Yellow fever natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

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.

The possible complications are:

The majority of infected persons will be asymptomatic or have mild disease with complete recovery. ^[1]
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.