Urgent Health Concerns in Florida: Dengue Fever, Encephalitis, Cholera, and Hookworm

The first locally acquired case of dengue fever in Miami-Dade County in more than 50 years was confirmed Thursday by health officials. Residents and visitor of Florida are being warned to take precautions against the mosquitoes that carry it.

The Dengue Fever victim had not traveled outside Miami-Dade County for more than two weeks. He was briefly hospitalized and has fully recovered.

Health officials said they don’t know where the man became infected. The Dengue Fever was a different strain from the one that has caused 57 locally acquired cases in Key West and one in Broward County.

Dengue fever and dengue hemorrhagic fever (DHF) are acute febrile diseases transmitted by mosquitoes, which occur in the tropics, can be life-threatening. Dengue Fever is caused by four closely related virus serotypes of the genus Flavivirus, family Flaviviridae. Dengue Fever is also known as breakbone fever, since it can be extremely painful.


The disease manifests as fever of sudden onset associated with headache, muscle and joint pains (myalgias and arthralgias—severe pain that gives it the nickname break-bone fever or bonecrusher disease), distinctive retro-orbital pain, and rash. The classic dengue rash is a generalised maculopapular rash with islands of sparing. A hemorrhagic rash of characteristically bright red pinpoint spots (bruise-like blotches), known as petechiae can occur later during the illness and is associated with thrombocytopenia (deficiency of platelets). Skin signs usually appear first on the lower limbs and the chest; in some patients, the rash-like sign of the disease spreads to cover most of the body. There may also be severe retro-orbital pain, (a pain from behind the eyes that is distinctive to Dengue infections), and gastritis with some combination of associated abdominal pain, nausea, vomiting coffee-grounds-like congealed blood, or severe diarrhea. Some cases develop much milder symptoms which can be misdiagnosed as influenza or other viral infection when no rash or retro-orbital pain is present.

Encephalitis Also a Concern …
Miami-Dade health officials also reminded the public that the Florida-wide alert issued in July 2010 about Eastern Equine Encephalitis has not been lifted, with four non-fatal human cases reported then in Hillsborough, Wakulla and Leon counties. Eastern Equine Encephalitis (EEE) is transmitted by mosquitoes.

Eastern equine encephalitis (EEE) is a rare illness in humans, and only a few cases are reported in the United States each year. Most cases occur in the Atlantic and Gulf Coast states (see map). Most persons infected with EEEV (the virus) have no apparent illness. Severe cases of EEE (involving encephalitis, an inflammation of the brain) begin with the sudden onset of headache, high fever, chills, and vomiting. The illness may then progress into disorientation, seizures, or coma. EEE is one of the most severe mosquito-transmitted diseases in the United States with approximately 33% mortality and significant brain damage in most survivors. There is no specific treatment for EEE; care is based on symptoms. You can reduce your risk of being infected with EEEV by using insect repellent, wearing protective clothing, and staying indoors while mosquitoes are most active.

Watching Out for Cholera from Haiti …
A warning is also out to local doctors and hospitals to be on the lookout for cholera cases that might be spread by people returning from Haiti, where a cholera epidemic has killed more than 600 people.

Cholera is an infection of the small intestine caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission is primarily through consuming contaminated drinking water or food. The severity of the diarrhea and vomiting can lead to rapid dehydration and electrolyte imbalance. Primary treatment is with oral rehydration solution and if these are not tolerated, intravenous fluids. Antibiotics are beneficial in those with severe disease.

A localized outbreak of Hookworm, too …
And Rivera said efforts by Miami-Dade County and Miami Beach are increasing to handle an outbreak of hookworm spreading on the Atlantic Ocean beach between 40th and 60th streets. Six human cases have been reported. The disease is spread primarily by the feces of dogs and cats.

Hookworm is an insidious infection which can remain silent or undetected until serious health problems develop in the intestines and lungs.

Hookworm precautions include wearing foot protection on the beach, always using a towel when lying on the beach, avoiding contact with sand and soil that is contaminated with animal feces, and washing hands thoroughly when contact has occurred.

See also …
Miami-Dade County Health Department

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