Jim Ruffolo probably didn't feel the mosquito bite, but his wife believes it happened as he was painting their north Modesto home in August.
The fever started Aug. 15 and his worsening symptoms prompted a trip to the emergency room four days later. A doctor said he might have the flu, and sent him home. But that night he became confused and extremely weak, and his wife, Ginny, gave him cold baths to bring down his 106-degree temperature.
The next morning, an ambulance took him to Memorial Medical Center, where he was put in an isolation room. Doctors thought the symptoms -- fever, confusion, body aches and loss of muscle control -- could mean contagious meningitis. On Aug. 24, a test of his spinal fluid showed he had West Nile encephalitis.
Because it isn't contagious, the 66-year-old Ruffolo was moved to an intensive care unit, where he spent weeks in a semiconscious state, breathing with the aid of a ventilator and was fed through a tube.
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The illness, striking the central nervous system, immobilized the muscles in his body, and doctors kept him heavily medicated to deal with the brain swelling, the family said.
"He would open his eyes and not be aware of what was going on," said his wife of 42 years. "It was a matter of sitting here praying that he would get better. They did not know if he would survive this."
Ruffolo, who is retired after working in purchasing for food companies such as Safeway and Zacky Farms, started coming out of it late last week. He has regained some muscle control, allowing him to swallow and move his arms and legs a bit.
His daughter, Jamie Ruffolo, said he can use gestures and notes to communicate, and after nearly a month of suffering he learned the cause of his mysterious illness. When Ginny told him it was West Nile virus, he nodded and rolled his eyes.
West Nile virus is known to have stricken 13 people in Stanislaus County this year, an illness rate of less than three in 100,000 residents, but Ruffolo's case is a reminder of what the illness can do.
County still recording cases
The mosquito-borne virus, which usually emerges in the summer, has infected 230 people in California this year, causing 10 fatalities. Stanislaus County continues to record cases in the latter days of summer, including a 54-year-old woman who has suffered from West Nile fever since Aug. 20.
That case, reported by public health officials Monday, prompted the East Side Mosquito Abatement District to spray the residential areas around Briggsmore and Rose avenues Thursday morning and fog the woman's back yard.
Her illness started with bad leg cramps, a fever and a sensation that she was going to faint, she said. For two weeks, she took Tylenol to bring down the fever so she could work as a licensed vocational nurse, then the fever came back on the weekends, she said. Her other symptoms were low back pain, body aches, joint pain, sensitivity to light and severe headaches.
"It hurts," said the woman, who declined to be identified. "It feels like your head is so swollen you can't carry it on your neck."
She recalls getting mosquito bites at the Graceada Park community concerts last month, but believes she likely was infected by a mosquito in her back yard, with its 150 varieties of plants and a small pond.
The pond has mosquito fish, but large trees in this area of Modesto attract crows and other large birds that can carry the virus and pass it to mosquitoes when they are bitten.
Rhiannon Jones, a vector biologist for the East Side district, said she put a trap in the woman's back yard this week and it caught 70 mosquitoes. None tested positive for West Nile, but the abundance of mosquitoes convinced the district to spray in the neighborhood.
Although it's not certain where she was infected, the woman told friends and parents with small children on her street to take precautions. Neighbor Dyane Jordan said Thursday she douses herself with insect repellant.
"Since our neighbor got it, I have been very afraid there are more (infected) mosquitoes around." Jordan said.
Since West Nile first appeared in Stanislaus County in 2004, the East Side district has recorded large numbers of infected, dead birds in Modesto's 95356 ZIP code, where the nurse lives, and 95350, where the Ruffolos have a home, said Lloyd Douglas, district general manager.
Ginny Ruffolo said that, before her husband got sick, they had spent a lot of time painting their home near Standiford Avenue and Prescott Road. She said she was concerned that nothing was done to alert people in her neighborhood about infected mosquitoes.
"There are elderly people and children in the neighborhood," she said. "My husband is not the only one (in the county) who has gotten sick."
Douglas said patient confidentiality laws prevent the district from identifying people who are sickened by West Nile. It receives a report from state health officials when a case is confirmed, and responds to the neighborhood where the person lives to set traps and possibly spray.
Patients not named
District personnel may tell residents they encounter that an infection occurred in the area, but they don't identify where the person lives, Douglas said. A reported case also doesn't mean the victim was infected at home.
Jamie Ruffolo said a crew sprayed around the home Sept. 7, but "they came only after my uncle called the county and told them my father was critically ill." That was two weeks after the state reported her father's case.
Douglas said the district sprayed in the neighborhood within three days of the report date, Aug. 23. He believed the family's pro- perty wasn't treated then because the mosquito count wasn't significant.
Jim Ruffolo, a Chicago native and avid Bears and Cubs fan, was in fair condition at Memorial on Thursday. Therapists come to his bedside each day to help him move his arms and legs and sit up in bed. Doctors are weaning him off the ventilator, so that he breathed on his own for much of Tuesday. He was so tired he was back on the ventilator Wednesday.
"Every time we get our hopes up, something happens and he takes a couple steps back," Jamie Ruffolo said.
Ginny Ruffolo said doctors are cautiously optimistic he will pull through. He is not expected to fully recover for two years and might have permanent effects of the illness.
Although the number of cases usually taper off near summer's end, county health officials believe more cases could emerge, because the virus would have thrived during the hot spell early this month. Symptoms may appear two to 14 days after infection.
The nurse who was infected said she wishes she had taken precautions. "I was bad like everyone else who is not paying attention," she said.