When my friends and I all came down with the same strange symptoms, we knew something was very wrong. 

By Amanda MacMillan
May 04, 2018

Mosquitoes have always been a mortal enemy of mine—one of the only things I don’t enjoy about summers in New York or vacations in tropical locations. I seem to be one of those unlucky people the blood-suckers are disproportionately drawn to, and they’ve put a serious damper on many of my otherwise lovely outdoor adventures.

That’s one reason I took notice of this week’s report from the Centers for Disease Control and Prevention (CDC) about vector-borne illnesses, a.k.a. diseases spread by insects like ticks, fleas, and mosquitoes. It turns out, incidence of these illnesses tripled in the United States from 2004 to 2016, and nine new germs spread by mosquitoes and ticks have been discovered or introduced here during that time.

But there’s another reason the news about mosquito-borne illnesses has me stocking up on DEET and long pants for the summer: I’ve experienced one of those illnesses first-person, and it wasn’t pretty. In February 2016, after a week in Costa Rica with my closest girlfriends, several of us came home with dengue fever.

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Yes, dengue fever—the exotic-sounding virus that’s been nicknamed “break-bone fever” and described as a fate worse than death. I’m pretty sure I had what’s considered a mild case, but it still made for one of the most miserable weeks of my life. As a health writer, it was also one of the most fascinating.

My symptoms started about five days after returning from Nosara, Costa Rica, where I’d just spent a blissful seven days learning to surf and relaxing at night under the stars. I woke up feeling seriously fatigued and achy, like I'd come down with a bad case of the flu. It was the middle of the winter, I told myself, and I had just been on an airplane.

I had just been assigned to write a story about the Zika virus. Scientists were beginning to suspect that outbreaks in Central and South America were linked to birth defects, and CDC officials had issued a travel warning for pregnant women. As I read up on the symptoms—flu-like illness, headache, red eyes—I half-joked to my editor that I might be a victim myself.

Things got worse throughout the day. I dragged myself to a high-school basketball game my husband was coaching, but as I sat shivering in the bleachers, trying to retreat into my oversized hoodie, I felt like I might pass out. When we got home, I went straight to bed and slept for 12 hours.

The next morning, the text messages began: Sarah, one of my surf-camp friends, had gone to an urgent-care facility because of flu-like symptoms and a strange rash on her face. The doctor sent her to the emergency room, where they placed her in a quarantined room for several hours after they learned she’d recently been out of the country.

A third friend, Sara, had suddenly felt ill following an after-work party the previous night. Before learning we were all sick, she worried someone may have spiked her drink, or that she had come down with something as serious as toxic shock syndrome. Now, because of the recent headlines, we suspected Zika.

“Does anyone have red eyes?” we texted back and forth. "Good thing none of us is planning to get pregnant soon!" and "Zika is supposed to be mild—this doesn’t feel mild!” Then someone brought up chikungunya, a mosquito-borne illness that causes high fever and crippling joint pain, which was starting to sound more accurate.

In the ER, Sarah was eventually tested for influenza (it was negative) and sent home. Testing for Zika was reserved for pregnant women at that time, due to high demand for lab facilities, and the doctors brushed off Sarah’s questions about other mosquito-borne illnesses. Determined to find answers, she and Sara both sought out tropical-medicine specialists.

To complicate matters, my husband and I were dealing with a family emergency. We traveled to his sister’s house in New Jersey, where I lay on the couch in the fetal position and anxiously awaited updates from the Sara(h)s. After three days of fever, chills, joint pain, and the worst headache I’ve ever had, I started to feel better. That’s when the really weird stuff began.

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The day after my fever broke, I woke up to a strange tingling in my hands. They felt hot, itchy, and swollen; I immediately pulled my rings off, out of fear they’d get stuck on my puffy fingers. Later, the burning spread from my hands to the rest of my body: My skin felt raw, like I’d gotten a bad sunburn, and I’d developed strange, red blotches all over. I attempted to shave my legs in the shower, but it felt like I was scraping my skin off. 

The other girls were experiencing something similar: “It feels like I’m wearing burlap pants filled with fire ants and fleas!” Sara emailed me. That’s when—thanks to more Googling—we first considered dengue fever: Flu-like symptoms? Check. Severe pain behind the eyes when you look in any direction? Check. A flat, red rash and "very uncomfortable" skin sensitivity? Check!!!

Sara was the first to get her results back, and our suspicions were confirmed: Her bloodwork tested positive for dengue antibodies, which meant that the virus had been present. Even though she was feeling better, her doctor warned her that she could still be at risk for hemorrhagic bleeding, a serious complication that affects about 1% of people with dengue fever.

She was told not to use any medications that could have blood-thinning effects, like ibuprofen, naproxen, aspirin, or products containing salicylic acid, until she was cleared in a follow-up visit. (Acetaminophen is recommended for pain and fever.) That was pretty much the only practical advice we could have been given up to that point, since there’s no real treatment—besides rest and plenty of fluids—for dengue.

Several others from our trip, myself included, were eventually diagnosed as well. Dengue can affect liver enzymes and can occasionally cause problems down the road, so it was recommended that we get a confirmed diagnosis, even after the worst had passed. Our test results were also reported to New York City’s health department, which keeps tabs on these types of illnesses.

My doctor also recommended laying off strenuous exercise and drinking alcohol for at least a few weeks. It took about that long to truly get my strength and energy levels back to normal, so he got no arguments from me.

Me (second from left) and my friends at surf camp in 2015. We never got around to sharing our photos from our 2016 trip, because five of us came home with dengue fever.

What this means for me, two years later, is not entirely clear: Some research suggests that once you have dengue, you develop antibodies that protect you against getting the same strain again. But other studies have shown that people who’ve had dengue once are more likely to develop the life-threatening hemorrhagic version—that involves bleeding internally and from the nose and gums—if they do get the virus a second time.

As cases of dengue have increased around the world (and in the United States, although it’s still rare here), researchers have been hard at work on developing a vaccine. But safety concerns have kept it off the market in most countries, and—living in New York—I likely wouldn’t be a candidate for it anyway.

I do know that I don’t have much to worry about, at least not yet, when it comes to mosquito-borne viruses here in the Northeast. (Ticks carrying Lyme disease are a much bigger threat here.) And I know that in the grand scheme of things, my experience with dengue was relatively tame compared to what others around the world have suffered.

But thanks to climate change and an increase in global human travel, these types of illnesses are becoming more common. They’re also spreading geographically, and it may not be long before the mosquitoes that carry these viruses can live and reproduce this far north.

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For now, I’m being much more careful about mosquitoes when I can—avoiding spots where they congregate and making an effort to keep doors and windows closed (or screened) when I’m indoors. I’m also being careful to carry and apply insect repellant more often. Embarrassingly, I don’t remember using it much that fateful week in 2016, because the bugs didn’t seem so bad!

This week’s CDC report is a good reminder for all of us to be more vigilant, especially if we live in or travel to areas affected by these illnesses. I’m not going to let my experience with dengue keep me from enjoying the great outdoors­, neither here at home nor back in Costa Rica. But the next time I return to Nosara, I’ll be on the lookout—for more than just sunburn and choppy surf.