‘I ached so much’: Man shares bout with dengue fever contracted during Florida’s outbreak
Meghan Holohan49 minutes ago.
Dengue
When Maurice Kurtz woke on September 19, he felt like a minivan had hit him. His temperature spiked to 101ºF, and he was intensely fatigued. He tried taking a walk but soon returned home because it felt so difficult.
“I went around the block and, oh, I ached so much,” Kurtz, 73, of St. Petersburg, Florida, told CIDRAP News. “This was way beyond the tightness and aching I get from the most strenuous workouts I’ve ever done.”
He thought maybe he had an early case of flu, even though he didn’t have a cough, sore throat, or stuffy or runny nose. To ease his pain, he took an over-the counter medication and rested. Over Saturday and Sunday, he slept for 16 hours, unusual for Kurtz, who enjoys swimming, biking, and running. A few days earlier, he started feeling itchy and noticed tiny red spots on his legs.
While his fever broke and he felt less sore by Monday, exhaustion still overwhelmed him. He took a test for flu and COVID-19, but the results were negative.
Staff initially refused to test Kurtz for dengue
A friend familiar with the dengue fever outbreak in central Florida urged Kurtz to see a doctor, and he visited a local urgent care clinic, where he asked to be tested for the mosquito-borne illness. Instead, staff said they would test him for flu and COVID-19.“I said, ‘Well, I did the COVID, flu thing, and it was negative.’ They said, ‘We just test for them,’” Kurtz recalled. “The doctor comes in and he says, ‘Well you don’t have any of those’ … I already told him I’d come for the dengue test based on the symptoms.”
Still, the doctor pushed back at Kurtz’ request for a test.
“He says, ‘Well, it’s really up in north county, in Hillsborough [County]. We don’t have it down here,’” Kurtz said.
The doctor asked if he had traveled, and Kurtz said he visited Tampa, Florida, the epicenter of the dengue fever outbreak, on Friday. But Kurtz didn’t think he’d feel so sick the following day. Finally, staff took a blood sample to test him for dengue.
This was way beyond the tightness and aching I get from the most strenuous workouts I’ve ever done.
Maurice Kurtz
As the week continued, Kurtz found himself sleeping more than usual. He’d check the health portal to see if his test results had returned but never found any updated information. After he woke late Saturday and enjoyed breakfast, he received a call from the Pinellas County Health Department.
“They’re calling me because I have dengue,” he said. “[They] interviewed me for about 45 minutes. A lot of contact tracing. A lot of history of where I had been in the past few weeks.”
Local acquisition out of ordinary
Kurtz is one of 324 cases of locally acquired dengue fever reported in Florida this year. It led to the death of an 80-year-old woman in Tampa, the only fatality so far this year.While dengue, also known as breakbone fever, has been reported in the United States in the past, it’s not often locally spread. Many people contract it from a mosquito bite they received when traveling to an area where its endemic, such as the Caribbean, South America, South Asia, and parts of Africa and the Middle East.
“It is unusual,” Dawn Wesson, PhD, director of Tulane University’s Vector-Borne Infectious Diseases Initiative, told CIDRAP News. “Florida is approaching or has already surpassed 300 cases, and it’s a lot. The epicenter is somewhat unusual in that we tend to see most of the cases that are local transmission … further south.”
Two types of mosquitos—Aedes aegypti and Aedes albopictus—can transmit dengue to people. Both thrive in Florida. Aedes aegypti tends to the primary vector for dengue in the United States.
“Aedes aegypti is typically more involved because it tends to feed more selectively on people,” Wesson explained. “Aedes albopictus will feed on people, but it’ll also feed on animals pretty readily, and that suppresses its ability to transmit dengue, because the animals are not becoming infected.”
“The virus is passed during the blood feeding event to the person that’s sitting there, not realizing they’re getting bitten,” she said. “These mosquitos are small, and the bites tend to be relatively painless, and you often don’t see them biting you until they’re done and gone.”
If a person visiting a country like Brazil, for example, contracts dengue and returns home to Florida, an Aedes aegypti and Aedes albopictus mosquito that bites them can then pass it along to other people.
“They’ve got enough virus present in their blood that the mosquito becomes infected, and it goes on, and the chain continues,” Wesson said. “In a few different places where the mosquitoes are good vectors, you can set off local transmission, and that’s what happened this year.”
More-frequent outbreaks in early 1990s
In the early 1900s, dengue fever outbreaks occurred more frequently in the southern United States, but mitigation practices such as spraying insecticide to kill mosquitos, helped eliminate it. The South has experienced smaller outbreaks that normally include only a handful of cases, she noted.
Florida is approaching or has already surpassed 300 cases, and it’s a lot. The epicenter is somewhat unusual in that we tend to see most of the cases that are local transmission … further south.
Dawn Wesson, PhD
As temperatures continue to climb because of climate change, there could be more dengue outbreaks.
“We need to be more prepared for these sorts of things and to understand what’s driving it,” Wesson said. “Is it human movement to areas where there’s transmission going on?” Or is it “people coming back who are either asymptomatic or have very mild illness, and we’ve got good vectors here?”
Spraying insecticides and removing objects such as discarded tires, which can hold standing water, can help reduce the mosquito population. This cuts the spread of dengue and other mosquito-borne illnesses, such as malaria and West Nile virus.
Both Hillsborough County, home to Tampa, and Pinellas County, where Kurtz lives, have increased mosquito mitigation efforts and declared states of emergency.
Characteristic symptoms
In Miami, doctors like Maria Alcaide, MD, have treated patients with dengue fever, who often pick it up from traveling.“It’s what we call a febrile illness, which means that people with dengue typically have symptoms of fever, body aches, maybe feel very ill and tired. They could have some nausea, some vomiting, some diarrhea,” said the professor of medicine at the University of Miami Health System and Miller School of Medicine. They may also experience rash and intense eye pain.
“The majority of cases, they recover. However, sometimes—and it usually happens after repeated infections—dengue can cause what’s called capillary leakage and can also cause hemorrhagic fevers that can be very severe.”
In capillary leakage, plasma seeps from the blood vessels into muscles, organs, and body cavities. It causes a person’s blood volume to dip.
“It’s a little different than plain loss of fluid from having a fever or sweating, and it is more complex and is very characteristic of dengue,” Alcaide explained. “That’s when people get very sick.”
“Dengue doesn’t have respiratory symptoms like flu,” Alcaide said. “Pain behind the eye is characteristic of dengue more than flu. Sometimes rashes are more common.”
The nickname breakbone fever nods to the severity of dengue-related body pain.
“What really differentiates it is the intensity of the pain,” Alcaide said. “People with dengue can say, ‘I can hardly move out of the bed to think about going to the hospital because it hurts so much.’”
There’s no treatment specifically for dengue, though taking acetaminophen (Tylenol), drinking lots of fluids, and resting can improve symptoms. It’s important that people with dengue fever avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs).
“The complications from dengue are usually from what we call volume depletion loss as well as perhaps hemorrhagic dengue,” she said. NSAIDs and aspirin can contribute to bleeding and volume depletion.
Serious illness occurs more often in people who are older and have comorbidities such as kidney disease, diabetes, or heart failure and in those who have had multiple dengue infections.
People can avoid getting dengue by protecting themselves from mosquito bites by using a DEET-containing product, removing standing water from their property, staying inside during the evening “mosquito hours,” and wearing long sleeves and pants.
“We know how people get dengue,” Alcaide said. “Not getting bitten by a mosquito will really decrease to 0% chance of getting dengue.”
‘It could happen to you’
Maurice Kurtz feels less sore and has more energy since his bout with dengue fever last month.As time has passed, Kurtz feels more energized. On the first Saturday of October, he joined a bike ride with a group of friends.
“I went with the slowest group, and we started going along. I said, ‘I just need to peel off,’” he said. “[I did] my own relaxed ride and did not overdo it.”
Kurtz doesn’t know when the mosquito bit him, though he does recall an evening on which he and a few neighbors chatted on the street and swatted a few mosquitos.
“I just got a mosquito bite and I’m recovering from this disease, which has a reputation of being this rare tropical thing,” he said. “The likelihood of you getting it is very, very slim. But it could happen to you—and in [my] case, it did.”