Woman in coma 2 months with rare mosquito-borne encephalitis
Before Debbie Casey slipped into a coma two months ago, she was a healthy 68-year-old, moving into a new home in Taylor County.
Then, one day in late May, she fell and couldn’t get up. She thought it was a dizzy spell and chalked it up to the stress of moving. She promised her son Brian Casey, a Sanford resident, that she’d go see a doctor.
But when he called her the next day, she didn’t answer the phone.
“My family went to her house and she couldn’t move anything and she couldn’t talk,” Casey said.
Debbie Casey was airlifted to UF Health Shands Hospital in Gainesville with what paramedics thought was a stroke. But 10 days and dozens of tests later, she was diagnosed with a rare mosquitoborne viral infection called East-
ern Equine Encephalitis.
EEE infection, which causes swelling of the brain, is rare among humans but kills about one-third of its victims.
The infection is characterized by chills, fever, malaise, joint and muscle pain, according to the CDC. Some patients survive without suffering longlasting effects, while others have more profound impairments that could include cognitive, motor, emotional or sensory functions.
“I thought it's important for people to know that there's a human side to this,” said Casey, who hasn’t left his mother’s side for two months.
Most of the EEE cases are documented in mosquitoes, birds and animals like horses, which raise the odds of human infections.
The best way to avoid the infection is by preventing mosquito bites. Wear protective clothing, use mosquito repellents and empty sources of standing water around your home.
This year, in particular, has been an active year for the virus. According to the most recent weekly Florida Arbovirus Surveillance report, several animals, including 44 horses and 116 sentinel chickens, have tested positive for EEE from 31 counties, including Lake and Orange. The number of animal infections this year has been above the 10-year average.
In March, an outbreak of EEE wiped out the chickens and emus of a farm in Levy County, according to local news reports.
There were three human cases of EEE in the U.S. last year — one in Florida in Duval County and two in Georgia. Seven human cases were reported in 2016, none of which was in Florida, according to national data.
And because the disease is so rare, there are no vaccines or specific treatments for the main result of the infection, which is swelling of the brain.
“It's general supportive treatment,” said Dr. Asim Ahmed, assistant in medicine at the Division of Infectious Diseases Boston Children's Hospital and Harvard Medical School. “[Patients] have increased pressure in the brain so the interventions are geared to decrease that pressure.”
Before Debbie was diagnosed with EEE, doctors gave her antibiotics, antivirals and antifungal medications, said Brian Casey. She was sedated and given breathing and feeding tubes. Later, she was put on anti-seizure medications when doctors noticed seizure activity in her brain.
Her most recent test showed there are still some irregular activities in her brain, Casey wrote in his mother’s CaringBridge journal.
“The doctor reminded me that they think it could take 6 months or more for her brain to recover from the shock of the encephalitis,” he wrote. “I guess I had my hopes up a bit but I have known for a long time that this is going to be a long haul; the doctors have always indicated such.”
Other than the brain swelling, EEE infection doesn’t have any specific signs to lead doctors to a quick diagnosis. The infection is currently diagnosed by running tests on the spinal fluid.
But according to some experts, new and upcoming sequencing technology can help with the quicker diagnosis of viral infections such as EEE.
“Some people say there are no treatments, so why try to figure out it early,” said Dr. Shibani Mukerji, associate director of the Neuro-Infectious Disease Unit at the Department of Neurology at Massachusetts General Hospital. “The argument is that if you figure it out early, maybe you can come up with treatments. Now it's a good time to invest in better diagnostic. We can do it better.”
Debbie Casey is still in a coma, but she’s breathing on her own. She's out of the ICU and in a specialized longterm care hospital. Her son has taken her outside to sit in the sun and has brought his Greyhound, Renley, by her side. And he’s patiently waiting for her to wake up.
“I just think when there's a human face to it, people pay attention to it. I know I never paid attention to the [mosquito warnings]. But I'm going to wear mosquito repellent now. If they saw my mom before and now, nobody would believe something as small as a mosquito could do this. It's unbelievable,” he said.
“If they saw my mom before and now, nobody would believe something as small as a mosquito could do this. It's unbelievable.” Brian Casey of Sanford, whose mother is in a coma with Eastern Equine Encephalitis