest outbreak since it was first reported in
the United States three years ago. Although other viral illnesses kill
vastly more people - the flu is blamed for 20,000 deaths annually -
public-health authorities are concerned about West Nile because it has
spread from coast to coast so quickly and produced unexpected symptoms,
with polio being the most recent example.

''We obviously have to learn a lot more about this virus,'' said Dr.
Alfred DeMaria, director of communicable disease control for the
Massachusetts Department of Public Health. ''This is another aspect that's
worrisome about West Nile.''

The New England Journal of Medicine released the articles on the polio
link nearly a month before their scheduled publication, an unusual step
reserved for reports of urgent medical importance. The doctors who wrote
the articles said yesterday they believe it is vital that their findings
circulate among physicians because some of the patients they treated had
been misdiagnosed and prescribed treatments that could have been

And they suspect - strongly - that other cases of West Nile-induced polio
have gone untreated and unreported. After discovering polio in their own
West Nile patients, the physicians in Mississippi and Georgia decided to
review previous outbreaks. In examining autopsy results from New York City
in 1999, the first time West Nile was identified in the nation, the
doctors uncovered symptoms that struck them as remarkably similar to the
cases they had seen this summer.

Dr. A. Arturo Leis, a neurologist at Methodist Rehabilitation Center in
Jackson, Miss., saw such a patient in late July or early August. He
recalled walking into an exam room and witnessing a 56-year-old man who
had been referred to him because of muscle weakness. In reviewing the
patient's medical chart, Leis discovered that the man had been diagnosed
weeks earlier with early signs of a stroke and prescribed {*filter*}-thinning
medication. The same man also was diagnosed with Guillain-Barre syndrome,
a disorder in which the body's immune system attacks part of the nervous

Only after running {*filter*} tests, observing symptoms similar to polio, and
performing a battery of electrically activated tests that record activity
in nerves and in spinal cord cells, did the Mississippi physicians reach
their diagnosis: polio, caused by West Nile virus.

Previously, severe cases of West Nile had been characterized by meningitis
and encephalitis, the brain swelling that is regarded as the most serious
consequence of the virus. But the muscle weakness and other problems
associated with polio were not evident.

''I thought, `This is extremely unusual - this can't be,''' Leis said.
''How can a virus, in this case West Nile, change its clinical properties
to such a marked degree? It had typically not presented this way.''

The medications the man had received initially, Leis said, could have
killed him. The stroke drug could have caused a hemorrhage, and the
medicine initially given to treat his misdiagnosed case of Guillain-Barre
had the potential to result in a stroke. That's why the Mississippi and
Georgia researchers became so determined to share their findings on the
link between polio and West Nile.

Leis has now seen four cases of West Nile-related polio, one additional
since he wrote his journal article. In Atlanta, Glass received a call from
a suburban physician one Saturday night in July. That doctor was
confounded by the symptoms of a patient he was seeing. She had muscle
weakness, along with fever and meningitis. The kind of muscle fatigue she
was experiencing was consistent with Guillain-Barre, but that disease does
not typically produce fever and meningitis.

''The guy called me and said, `Help. I don't know what I'm looking at,'''
Glass said. ''And I said, `I don't know what you're looking at either.'''

The 50-year-old woman, who lives in Louisiana, which was hard hit by West
Nile and was in Georgia visiting grandchildren, was transferred to the
university hospital in Atlanta. There, a neurology resident, Dr. William
Hewitt, examined her and confirmed the presence of an unusual
constellation of symptoms.

Glass spent the night poring over old medical textbooks and epidemiology
reports on the New York cases. All evidence began pointing toward polio.

The woman treated by Glass is expected to survive but remains in a
rehabilitation hospital. The four patients in Mississippi also will live,
their doctor said, although three will probably have permanent

 This story ran on page A1 of the Boston Globe on 9/24/2002.
  Copyright 2002 Globe Newspaper Company.


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