City man in coma with W. Nile

Druid Hill 72-year-old 1st Md., 10th U.S. case reported this year

September 07, 2001|By Frank D. Roylance | Frank D. Roylance,SUN STAFF

A 72-year-old Baltimore man was in a coma and on life support at Sinai Hospital yesterday with Maryland's first reported human case of West Nile encephalitis, an inflammation of the brain.

The diagnosis was made late yesterday after tests for antibodies in the man's blood and spinal fluid showed a 98 percent likelihood of infection by the mosquito-borne West Nile virus, said Baltimore's health commissioner, Dr. Peter L. Beilenson.

He said that the federal Centers for Disease Control and Prevention "finds it is extremely likely that this is an actual West Nile case" but that further testing will be done to confirm the diagnosis.

The victim's identity was not disclosed.

His illness is only the 10th reported case of human West Nile encephalitis or meningitis in the United States this year. One of those cases was fatal to a 71-year-old Georgia woman.

Last year, 20 people were hospitalized with the illness and two died. In 1999, 60 were hospitalized and seven died.

Since its arrival in the United States in 1999, the West Nile virus has been primarily a disease of wild birds. It is transmitted through the bite of mosquitoes from birds to people, horses and other mammals.

Beilenson said the city will spray to kill adult mosquitoes in the Druid Hill neighborhood where the stricken man lived. But he stressed that the risk to city residents remains low.

"The vast majority of people's immune systems take care of it," he said. "We are trying to reassure people that this does not change our message - that this is not a major public health threat."

He said two Marylanders die every day from AIDS. Far more die from smoking-related illnesses.

Studies have found that between 70 percent and 80 percent of people infected by the West Nile virus never show symptoms. The antibodies they develop give them immunity to the virus, although no one is sure for how long.

The 20 percent to 30 percent who do become ill generally experience mild, flu-like aches and fever, according to information provided by the Cornell University Environmental Risk Analysis Program.

Only one infected person in 150 will develop the serious neurological symptoms that indicate West Nile encephalitis or meningitis - inflammations of the brain and spinal cord.

The death rate among people who have developed West Nile neurological symptoms in the United States, Israel, Russia and Romania has been between 5 percent and 14 percent, according to the CDC.

Beilenson said the Baltimore man was taken to the emergency room at Sinai Hospital on Aug. 22.

"His friends became concerned when they didn't see the gentleman for a couple of days," he said. "The family was called, and they found him unconscious." It was not known how long he had been in that condition.

Beilenson said it was likely that he had been bitten by an infected mosquito near his home.

The man fits the profile of people most vulnerable to serious illness from the West Nile virus - the elderly and those with weakened immune systems.

"He is 72, with a significant number of chronic, debilitating conditions," Beilenson said. He declined to disclose further details, citing patient confidentiality.

The other human West Nile cases this year have been reported in Florida (4), New York state (3), Georgia (1) and New Jersey (1).

Two of the victims were in their 40s. One was 64, and the rest were in their 70s.

The number of severe and fatal human cases of West Nile fever in the United States has been falling each year since 1999. Health officials aren't sure why. The toll of dead birds and the number of states in which they have been found have been climbing, so the number of people exposed to the virus is increasing.

Authorities suggest that public education, better mosquito "hygiene," and more extensive larvicide applications in the spring and early summer may deserve the credit for the drop in cases.

The appearance of a human West Nile case in Baltimore was not a surprise. "We were expecting one," Beilenson said.

In late July and early last month, hundreds of dead crows began turning up in some Northeast Baltimore neighborhoods. The numbers got so high that the city health department announced that it would no longer routinely collect and test them.

At one point, Baltimore and Maryland led the nation in the number of reported West Nile infected birds.

The first infected mosquitoes in Maryland were also found this summer, in 11 batches of mosquitoes among the 10,000 tested. Most were found in the Baltimore area.

A study by the New York State Department of Health found that serious human cases of West Nile fever began to appear in New York communities last year, a few weeks after the number of dead crows found there began rising sharply and exceeded 1 per square mile.

The Druid Hill man did not live where the heaviest concentrations of infected crows were found; only two dead crows having been found in his 21217 ZIP code.

But Beilenson was not very surprised. "Birds with West Nile virus have been found all over the city now," he said.

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