The tiny bite arrived and faded from Dot Ingle's skin before she even noticed it was there.
She never detected the tiny legs that landed on one of her limbs one day in late August of 2012. She never felt the sting when the tiny beak pierced her skin. There was no peculiar itch.
All evidence of the attack was gone by the time Dot was rushed into the Erlanger emergency room, two years ago today. There was only damage.
Dot's legs buckled beneath her, leaving her unable to move. Her whole body ached. And she had no idea who she was.
She faded in and out of consciousness as doctors worked to both stabilize her and solve the mystery of what was shutting down her nervous system.
• Avoid mosquito bites. Use bug repellents when you go outdoors, especially in the evening and the morning, when mosquitoes are most active.
• Repellents containing DEET, picaridin, IR3535, and some oil of lemon eucalyptus and para-menthane-diol products provide longer-lasting protection.
• Wear long sleeves and pants from dusk through dawn when many mosquitoes are most active.
• Install or repair screens on windows and doors. If you have it, use your air conditioning.
• Make your home less hospitable to mosquitoes. Try to rid the area outside your home of any stagnant water, where mosquitoes develop. Empty standing water from containers such as flowerpots, gutters, buckets, pool covers, pet water dishes, discarded tires, and birdbaths.
Source: U.S. Centers for Disease Control and Prevention
They hustled samples of blood and other fluids to the lab. The doctor who took a spinal tap soon approached Dot's husband, James, and took him aside.
"She may not make it," the doctor told James.
All James felt was emptiness, a caving-in within himself. He could barely keep himself upright.
Just a few days ago his 67-year-old wife had been working outside and swimming in the pool, vivacious and in top-notch health. Recently retired, the two were dreaming of travel out West. They were planning a trip to San Antonio in a few weeks.
That week she started feeling like she had the flu, worsening each day. On Friday, when Dot woke up not knowing who James was, he told her to get dressed. They were going to the ER.
Dot dressed herself, walked down the steps to the car, and climbed in. By the time they had driven 26 miles to Erlanger hospital, she couldn't move her legs.
There was no warning for such a sudden deterioration, no clues James could give the doctors, nothing he could point to that could be responsible.
That would come 10 days later when a doctor with the U.S. Centers for Disease Control and Prevention named the tiny, inconspicuous culprit:
West Nile virus is a newer battle in one of history's most enduring wars: man versus mosquito.
The chronic backyard pests typically draw little more than scant precautions from people. Caution is typically saved for more sizable threats.
Between 2004 and 2014:
West Nile Virus: 173 cases (2 this year)
La Crosse encephalitis: 109 cases (4 from this year)
Malaria*: 154 cases (9 this year)
Chikungunya*: 25 cases (This year alone. No cases reported before 2014).
* Travel-related, not local
Source: Tennessee Department of Health
2002 - 56
2003 - 26
2005 - 18
2007 - 11
2008 - 19
2010 - 4
2011 - 18
2012 - 33
2013 - 24
2014* - 2
* As of Aug. 21, 2014
Source: Tennessee Department of Health
2010 - 13
2011 - 8
2012 -100 cases
2013 - 10
Source: Georgia Department of Public Health
Yet to do so is to ignore the serious - sometimes epidemic-level - consequences of the ever-growing collection of diseases mosquitoes carry: yellow fever, malaria, dengue fever and encephalitis, among others.
West Nile is spread when mosquitoes feed on birds infected with the disease. The insects - now "vectors" - can spread the virus when they bite humans and animals.
The virus first showed up in the U.S. in 1999. There has been an outbreak of the virus every summer since.
"West Nile is here to stay," said Dr. Abelardo Moncayo, Tennessee's state medical entomologist and director of the state health department's vector-borne diseases program.
"Every year it's going to be different, but we can expect it every year."
In 2012, the year Dot got sick, a mild winter and a hot summer created perfect conditions for one of the worst outbreaks the country has seen.
Thirty-two other people in Tennessee were diagnosed, including one other person in Hamilton County, and 100 people in Georgia. Nationwide, the disease killed 286 people that year, the CDC reported.
Most people who contract the virus will never even know they were infected. Twenty percent of people infected may feel flulike symptoms, and fewer than 1 percent of people will develop a severe illness like Dot's. Those over 50 have a higher risk, along with those with underlying conditions like diabetes.
Public health officials still warn about mosquito-borne diseases every summer. This summer, a virus called chikungunya arrived in the U.S. for the first time.
Twenty-five people in Tennessee have been diagnosed with chikungunya this year alone, including three confirmed cases in Hamilton County. All were travelers who contracted the disease elsewhere, Moncayo said.
And there are always other strains, lurking in animals or in other countries, that health officials keep an eye on. The diseases change, but the mosquitoes aren't going anywhere.
For Dot, a diagnosis of West Nile brought relief, but not answers.
There is no treatment for the virus. And though 25 doctors examined Dot, none could give her a long-term prognosis.
"They told us there are no guarantees," says James.
The couple turned to their faith, putting the matter in the Lord's hands, they say.
In churches across the region, people lifted prayers for Dot. The couple's mailbox was stuffed with get-well cards from strangers.
After two weeks at Erlanger, Dot was admitted into inpatient care at Siskin Hospital for Physical Rehabilitation.
The virus had ravaged her spine, damaging the nerves that let her balance and allowed her legs to work. They were like noodles when she started therapy.
She had to learn how to use her muscles again, step by grueling step.
Through it all, James never left her side. He spent all 64 nights of Dot's treatment in a plastic chair beside his wife's bed. Even now, every move Dot makes - standing, sitting, turning - James helps her make it.
Today, each day's schedule is devoted to the fight to get better: Wake up. Start a series of stretches. Then head down to Veterans Park off Dayton Pike early to walk the track before the heat settles in.
Dot makes the rounds slow and steady - braces on both legs, walker grasped with both hands, and James at her side to make sure she doesn't fall.
After that, there's the stationary bike. And in these summer months, there's the pool. In the coolness of the water, her legs carry her again.
The Ingles don't know how long this routine will fill their days. They still dream of travel, even though they're not sure they'll ever be able to hit the road like they used to.
They know they can't detour from the journey before them now. Each day of therapy isn't just about progress. It's also about keeping her muscles from deteriorating again.
"That is why we work as hard as we do," Dot says after finishing her morning walk. "If we quit, we could lose everything we've gained. You can't just give up."
On Monday, Dot starts another round of therapy at Siskin. She wants to get well enough for a little trip to Destin in the fall.
They hope to find a little place close to the water. Dot won't be able to go to the beach, but she wants to sit outside and watch the tide roll in.
It would be just a little change, a little step forward. But these days - more than ever - she knows how much power such little things can carry.
Contact staff writer Kate Harrison Belz at firstname.lastname@example.org or 423-757-6673.