Medical Surveillance Monthly Report (MSMR). Volume 1, Number 8, November 1995

The patient is a 48 year old army reservist who was in Port Au Prince, Haiti from May 28 through October 12, 1995. His duties as a flight engineer involved supervising loading and unloading of Chinooks for troop transport, vehicle transport, and ballot distribution (for the elections) throughout the island; consequently, he had contact with many foreign troops, including Pakistani, Bangladeshi, Argentinian, and Canadian. Despite using military-issued insect repellent regularly as well as other repellents, he was bitten frequently by mosquitoes. He applied repellent in the morning and in the evening after a shower and recalls being bitten mostly on the arms, legs, and face in the early morning around sunrise and late afternoon around dusk when the winds died down. He treated his bednet every one to two weeks with permethrin and treated his uniform once on arrival and again two months later, but spent most of the hot days wearing PT shorts. In early September, he developed malaise which lasted for three days. At the same time he developed axillary adenopathy and a fine erythematous rash on his abdomen and arms, which he said looked like a heat rash. He presumed he had the flu as his symptoms progressively worsened over the next three days. The soldier became bedridden while on a previously-scheduled R&R, developing temperatures up to 105 degrees Fahrenheit which fluctuated with two hour intervals between temperature spikes, possibly related to his frequent use of acetaminophen. These were accompanied by anorexia, conjunctival erythema, myalgias, severe headaches (described as a constant dull ache 6/10 and his hair hurt), shaking chills, and were followed by diaphoresis. He denies any epistaxis, hematuria, hematochaezia, nausea, vomiting, altered taste, back pain, or arthralgia, but complained of a cough productive of yellow sputum for the next month. He experienced some loose stools approximately three times a day which were unchanged from prior to his illness. Pub. in Medical Surveillance Monthly Report (MSMR), v1 n8, p1-12, November 1995.