For some people who contract West Nile virus - the small percentage who develop the most serious forms of the illness - the only silver lining is that they probably never will get sick again from the mosquito-borne disease.
Survivors of the most serious infections have trouble finding words to describe the prolonged misery they endured as a result of a tiny insect bite.
"I felt like my brain was short-circuiting," said 40-year-old Ronni Nann of Antelope.
"I felt like I got hit by a truck," said Dana Andrews, a 48-year-old from Land Park.
"My legs felt like someone stuck a knife in them and wiggled it around," said Michael Johansen, 45, of Stockton.
Sacramento County is the state's top producer of West Nile cases this year, with 129 logged as of Friday, and California leads the nation with 593 cases.
The number of people actually infected with West Nile is believed to be far higher, since four out of five people who contract the virus won't experience symptoms. Twenty percent of those infected will get symptoms that can be as mild as flulike fever, body aches and rash. Only one in 150 will experience the most serious consequences: central nervous system problems such as disabling paralysis, brain inflammation or meningitis that can lead to death.
But the unlucky ones who do get sick describe an illness that surpasses just about anything they've suffered.
"It's like 10 times the worst flu I have ever had," said Johansen, who considers himself an otherwise healthy man. "I needed help even to go to the bathroom."
While they don't reflect the most common West Nile cases, the stories of Johansen, Nann and Andrews help illustrate how serious the disease can be, even in relatively young people. They also shed light on the wide spectrum of illnesses caused by the virus, including symptoms that may never entirely disappear.
Johansen, who runs a machine shop in Fremont, frets he may never again be able to work running mills and lathes and other shop equipment at full capacity.
About a week after his first symptoms - the excruciating leg pains, fever and sore joints - Johansen lost movement of his left shoulder.
That was Aug. 23. To this day, he said, he can move his fingers but can't lift his elbow. He eventually was diagnosed with West Nile meningitis - an inflammation of the lining of the brain and spinal cord - and later with a related case of brachial neuritis, inflammation of the nerves that allow movement of the arm.
"I don't know how I am going to work," said Johansen, who temporarily is collecting disability payments. "I find even three hours of physical work feels like 15 hours of work. But I need to be there. I don't want to lose my job."
The nerve damage that in rare cases occurs with West Nile has been referred to as acute flaccid paralysis. It also is being called polio-like syndrome.
"The virus gets into the spinal cord and picks only the nerve cells that control the muscles," explained Dr. David Richman, a neurology professor at UC Davis Medical Center. He said researchers cannot predict how permanent the nerve damage will be in any particular patient.
A recently published study of 32 patients who had West Nile-related paralysis in Colorado found that half still had the condition four months after the illness set in.
Nann, of Antelope, was luckier, in that she never lost the ability to move a limb. But her case proved surprisingly serious as well.
"I spent my 40th birthday in the hospital," said the stay-at-home mom.
Nann suffered for a week with high fever and diarrhea before her symptoms really began to worry her.
"I slept for two days straight," she said. "About a week after that, I started getting the headache. It started out with some weird dizziness. It felt like my brain was short-circuiting. My vision was a little blurry."
Nann went to the emergency room, where she was told to check in with her regular doctor the next day. That's when a spinal tap confirmed the meningitis. More than a week later, the West Nile test results came back positive. She spent five days in the hospital.
Even after she went home, she felt anything but herself. "My mom had to come and stay with us for 2 1/2 weeks because I was so weak," she said. "Even a shower exhausted me."
Seven weeks later, she said, she is easily fatigued and needs naps of up to two hours a day.
Even those whose symptoms don't escalate to a neuroinvasive illness - those diagnosed with West Nile fevers - can feel lousy for weeks.
"We used to say, 'As long as it's not a neuroinvasive case, don't worry about it,' " said Dr. Carol Glaser, chief of the viral disease laboratory at the state Department of Health Services. "We all have an acceptance now that West Nile fevers are not as benign as we thought."
A recent study out of Illinois found that West Nile fever patients typically felt exhausted for at least a month and had muscle weakness for nearly as long. About a third required hospitalization.
Even more intriguing, study authors found, was that the duration of illness was not associated with the patient's age.
That may be of some consolation to Andrews, the Land Park man who got sick last month.
"I was relieved to know what I had," Andrews said, "but I felt like a chump for not being one of the 80 percent (who had no symptoms)."
Fit and active, the stay-at-home dad had joked with his wife that his symptoms could be those of West Nile when he fell ill Aug. 9.
He had a fever and body aches for nearly a week before he went to his doctor. An initial West Nile test came back negative, and soon Andrews felt well again, even venturing to the beach one day.
"In the middle of the following week, I got the rash, and by Friday I couldn't get out of bed. I was in bed for seven days. I had a very severe headache. When I coughed, it felt like I was going to explode."
Andrews was retested, and on Aug. 26 learned he had West Nile virus.
Andrews began feeling stronger early last week, well enough to tackle overdue projects in his back yard and garage.
"The next day, I woke up and felt like I had gone back four days," he said. "Now, I'm afraid to do too much."
WEST NILE AT A GLANCE
Here's a summary of information about West Nile virus in the region, the measures taken to deal with it, and tips to avoid it:
Reported human cases of the disease in regional counties: Sacramento, 129; Stanislaus, 65; San Joaquin, 26; Placer, 23; Butte, 15; Yolo, 10; Sutter, seven; Solano, three; Tehama, two; Yuba, two; Nevada, one; Plumas, one; Solano, one.
Where to get information
* To report a dead bird, call (877) 968-2473. (WNV-BIRD)
* Sacramento and Yolo counties: Residents can request mosquitofish, report untreated pools of standing water, get aerial spraying information and sign up for e-mail notification of local insecticide treatments by calling the Sacramento-Yolo Mosquito and Vector Control District at (800) 429-1022 or (916) 685-1022, or at www.fightthebite.net.
* Placer County: Residents can get information and obtain mosquitofish by calling the Placer Mosquito Abatement District at (916) 435-2140.
For updates and changes to the ground-spraying schedule, go to www.roseville.ca.us or call (916) 435-2140.
* Butte County: Residents can go to www.buttecountypublichealth. org, or call (800) 339-2941.
* Anyone with concerns about the health effects of spraying can call the California Poison Control number at (800) 876-4766.
To reduce the risk of catching West Nile virus, the Sacramento-Yolo Mosquito and Vector Control District recommends:
* Use an effective mosquito repellent containing ingredients such as DEET, Picaridin or oil of lemon eucalyptus.
* Repair tears in door and window screens.
* Drain standing water.
* Wear long pants and long sleeves outdoors when practical.
* Avoid being outside at dawn and dusk, when mosquitoes are most active.
For additional stories and information on West Nile virus, see: www.sacbee.com/links
About the writer:
- The Bee's Dorsey Griffith can be reached at (916) 321-1089 or firstname.lastname@example.org.