Yellow fever natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]

Overview

Initial symptoms of yellow fever start 3-6 days after the mosquito bite, these include sudden onset of fever, chills, severe headache, back pain, general body aches, nausea and vomiting, fatigue, and weakness. Most people improve after these initial symptoms. However, roughly 15% of people will have a brief period of hours to a day without symptoms and will then develop a more , severe form of yellow fever disease. Possible complications include coma, disseminated intravascular coagulation (DIC), kidney failure, liver failure and shock. The prognosis is good in the majority of patients, infected persons will be asymptomatic or have mild disease with complete recovery.

Natural History, Complications and Prognosis

Natural History

• In its mildest form, yellow fever is a self-limited infection characterized by sudden onset of fever and headache without other symptoms.
• Other patients experience an abrupt onset of a high fever (up to 104°F/40° C), chills, severe headache, generalized myalgias, lumbosacral pain, anorexia, nausea, vomiting, and dizziness.
• The patient appears acutely ill, and examination might demonstrate bradycardia in relation to the elevated body temperature (Faget's sign).
• The patient is usually viremic during this period, which lasts for approximately 3 days.
• Many patients have an uneventful recovery, but in approximately 15% of infected persons, the illness recurs in more severe form within 48 hours following the viremic period.
• Symptoms include fever, nausea, vomiting, epigastric pain, jaundice, renal insufficiency, and cardiovascular instability. Viremia generally is absent during this phase of symptom recrudescence.
• A bleeding diathesis can occur, with hematemesis, melena, metrorrhagia, hematuria, petechiae, ecchymoses, epistaxis, and oozing blood from the gingiva and needle-puncture sites.

Complications

The possible complications are:

• Coma
• Death
• Disseminated intravascular coagulation (DIC)
• Kidney failure
• Liver failure
• Parotitis
• Secondary bacterial infections
• Shock

Prognosis

• The majority of infected persons will be asymptomatic or have mild disease with complete recovery.
• In persons who become symptomatic but recover, weakness and fatigue may last several months.
• Among those who develop severe disease, 20% - 50% may die.
• Those who recover from yellow fever generally have lasting immunity against subsequent infection.

References

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