Alexandra Inghilterra was in a place she knows well — on a climbing wall, 10 feet up, leaning backward with her spine approaching parallel to the floor and nothing but open air in between.
Only this time as she leaped for the next hold, her coordination failed and she crashed to the ground, her head whipping into the mat.
Within hours, she had a terrible headache. Probably a concussion, the doctors in the emergency room said.
Within a couple of weeks, she had a rash on her arms and still had a brutal headache. Then came exhaustion, a fever spiking up to 105.5 degrees and near-constant vomiting. She was admitted to the hospital.
“I remember having my whole doctor team in the hospital trying to keep me awake,” said Inghilterra, who goes by Alex and is 17.
After testing, she was diagnosed with meningitis, but the source of the infection was a mystery until a second test came back. It was West Nile virus, a disease that can be fatal or debilitating but is often not thought of as a threat to people who are young and healthy.
Alex is an elite competitive climber — a bronze medalist at this year’s national championships and a veteran of international competitions. After her infection last August, it took her months to recover, regain her coordination and build back her strength to climb at the same level as before.
And, while bug-ridden places near standing or slow-moving water like irrigation canals or retention ponds are especially risky for exposure to West Nile, what gets her mom most is where Alex likely caught the virus: sitting on her patio in Greenwood Village.
“I never saw that coming, especially from our backyard,” said Alex’s mom, Kim, “and we travel all over the world.”
Colorado’s West Nile season is underway
West Nile is the most common mosquito-transmitted disease in the United States. Despite not being a particularly buggy state, Colorado is far and away the place hardest hit by the virus in recent years in America. And this year could be especially bad.
Last year, the state saw 286 reported cases of West Nile virus and 20 deaths, a slightly worse-than-average year by recent standards. But that was nearly double what any other state saw. In 2023, a particularly bad year for mosquitoes locally, Colorado recorded more than 600 cases, including 316 neuroinvasive cases — the kind of illness Alex had — and 50 deaths.
“We just have the right environment for the birds that introduce the virus, the mosquitoes that transmit the virus and both of those are found in close proximity to population centers,” said Chris Roundy, a medical entomologist with the Colorado Department of Public Health and Environment.
This year’s season is already underway, with authorities in Jefferson County reporting the first human case of West Nile virus last week, a whole month earlier than the season typically starts.
West Nile transmission is notoriously difficult to predict. It involves temperature and moisture and how water moves and where.
“There are a lot of moving parts to understand,” Roundy said.
The type of mosquitoes that spread West Nile — from the genus Culex — typically feast on birds and like to hang out in wetland areas. Think: irrigation ditches, canals, runoff ponds, cattail marshes. That is why communities with a lot of agricultural operations or open spaces next to housing developments can be particularly hard-hit with West Nile. Larimer and Weld counties rank in the top five nationally for the number of West Nile cases since 1999.
But the mosquitoes can also be found in your backyard and can lay eggs in whatever happens to be holding onto a little stagnant water. That might mean the drip trays under flower pots, upturned buckets or watering cans, kids’ play equipment, old tires, or that pile of junk you’ve been meaning to throw out.
That flexibility means both wet years and drought years in Colorado have the ability to produce plenty of West Nile cases. In fact, drought years might produce even more West Nile activity because the songbirds that are carriers of the virus and the mosquitoes that transmit the virus pack in tighter at fewer available watering holes.
Add in Colorado’s mild winter this year — Culex mosquitoes can actually survive the winter holed up in little hideaway spaces — and a recent spate of thunderstorms in many parts of the state, and it’s possible that all those moving parts will align to create an especially active season.
“This year has the potential for it to be an earlier mosquito season,” said Dr. Kevin Messacar, an infectious disease specialist at Children’s Hospital Colorado who was among the doctors who treated Alex.
The long climb to recovery
West Nile infections often pass with a few cold-like symptoms — or maybe even no symptoms at all. Many people may not even realize they were infected.
But in a small percentage of cases, the virus can progress into neurologic disease that causes swelling in the brain or spinal cord or the protective layers around them. People 50 and older are most at risk of severe infection, but kids can also get sick, Messacar said.
“It’s something we want people to be aware of because it can be a challenging diagnosis to make,” Messacar said.
Though they aren’t certain, Alex and her mom believe her fall at the climbing gym may have been the first symptom. Just a little less coordination than usual.
By the time the high fever and massive vomiting kicked in, Kim Inghilterra said she knew it was more than a concussion.
“It’s a great reminder just to trust your instincts,” Kim said. “If you see your kid not feeling well, go to the hospital and keep pushing.”
Alex said the first month of recovery was especially hard, wondering whether she would be able to climb at the same level again. It took a few weeks before she felt confident in her coordination and proprioception — the body’s ability to sense itself in space — to return. After that, it took months more before she felt back at full strength.
“I felt so, so weak for so long,” she said. “It definitely took a lot of patience and perseverance and also a lot of self-regulation. It was just slowly trying to do more things again.”
Messacar said people can protect themselves from West Nile by wearing insect repellant, specifically Environmental Protection Agency-registered repellent. Those repellents often have DEET or Picaridin as the active ingredient. Screens on windows and doors — and making sure they don’t have holes in them — will keep mosquitoes out of the house. Draining standing water around the yard is also important.
As her daughter recovered, Kim dove into that task with a passion. Their house faces south, which means the flower pots received frequent watering. She now eyed the trays beneath those pots with concern.
“I saw all these just very everyday places where water is sitting there,” she said. “It suddenly changed into something that could have changed my kid’s life.”