Andy Irons’ father said he believes that the world champion surfer died this week of dengue fever, a painful, mosquito-borne illness that causes flu symptoms and sometimes blinding pain.
Irons had been in Puerto Rico last week, where dengue fever infections are reported "year-round," said Esther Volper, a Ph.D. candidate and dengue fever expert at the University of Hawaii’s John A. Burns School of Medicine.
DENGUE FEVER FACTS
» The viral illness is spread by mosquitoes mainly in tropical Asia, Africa, the Caribbean and the South Pacific.
"The name is derived from an Indian word that means ‘break bone,’" Volper said. "It’s also called ‘break bone fever’ because of the pain, which some people would describe as the worst flu they’ve ever had."
Dengue is characterized by high fever, severe headache, chills, joint and muscle pain, nausea and vomiting, eye pain and a rash.
It typically takes four to seven days for dengue fever to show its symptoms, Volper said.
Before he arrived in Puerto Rico last week, Irons had competed in Portugal, a country that does not have dengue fever, Volper said.
"If he, indeed, had dengue fever he would have had to be bitten by an infected mosquito in Puerto Rico," Volper said.
The medical examiner’s office in Tarrant County, Texas, told the Star-Advertiser Tuesday that a prescription medicine container of Zolpidem found in Irons’ hotel room at Dallas-Fort Worth airport contained methadone.
Abby Collier, an assistant professor of pharmacology at the UH medical school, said clinicians make their own decisions, but it would be "highly unusual" for methadone to be prescribed for dengue fever.
Methadone is primarily used in the United States as a treatment for drug withdrawal, Collier said.
"There are very few other applications for it," she said. "It is a painkiller if somebody — for whatever reason — was unable to take morphine."
It would be an unlikely prescription for dengue fever, Collier said.
"Dengue fever can cause incredible bad muscle pain and a horrible bad headache behind your eye, like a really bad migraine — or worse," Collier said. "We have drugs for migraines and methadone’s not one of them. Methadone is an extremely strong narcotic drug and it would be considered highly unusual for it to be prescribed in that situation, but it is possible."
Spread by mosquitos in tropical climates, dengue fever is a viral illness that Hawaii health officials have battled before.
The last outbreak of dengue in Hawaii occurred in 2001, when the disease was transmitted to 153 people, many of whom lived in Maui’s rural communities, primarily Hana. Last year, there were six reported cases in Hawaii, down from 14 in 2008.
Maui’s 2001 outbreak spread out of the remote East Maui areas of Hana, Nahiku and Hamoa, to as far west as Haiku. There were also confirmed cases on Oahu, Kauai and the Big Island.
"We had an outbreak here and we were trying to determine if dengue had become endemic in Hawaii," said Health Department spokeswoman Janice Okubo. "That’s when we had a media campaign, a lot of mosquito control efforts and we were able to reduce the number of cases. We haven’t seen any outbreak that large since 2001."
The outbreak generally involved "imported cases" when people from other countries carried the disease to the islands and infected local mosquitoes. There are four primary types of dengue viruses.
Before 2001, Hawaii’s last major outbreak of dengue fever followed the end of World War II when more than 1,200 cases and several deaths were reported.
The disease is endemic in Pacific Island nations and other areas of the United States and is something "you don’t often see in Hawaii, so it’s difficult for physicians to diagnose," Okubo said. "It can become a very serious infection."
In 2008, UH researchers developed a new test to detect the dengue virus and its type in six hours, said Volper, who helped develop the test.
Health officials said in 2001 that they believed the virus was brought to Maui by visitors who had also traveled to French Polynesia and the Samoas.
"So when you travel oversees, you should take precautions," Okubo said. "Use mosquito repellent."