OZ.VGI.CO.ID - St. Petersburg, FL – Maurice Kurtz, a 73-year-old resident of St. Petersburg, Florida, experienced an abrupt and severe onset of illness on September 19, describing the feeling as being “hit by a minivan.” His initial symptoms included a fever of 101ºF and overwhelming fatigue, rendering even a short walk around the block an arduous task. "I went around the block and, oh, I ached so much," Kurtz recounted to CIDRAP News. "This was way beyond the tightness and aching I get from the most strenuous workouts I’ve ever done." This profound body ache, a hallmark of dengue fever, also known as “breakbone fever,” characterized his debilitating experience amidst Florida's escalating dengue outbreak.
Initially, Kurtz suspected he might be contracting an early case of the flu, despite lacking typical respiratory symptoms like a cough, sore throat, or nasal congestion.
He sought relief with over-the-counter medication and rest.
Over the subsequent weekend, his unusual need for sleep became apparent as he spent 16 hours resting each day, a stark contrast to his usual active lifestyle that includes swimming, biking, and running.
In the days leading up to his diagnosis, he had also noticed an itching sensation and the appearance of small red spots on his legs, subtle precursors to the more severe symptoms.
Delayed Diagnosis and Public Health Concerns
By Monday, Kurtz’s fever had subsided, and some of the soreness had abated, but profound exhaustion persisted.
Negative results from flu and COVID-19 tests offered no immediate answers.
It was a friend, aware of the burgeoning dengue fever situation in central Florida, who urged Kurtz to seek medical attention specifically for this mosquito-borne illness.
Upon visiting a local urgent care clinic, Kurtz requested a dengue test.
However, clinic staff initially insisted on testing only 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 physician, after reviewing his symptoms, confirmed he did not have flu or COVID-19 but was initially dismissive of the possibility of dengue.
"He says, ‘Well, it’s really up in north county, in Hillsborough [County].
We don’t have it down here,'" Kurtz stated, referencing the county which had become an epicenter for the outbreak.
The medical professional inquired about his recent travel.
Kurtz mentioned a visit to Tampa, Florida – the acknowledged epicenter of the outbreak – on the preceding Friday.
He expressed surprise at the swift onset of his severe illness, believing he would not fall ill so quickly after his visit.
Despite his initial resistance, the clinic eventually collected a blood sample for dengue testing.
The wait for results was agonizing, with Kurtz finding no updates on the health portal.
It was not until the following Saturday, after waking up and having breakfast, that he received a call from the Pinellas County Health Department.
"They’re calling me because I have dengue," he reported.
The call involved an extensive 45-minute interview, focusing heavily on contact tracing and detailing his movements over the preceding weeks.
Understanding Dengue Fever: An Unusual Outbreak in Florida
Kurtz is one of 324 reported cases of locally acquired dengue fever in Florida this year, a number that has raised significant public health concerns.
The outbreak has tragically led to the death of an 80-year-old woman in Tampa, marking the sole fatality recorded thus far in 2023.
While dengue fever has been documented in the United States previously, sustained local transmission is relatively uncommon.
Typically, U.S. cases are linked to international travel to endemic regions such as the Caribbean, South America, South Asia, or parts of Africa and the Middle East.
Dawn Wesson, PhD, director of Tulane University’s Vector-Borne Infectious Diseases Initiative, described the current Florida situation as unusual.
"Florida is approaching or has already surpassed 300 cases, and it’s a lot," Wesson told CIDRAP News.
"The epicenter is somewhat unusual in that we tend to see most of the cases that are local transmission … further south." The primary vectors for dengue in the United States are the *Aedes aegypti* and *Aedes albopictus* mosquito species, both of which are prevalent in Florida.
Wesson elaborated that *Aedes aegypti* is typically the more significant carrier because it has a preference for feeding on humans.
In contrast, *Aedes albopictus*, while it will bite humans, also feeds on animals, which can reduce its efficiency in transmitting dengue to people, as animals do not become infected with the virus.
The transmission occurs when an infected mosquito bites a human, transferring the virus during the blood-feeding process.
These mosquitoes are often small, and their bites can be nearly imperceptible, leaving the host unaware of the intrusion until after the mosquito has departed.
The Chain of Transmission and Climate's Role
The cycle of local dengue transmission is established when a mosquito becomes infected by biting an individual who has contracted the virus, potentially during travel.
This infected mosquito can then transmit the virus to other humans it subsequently bites.
"They’ve got enough virus present in their blood that the mosquito becomes infected, and it goes on, and the chain continues," Wesson explained.
"In a few different places where the mosquitoes are good vectors, you can set off local transmission, and that’s what happened this year." Historically, the southern United States experienced more frequent dengue outbreaks in the early 1900s, but public health interventions like widespread insecticide spraying significantly reduced their incidence.
More recent outbreaks in the South have generally been smaller, involving only a limited number of cases.
Looking ahead, experts like Wesson suggest that climate change, with its associated rise in temperatures, could contribute to an increase in dengue outbreaks.
"We need to be more prepared for these sorts of things and to understand what’s driving it," she advised.
Key questions revolve around the role of increased human movement to areas with active transmission and the return of individuals who may be asymptomatic or have very mild symptoms, coupled with the presence of effective mosquito vectors.
Mitigation strategies, including insecticide spraying and the elimination of standing water sources like discarded tires, are crucial for reducing mosquito populations and curbing the spread of dengue and other vector-borne diseases such as malaria and West Nile virus.
Both Hillsborough County, which includes Tampa, and Pinellas County, where Kurtz resides, have intensified mosquito control efforts and declared states of emergency in response to the growing threat.
Recognizing Dengue Symptoms and Prevention
Medical professionals, such as Maria Alcaide, MD, a professor of medicine at the University of Miami Health System, frequently treat patients with dengue, often acquired through travel.
Dr.
Alcaide describes dengue as a "febrile illness," characterized by symptoms including fever, significant body aches, profound fatigue, and sometimes nausea, vomiting, or diarrhea.
Affected individuals may also develop a rash and experience intense pain behind the eyes.
While most dengue cases result in recovery, repeated infections can lead to severe complications such as capillary leakage syndrome and hemorrhagic fevers.
Capillary leakage involves the seepage of plasma from blood vessels into surrounding tissues, leading to a dangerous drop in blood volume.
"That’s when people get very sick," Dr.
Alcaide noted, distinguishing this from fluid loss due to fever or sweating.
Unlike the flu, dengue typically does not present with respiratory symptoms.
The distinctive pain behind the eyes and a potential rash are more characteristic of dengue.
The common moniker, "breakbone fever," stems from the severity of the musculoskeletal pain.
"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,’" Alcaide emphasized.
Currently, there is no specific antiviral treatment for dengue fever.
Management focuses on symptom relief through rest, adequate hydration, and the use of acetaminophen (Tylenol).
It is critical for individuals diagnosed with dengue to avoid aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, as these medications can exacerbate bleeding risks and contribute to volume depletion, which is a primary cause of severe dengue complications.
Older individuals, those with underlying health conditions like kidney disease, diabetes, or heart failure, and those who have experienced multiple dengue infections are at higher risk for severe outcomes.
Prevention remains the most effective strategy, centered on avoiding mosquito bites.
This includes using insect repellent containing DEET, eliminating standing water around homes where mosquitoes breed, seeking indoor shelter during peak mosquito activity hours (typically dawn and dusk), and wearing protective clothing such as long sleeves and pants.
"Not getting bitten by a mosquito will really decrease to 0% chance of getting dengue," Dr.
Alcaide stated.
As of early October, Maurice Kurtz reported feeling a resurgence of energy.
He participated in a relaxed bike ride with friends, opting for a gentler pace.
Kurtz, who still does not know the exact moment of his infection, recalled an evening spent socializing with neighbors when a few mosquitoes were present and swatted away.
"I just got a mosquito bite and I’m recovering from this disease, which has a reputation of being this rare tropical thing," he reflected.
"The likelihood of you getting it is very, very slim.
But it could happen to you—and in [my] case, it did." His experience serves as a personal testament to the reality of dengue fever's presence and potential impact, even in locales not traditionally considered its primary domain.
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