West Nile infections spreading, but anxiety is mounting faster

Doctors grapple with often outsized concerns as this mosquito-borne virus is detected in more states.

By Victoria Stagg Elliott, AMNews staff . Aug. 26, 2002.

Robert Goldstein, MD, a preventive medicine resident at Tulane University in New Orleans stepped on his back porch at dusk one evening in June. In the five minutes that passed before he went back inside he was bitten by dozens of mosquitoes. A few days later he had severe muscle aches, chills, and a rash that covered his body.

Having moved to town from Pennsylvania only about a week earlier, this was not the welcome he expected. Ultimately, he was found to have one of this year's first human cases of West Nile fever. Dr. Goldstein has since recovered and has joined the public health team investigating the outbreak.

"It's kind of ironic," he said. "But it was a surprise because the odds of even having symptoms are against it."

His case illustrates several aspects of what makes the West Nile virus situation so tricky for physicians. There are two primary means of prevention: Eliminating standing water that allows mosquitoes to breed and wearing mosquito repellant -- a step that most concede is tough to do consistently.

Also, because the index of suspicion was low at the time he contracted the virus, it was challenging for Dr. Goldstein to get a diagnosis.

And this is another issue physicians face.

West Nile experts say that a diagnosis for moderate, mild or asymptomatic cases is not that crucial -- it's more important for surveillance than for patient care. Mostly because there is no available treatment except supportive therapy in the most dire cases. Dr. Goldstein, for example, confirmed that he had West Nile with a blood test after he had recovered. In the meantime, he had treated himself with over-the-counter pain relievers. [...]