Yellow fever

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Background

  • A Flavi virus transmitted by Aedes and Haemagogus mosquitos
  • 200,000 cases per year with 30,000 deaths mostly in Africa
  • Endemic in tropical areas of sub-Sahara Africa and South America

Clinical Features

3 stages

  • Infection- 3 to 4 days of fever, myalgias, knee pain, nausea, vomiting
    • Faget’s sign-low pulse compare to high fever
  • Remission- either recovers or progresses to next stage in 48 hours
  • Intoxication- 15% of patients with return of symptoms plus:
    • Hepatic dysfunction
    • Renal failure
    • Myocardial injury
    • CNS dysfunction
    • Bleeding complications

Differential Diagnosis

Workup

  • CBC
  • Chem
  • LFTs
  • Coags
  • Viral PCR
  • ELISA for IgM

Management

  • Symptomatic
  • Vaccination in endemic areas

Disposition

  • Admit

Sources