Local expert says to be cautious, not panicked about West Nile

September 30, 2012|By CHRIS COPLEY |
  • Dr. Mohammed Bilgrami, infectious disease specialist with WillowWood Adult Medicine in Robinwood Medical Center, east of Hagerstown, said West Nile is of concern, but the chances of getting it are low.
ByJoe Crocetta/Staff Photographer

Don't panic.

The odds of catching West Nile Virus are very low, and the odds of suffering serious illness or death are enormously remote.

That's the message from Dr. Mohammed Bilgrami, infectious disease specialist with WillowWood Adult Medicine in Robinwood Medical Center, east of Hagerstown.

"The message is: Do not panic," Bilgrami said during an interview in mid-September.

Yes, West Nile Virus does kill or cause serious illness in a tiny percentage of infected people. But keep it in perspective: Americans are more likely to die from drowning, accidental poisoning, even from falling, than from West Nile Virus.

Family tradition

Bilgrami joined the staff at WillowWood about three months ago. He transferred to Hagerstown from a residency in infectious disease at Loyola University Medical Center in Chicago.

In specializing in infectious diseases, he is following in his father's footsteps.

"I'm Indian. I came the United States seven years ago," he said. "I've grown up seeing my family working in infectious diseases. My father was a chief medical officer in the Institute of Tropical Diseases in India, where the malarial parasite was discovered. And my elder brother works here in Hagerstown, also in infectious diseases."

Bilgrami said his specialty offers endless opportunity to learn about human health.

"It is always new — always new things come up with infectious disease," he said. "And it's not localized to a specific organ, like cardiology, where they're restricted to heart, or pulmonary, where they're restricted to lungs. My interest is in any infection, from head to toes."

Recently Bilgrami encountered a new virus first-hand. He oversaw a patient infected with West Nile Virus, which is an infectious disease carried by mosquitoes.

"This year, there were 3,142 cases (of West Nile infections) in the country so far. Maryland had 30 cases," he said. "There's one case from Washington County. I took care of this patient. She was discharged with no problems."

A new health threat

West Nile Virus first appeared in the United States in 1999, according to the U.S. Centers for Disease Control and Prevention. It was found in humans and horses. The disease's roots are African, as the name suggests.

"The name came from the place it was first derived — the east of Africa, in Uganda, in 1937," Bilgrami said. "Previously, it was found this was a virus that only infected animals — birds, horses, cats, dogs, squirrels, chipmunks and domestic rabbits."

Nationwide the highest incidence of West Nile is in August when mosquitoes are at their most active, he said.

Over the past 13 years, the disease has spread rapidly across the United States and around the world. Infection numbers are increasing, but not steadily. In 2009, the CDC reported 720 cases in the United States, with 32 deaths. In 2010, there were 1,021 cases, with 57 deaths. In 2011, there were 712 cases with 43 deaths.

There was a huge jump in numbers of cases in 2012. On Sept. 25, the CDC reported 3,545 cases so far this year, with 147 resulting in death.

As of Sept. 25, there have been 33 cases in Maryland, resulting in three confirmed deaths.

By far, most infections are benign, Bilgrami said. About 80 percent of people infected with West Nile Virus have no symptoms at all. They do not even know they are infected. Another 20 percent of infected people have symptoms resembling a mild flu.

"These people might get headaches, fevers, body pains," he said. "They might get swollen lymph glands. They might get a rash on their trunk — the chest and belly. And they may or may not seek medical attention. They might stay at home, because this infection goes away within a few days without any blood test, without any treatment."

Serious infections

Only about 1 person in 150 people infected with West Nile has serious complications, Bilgrami said. The virus can go to the brain or spinal cord and cause inflammation.

"If it causes inflammation of the covering of the brain, we call that meningitis. Sometimes it causes inflammation of the brain tissue itself, which we call encephalitis," he said. "Sometimes, very rarely, it causes inflammation of the spinal cord, which causes paralysis, just like polio."

Particularly susceptible to serious illness are older people and people with weakened immune systems, Bilgrami said.

"What we have seen from the literature is people who are older than 50 or people who have underlying immune problems, they are at risk for this disease," he said. "Younger people will come into that 99.3 percent of cases that are asymptomatic or they just have fever which goes away without treatment.

There is no vaccine against West Nile Virus, Bilgrami said, but researchers are working on it. But prevention is fairly simple: Avoid mosquitoes. Mosquitoes carry the virus from infected birds to humans.

"It's all about the mosquitoes. Wherever there are mosquitoes, there is disease," Bilgrami said. "So, to prevent the disease: No. 1, prevent the mosquito bites. Prevent them being around you at work and in the place where you live."

Bilgrami offered recommendations for reducing exposure to mosquitoes — see the sidebar below — but, basically, he urged local residents to keep things in perspective. Out of tens of thousands of mosquito bites annually in Washington County, only one case of West Nile Virus was reported to the county health department.

"(At worst,) this is a mild disease. More than 99 percent of people are fine. They get better without any treatment," he said. "But just because mosquitoes can transmit the virus, take precautions."

Reduce your exposure

Reduce exposure to West Nile Virus by reducing exposure to mosquitoes

West Nile Virus breeds in certain species of wild birds and is carried by mosquitoes to vulnerable mammals such as horses, cats, dogs, squirrels, chipmunks, domestic rabbits and humans.

The best ways to prevent West Nile infections, according to Dr. Mohanned Bilgrami of WillowWood Adult Medicine in Robinwood Medical Center, are to reduce the local mosquito population and to make it difficult for mosquitoes to get to bare skin.

  •  Check doors and windows for holes where the mosquitoes can get in.
  •  Eliminate or limit the amount of stagnant water at home and work. Frequently change water in bird baths and dog water bowls. Put mosquito larva-killing rings in rain barrels or low spots in gutters. Empty water from trash containers and potted plants.
  •  Avoid outdoor activities between dusk and dawn.
  •  When going outdoors, wear long pants and long-sleeved shirts.
  • Use insect repellents with DEET or pyrethrin on exposed skin.

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