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This tickborne viral infection may cause marked leukopenia and thrombocytopenia. Symptoms of encephalitis may develop. Hemorrhages, but no skin rashes, are seen in severe cases. Patients may have low back and limb pain, conjunctivitis, and cervical lymphadenopathy. A biphasic course is common with neurological symptoms developing 1-2 weeks after the initial febrile period. The case-fatality rate varies from 1-10%. There is an experimental vaccine that has been used in India. The reservoirs are probably wild rodents, shrews, monkeys, and ticks. [CCDM, p. 54-5] About 500 cases per year are reported in Kyasanur Forest in India. Symptoms include fever, myalgias, headache, diarrhea, vomiting, bradycardia, and stomatitis. A minority of patients have hepatosplenomegaly and bleeding (epistaxis, hematemesis, and hemoptysis). The disease may be complicated by pulmonary edema, and about 8% of patients die. [Guerrant, p. 728-31, 828] Patients initially have a flu-like illness with vomiting. Photophobia and conjunctival suffusion are sometimes complicated by iridokeratitis. The first phase of illness may also include lymphadenopathy, hepatosplenomegaly, petechiae, and hemorrhages. After a 1-3 week remission, neurological symptoms develop in about 15% to 40% of patients. Lab findings include elevated liver enzymes. Hemorrhagic pulmonary edema and acute renal failure occur in severe cases. [PPID, p. 1945] |
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