A 35‐year‐old Hispanic woman from New York City presented with a 7‐day history of fever, headache, retro‐orbital pain, and myalgia. Her symptoms began during her visit to Puerto Rico, where she suffered from multiple mosquito bites. Her medical history was insignificant. Her vital signs were temperature 101.5°F, blood presure 110/70 mmHg, heart rate 101/min, respiratory rate 18/min, and SpO2 95% on ambient air. Her conjunctivae were injected but without icterus. Her neck was supple, her heart sounds were regular without murmurs, and her lungs were clear to auscultation. The abdomen was soft and nontender without hepatosplenomegaly. Scattered petechial rash was observed on the anterior chest and bilateral shoulders. A tourniquet test was positive. Labs revealed white blood cell count 1500/μL, hemoglobin 12.9 g/dL, platelets 67,000/μL, Na 139 mEq/L, K 3.8 mEq/L, Cl 101 mEq/L, CO2 24 mmol/L, blood urea nitrogen 12.0 mg/dL, Cr 0.8 mg/dL, alkaline phosphatase 49 U/L, AST 32 U/L, ALT 44 U/L, PT 14.1 seconds, PT‐INR 1.1. Blood cultures and stool studies were normal. The results of a blood smear for malaria and serological tests for hepatitis profile, HIV, syphilis, Leptospira, and measles were negative. An acute‐phase serum was strongly positive for dengue IgM titer of 22.9 (normal, < 1.64). With conservative management, her fever subsided and thrombocytopenia resolved.
According to the Centers for Disease Control report, New York City is the second‐highest city for dengue fever cases. The incidence of dengue fever in New York City has been rising year by year since 2006. Twenty‐three cases have already been reported in 2010. The rise is likely because of large outbreaks of dengue fever occurring in tropical areas that are frequent travel destination for New York City residents. The potential for a local outbreak of dengue fever in New York City is a major public health concern. Dengue infections are transmitted primarily by the mosquito Aedes aegypti and less commonly by Aedes albopictus. However, the replacement of A. aegypti by A. albopictus has been reported recently in urban cities. A. albopictus is a more competent vector and resistant to insecticides than A. aegypti. A. albopictus has been collected in New York City during the summer after wintering in southern New Jersey. A. albopictus is a day biter, with feeding peaks in the early morning and late afternoon, so mosquito bites theoretically can be avoided by limiting outdoor activities when mosquitoes are most active. However, more effective mosquito control should be sought, including reduction of breeding sites, especially in New York City where there are a large number of immigrants and tourists.
The potential risk for a local outbreak of dengue fever exists in New York City. Effective measures should be taken, including mosquito control.
T. Shinha ‐ none; P. Nautiyal ‐ none