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Yellow Fever

Fevers Yellow

Yellow fever is an acute arbovirus infection. It is transmitted by the bite of the yellow fever mosquito (Aedes aegypti) and other species.


Presentation

Yellow fever has an incubation period of five to six days. In the initial phase that lasts for three to four days, there is mild fever with rigors and chills and yellowing of the skin. The yellowing occurs as the disease affects liver causing hepatitis [7].

The patient also complains of headache, joint and muscle pain, loss of appetite, abdominal pain, back pain, nausea and vomiting, fatigue, weakness and dehydration. The next phase is remission, which lasts for 48 hours. Most patients recover after this phase.

If not treated completely, the disease becomes worse and the sufferers enter a more toxic, third phase of infection. It can lead to a condition called viral hemorrhagic fever with shock, jaundice and abdominal pain [8] [9].

In the toxic phase, there can be bleeding in the mouth, the eyes and the gastrointestinal tract. This will cause vomiting containing blood. It results in damage to the liver, kidneys, and the circulatory system. The World Health Organization estimates that about 50% of people worldwide who reach this severe phase of infection die, while half recover.

Easy Bruising
  • ., nose or gums bleed, easy bruising). During the meeting, some residents told the council they were concerned about the chemicals used in mosquito spraying and sought improved notice of the sprayings. One such spraying is set for 3 to 5 a.m.[pe.com]
Fever
  • What can travelers do to prevent yellow fever? Get yellow fever vaccine Yellow fever vaccine is the best protection against yellow fever disease, which can be fatal.[wwwnc.cdc.gov]
  • […] specified arthropod-borne viral fevers A94 Unspecified arthropod-borne viral fever A95 Yellow fever A95.0 Sylvatic yellow fever A95.1 Urban yellow fever A95.9 Yellow fever, unspecified A96 Arenaviral hemorrhagic fever A96.0 Junin hemorrhagic fever A96.1[icd10data.com]
  • […] professional for advice; Adoption of measures to avoid mosquito bites; Awareness of symptoms and signs of yellow fever; Seeking care in case of symptoms and signs of yellow fever, while travelling and upon return from areas at risk for yellow fever transmission[web.archive.org]
  • There is no specific treatment for yellow fever.[nlm.nih.gov]
Vomiting
  • Symptoms may include: Fever, headache, muscle aches Nausea and vomiting, possibly vomiting blood Red eyes , face, tongue Yellow skin and eyes (jaundice) Decreased urination Delirium Irregular heartbeats (arrhythmias) Bleeding (may progress to hemorrhage[nlm.nih.gov]
  • Abstract In September 2014, a previously healthy Oregon woman in her 60s went to a hospital emergency department with malaise, dyspnea, vomiting, and diarrhea of 3-5 days' duration. She reported no recent travel, ill contacts, or dietary changes.[ncbi.nlm.nih.gov]
  • Our patient presented with a clinical syndrome of fever, headache, nausea, and vomiting, which quickly progressed to multiorgan failure and ultimately death on hospital day 4.[ncbi.nlm.nih.gov]
  • The patient suffered from fever, chills, sweating, headaches, backaches, myalgia, epigastric pains, nausea, vomiting, diarrhea and prostration. He was unvaccinated and had been working in areas where cases of jungle yellow fever had been confirmed.[ncbi.nlm.nih.gov]
Nausea
  • Our patient presented with a clinical syndrome of fever, headache, nausea, and vomiting, which quickly progressed to multiorgan failure and ultimately death on hospital day 4.[ncbi.nlm.nih.gov]
  • The patient suffered from fever, chills, sweating, headaches, backaches, myalgia, epigastric pains, nausea, vomiting, diarrhea and prostration. He was unvaccinated and had been working in areas where cases of jungle yellow fever had been confirmed.[ncbi.nlm.nih.gov]
  • Yellow fever has an incubation period of 3 to 6 days and sudden onset of symptoms with high fever, myalgia, headache, nausea/vomiting and increased transaminases. The disease ranges from asymptomatic to severe forms.[ncbi.nlm.nih.gov]
  • Yellow fever is spread through infected mosquitoes and has a wide array of symptoms from nausea and vomiting to kidney failure, jaundice and bleeding.[web.archive.org]
Loss of Appetite
  • The patient also complains of headache, joint and muscle pain, loss of appetite, abdominal pain, back pain, nausea and vomiting, fatigue, weakness and dehydration. The next phase is remission, which lasts for 48 hours.[symptoma.com]
  • Yellow fever has 3 stages: Stage 1 (infection): Headache, muscle and joint aches, fever, flushing, loss of appetite, vomiting, and jaundice are common. Symptoms often go away briefly after about 3 to 4 days.[nlm.nih.gov]
  • […] of appetite, and nausea or vomiting About 15% of people face a second, more serious phase involving high fever, jaundice, bleeding and deteriorating kidney function Half of those who enter the "toxic" phase usually die within 10 to 14 days Source: WHO[bbc.com]
  • Initial symptoms usually include sudden onset of fever, chills, headache, joint and muscle pain, loss of appetite, abdominal pain, back pain, nausea and vomiting, fatigue, weakness and dehydration. Most patients recover after this stage.[travel.gc.ca]
Black Vomit
  • The trademark of the disease, however, was the victim's black vomit, composed of blood and stomach acids. Although its cause was unknown until 1900, yellow fever was transmitted from person to person by the female Aedes aegypti mosquito.[web.archive.org]
  • The trademark of the disease, however, was the victim’s black vomit, composed of blood and stomach acids. Although its cause was unknown until 1900, yellow fever was transmitted from person to person by the female Aedes aegypti mosquito.[tennesseeencyclopedia.net]
  • Bleeding in the mouth, the eyes and in the gastrointestinal tract can cause vomits containing blood (giving the name black vomit). Approximately 20% of cases entering the toxic phase end in fatality.[tripadvisor.com]
  • The first was that the appearance of black vomit invariably meant the patient would die. The second was that patients who evidenced ptyalism or severe salivation all recovered.[bobarnebeck.com]
  • Internal bleeding would develop which produced the trademark black vomit, composed of blood and stomach acids. The liver and kidneys failed and the victim turned yellow and soon died, usually within 2 weeks.[web.archive.org]
Hematemesis
  • Hemorrhage and erosion of the gastric mucosa lead to hematemesis, popularly known as black vomit. Fatty infiltration of the myocardium, including the conduction system, can lead to myocarditis and arrhythmias.[emedicine.com]
Hypotension
  • In the late stages of yellow fever, patients present with the following: Tachycardia Hypothermia or hyperthermia Hypotension Individuals who are severely hypoperfused appear mottled and cyanotic; they are also often obtunded.[emedicine.com]
  • All U.S. cases required intensive care after experiencing fever, hypotension, respiratory failure, elevated hepatocellular enzymes, hyperbilirubinemia, lymphocytopenia, and thrombocytopenia; eight of the nine also had renal failure, which required hemodialysis[web.archive.org]
Tachycardia
  • Shock, tachycardia, bleeding, oliguria, proteinuria and azotemia confer a poor prognosis. Although convalescence may be prolonged, survivors usually have no lasting sequelae.[orpha.net]
  • On general physical examination, the findings include tachycardia, yellowness of eyes and skin, coated tongue, state of dehydration and dark colored urine. The laboratory testing helps to confirm the diagnosis.[symptoma.com]
  • In the late stages of yellow fever, patients present with the following: Tachycardia Hypothermia or hyperthermia Hypotension Individuals who are severely hypoperfused appear mottled and cyanotic; they are also often obtunded.[emedicine.com]
Slow Pulse
  • Often, the high fever is paradoxically accompanied by a slow pulse. After four days, most patients improve and their symptoms disappear.[dermnetnz.org]
  • Often, the high fever is paradoxically associated with a slow pulse. After three to four days most patients improve and their symptoms disappear. However, 15% enter a "toxic phase" within 24 hours.[web.archive.org]
Jaundice
  • Abstract For more than 95% of acute febrile jaundice cases identified through surveillance for yellow fever, a reemerging arthropod-borne viral disease, no etiological exploration is ever done.[ncbi.nlm.nih.gov]
  • The majority of patients with acute febrile jaundice ( 95%) identified through a yellow fever surveillance program in the Democratic Republic of Congo (DRC) test negative for antibodies against yellow fever virus.[ncbi.nlm.nih.gov]
  • Yellow fever has 3 stages: Stage 1 (infection): Headache, muscle and joint aches, fever, flushing, loss of appetite, vomiting, and jaundice are common. Symptoms often go away briefly after about 3 to 4 days.[nlm.nih.gov]
  • In most of the cases, symptoms take 3 to 6 days to develop and include fever, chills, jaundice, loss of appetite, nausea, headache, backache, and muscular aches. Vaccination may be effective against yellow fever.[symptoma.com]
  • The outbreak resulted in nearly 50 000 clinical cases, including 29 000 cases of overt jaundice. More than 300 000 troops may have been infected with HBV.[ncbi.nlm.nih.gov]
Scleral Icterus
  • icterus Jaundice Epigastric tenderness Hepatomegaly The following will also often be apparent: Petechiae Purpura Mucosal bleeding Gastrointestinal bleeding (gross or occult) Organ ischemia, which primarily affects the kidneys and central nervous system[emedicine.com]
Red Eye
  • Symptoms may include: Fever, headache, muscle aches Nausea and vomiting, possibly vomiting blood Red eyes , face, tongue Yellow skin and eyes (jaundice) Decreased urination Delirium Irregular heartbeats (arrhythmias) Bleeding (may progress to hemorrhage[nlm.nih.gov]
Photophobia
  • Yellow fever has an abrupt onset after an incubation period of 3--6 days, and usually includes fever, prostration, headache, photophobia, lumbosacral pain, extremity pain (including the knee joints), epigastric pain, anorexia, and vomiting.[cdc.gov]
Myalgia
  • The illness was characterized by fever, headache, myalgia, gastrointestinal symptoms, hepatic and renal dysfunction, and (in the fatal case), shock and coagulopathy, compatible with YEL-AVD.[ncbi.nlm.nih.gov]
  • The patient suffered from fever, chills, sweating, headaches, backaches, myalgia, epigastric pains, nausea, vomiting, diarrhea and prostration. He was unvaccinated and had been working in areas where cases of jungle yellow fever had been confirmed.[ncbi.nlm.nih.gov]
  • FINDINGS: The clinical presentations were characterised by fever, myalgia, headache, and confusion, followed by severe multisystemic illnesses. Three patients died.[ncbi.nlm.nih.gov]
  • Yellow fever has an incubation period of 3 to 6 days and sudden onset of symptoms with high fever, myalgia, headache, nausea/vomiting and increased transaminases. The disease ranges from asymptomatic to severe forms.[ncbi.nlm.nih.gov]
  • After an incubation period of 3-6 days, patients typically present with the abrupt onset of non-specific signs and symptoms including fever, malaise, headache, chest pain, and myalgia/arthralgia, followed rapidly by gastrointestinal (nausea, vomiting,[orpha.net]
Purpura
  • […] of fever (Faget sign) Conjunctival injection Skin flushing As the disease progresses, additional physical findings include the following: Scleral icterus Jaundice Epigastric tenderness Hepatomegaly The following will also often be apparent: Petechiae Purpura[emedicine.com]
Epistaxis
  • The initial onset is abrupt with fever, myalgia, headache, vomiting, and minor gingival hemorrhage or epistaxis lasting for about 3 days.[ncbi.nlm.nih.gov]
Oliguria
  • The patient presented with hemorrhagic fever, jaundice and oliguria at day 3 after onset, which rapidly progressed to multisystem organ failure with extremely elevated liver, pancreatic and myocardial enzymes.[ncbi.nlm.nih.gov]
  • Shock, tachycardia, bleeding, oliguria, proteinuria and azotemia confer a poor prognosis. Although convalescence may be prolonged, survivors usually have no lasting sequelae.[orpha.net]
  • Prerenal azotemia as well as acute tubular necrosis may give rise to oliguria and acid-base disturbances. Myocardial fiber degeneration and myocarditis may contribute to general circulatory collapse.[ncbi.nlm.nih.gov]
Dark Urine
  • Call your doctor right away if you have signs of liver problems like dark urine, not hungry, stomach pain, light-colored stools, or yellow skin or eyes.[drugs.com]
  • In this phase people are likely to develop jaundice (yellowing of the skin and eyes, hence the name ‘yellow fever’), dark urine and abdominal pain with vomiting. Bleeding can occur from the mouth, nose, eyes or stomach.[web.archive.org]
Headache
  • Yellow fever has 3 stages: Stage 1 (infection): Headache, muscle and joint aches, fever, flushing, loss of appetite, vomiting, and jaundice are common. Symptoms often go away briefly after about 3 to 4 days.[nlm.nih.gov]
  • Our patient presented with a clinical syndrome of fever, headache, nausea, and vomiting, which quickly progressed to multiorgan failure and ultimately death on hospital day 4.[ncbi.nlm.nih.gov]
  • The illness was characterized by fever, headache, myalgia, gastrointestinal symptoms, hepatic and renal dysfunction, and (in the fatal case), shock and coagulopathy, compatible with YEL-AVD.[ncbi.nlm.nih.gov]
  • The patients usually present with fever, headache, yellowing of the skin and internal bleeding. Yellow fever can be prevented by a vaccine.[symptoma.com]
  • The patient suffered from fever, chills, sweating, headaches, backaches, myalgia, epigastric pains, nausea, vomiting, diarrhea and prostration. He was unvaccinated and had been working in areas where cases of jungle yellow fever had been confirmed.[ncbi.nlm.nih.gov]

Workup

A diagnosis of yellow fever is established on the basis of complete medical history including history of travel and vaccination status.

On general physical examination, the findings include tachycardia, yellowness of eyes and skin, coated tongue, state of dehydration and dark colored urine.

The laboratory testing helps to confirm the diagnosis. These include:

  • Complete blood count: The findings in a complete blood count for patients with yellow fever include leukopenia, thrombocytopenia, increased hemoglobin and hematocrit levels and initial hemoconcentration.
  • Coagulation studies: These studies reveal reduced fibrinogen and clotting factors II, VI, VII, VIII, XI, and X. It also indicates prolonged clotting time.
  • Urinalysis: It indicates elevated urinary proteins and urobilinogen levels.
  • Liver function tests: These tests reveal elevated serum AST levels, direct bilirubin levels and hypoalbuminemia.
  • Polymerase chain reaction (PCR) assay: It helps in the detection of viral genome in tissue or in blood.
  • Enzyme-linked immunosorbent assay (ELISA): This serologic test aids in making the correct diagnosis. A rise in yellow fever-specific antibody titer confirms a diagnosis.

Treatment

There is no specific treatment for yellow fever. Treatment is supportive and effective treatment involves complete bed rest under mosquito nets.

Antipyretics and analgesics are helpful to control fever and pain respectively. Drugs like antacids and histamine blockers are used to control gastric bleeding. Blood transfusions can be given for severe bleeding.

Oral or intravenous intake of fluids help to maintain dehydration, blood volume, increase blood pressure and correct hypoglycemia. Dialysis may be needed if kidney failure develops.

Prognosis

Mortality due to yellow fever varies according to the severity of the disease. It varies from 50% without medical treatment to about 5% with complete medical care.

Mortality rate is higher with life-threatening hemorrhagic fever, jaundice, liver and kidney failure. Death usually occurs within 7 to 10 days of the toxic phase of yellow fever. Those who recover have life-long immunity. So overall, the prognosis is good if diagnosed and treated properly.

Etiology

Yellow fever is caused by an enveloped RNA virus called yellow fever virus [3]. The individuals who are more at risk of developing yellow fever include travelers to certain parts of South America and Africa. The risk of the disease can increase with various factors like travel to endemic areas, visiting rural areas or participating in outdoor activities such as camping, cycling, hiking or fieldwork.

Epidemiology

Yellow fever is endemic in tropical areas of South America and Africa [4]. About 15% of the cases who develop yellow fever can have serious complications. The World Health Organization estimates that there are 200,000 cases of yellow fever worldwide each year, resulting in 30,000 deaths.

Due to decreased immunity to infection, deforestation, climate changes and increased urbanization, yellow fever appears to be on the rise internationally. Yellow fever transmission with a high risk have been identified in 45 countries, many of them with tropical climates.

Sex distribution
Age distribution

Pathophysiology

Yellow fever virus is transmitted to humans through the bite of an infected mosquito, Aedes aegypti. Some other mosquitoes such as Tiger mosquito can also serve as a vector for this virus. Yellow fever virus is taken up by a female mosquito by feeding on infected humans. The mosquito can then transmit the virus to other humans. Yellow fever virus can also be transmitted by mosquitoes from monkeys to humans by a sylvatic cycle [5]. It mostly occurs in travelers while visiting or working in jungle border areas.

Mosquitoes that spread viruses usually bite during the day time, particularly around sunrise and sunset. Viruses reach the stomach of the infected mosquitoes and then reach the salivary glands via blood stream. When the infected mosquito bites a person, the virus is transmitted to blood system of the person through mosquito’s saliva.

After transmission of the virus from a mosquito to human, the virus replicates in the lymph nodes, particularly the dendritic cells. From there, the viruses reach the hepatocytes in liver. This results in eosinophilic degradation and release of cytokines [6]. If left untreated, it can lead to complications such as cytokine storm, shock, and multiple organ failure, causing fatality.

Prevention

Yellow fever is preventable by vaccination which is valid for ten years. It is effective in ninety five percent of the cases [10]. The vaccination is not recommended for children under 9 months of age and immunocompromised individuals. Immunization should be done in travelers particularly who visit areas where yellow fever exists. The preventive measures should be taken to avoid mosquito bite by wearing full protective clothing, using insect repellant and living in screened areas.

Summary

Yellow fever is a viral infection caused by flavivirus that is transmitted by the bite of an infected mosquito. The virus is found in tropical and subtropical areas in South America and Africa [1][2].

In most of the cases, symptoms take 3 to 6 days to develop and include fever, chills, jaundice, loss of appetite, nausea, headache, backache, and muscular aches.

Vaccination may be effective against yellow fever. Untreated cases can lead to severe complications like bleeding, shock, organ failure, and sometimes death.

Patient Information

Yellow fever is a viral disease which is transmitted by the bite of an infected mosquito. The virus is more common in subtropical areas.

The patients usually present with fever, headache, yellowing of the skin and internal bleeding. Yellow fever can be prevented by a vaccine.

References

Article

  1. Bryan CS, Moss SW, Kahn RJ. Yellow fever in the Americas. Infectious disease clinics of North America. Jun 2004;18(2):275-292, table of contents.
  2. Barnett ED, Wilder-Smith A, Wilson ME. Yellow fever vaccines and international travelers. Expert review of vaccines. Jul 2008;7(5):579-587.
  3. Liceaga E. [The etiology of yellow fever, 1898]. Salud publica de Mexico. Sep-Oct 1989;31(5):708-719.
  4. Barnett ED. Yellow fever: epidemiology and prevention. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. Mar 15 2007;44(6):850-856.
  5. Barrett A, Higgs, S. Yellow fever: A disease that has yet to be conquered. Annu Rev Entomol. 2007;52.
  6. Monath TP, Barrett AD. Pathogenesis and pathophysiology of yellow fever. Advances in virus research. 2003;60:343-395.
  7. Monath TP. Treatment of yellow fever. Antiviral research. Apr 2008;78(1):116-124.
  8. Cleri DJ, Ricketti AJ, Porwancher RB, Ramos-Bonner LS, Vernaleo JR. Viral hemorrhagic fevers: current status of endemic disease and strategies for control. Infectious disease clinics of North America. Jun 2006;20(2):359-393, x.
  9. Quaresma JA, Pagliari C, Medeiros DB, Duarte MI, Vasconcelos PF. Immunity and immune response, pathology and pathologic changes: progress and challenges in the immunopathology of yellow fever. Reviews in medical virology. Sep 2013;23(5):305-318.
  10. Roukens AH, Visser LG. Yellow fever vaccine: past, present and future. Expert opinion on biological therapy. Nov 2008;8(11):1787-1795.

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Last updated: 2018-06-21 12:38