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Severity ranges from an inapparent infection to a 20%-40% case-fatality rate in some outbreaks. Most cases resolve after 5 days without hemorrhagic symptoms. The disease has been reported as an occupational hazard for young men working in the forests of Bolivia, Brazil, Columbia, Ecuador, and Peru. In the United States, no cases transmitted by mosquitoes have been reported since 1942. Reservoirs are humans in urban areas and monkeys in forests. [CCDM, p. 595-600] Jaundice, albuminuria, and hematemesis are seen in severe cases. Thrombocytopenia is associated with petechiae and mucosal bleeding. [Merck Manual, p. 1624-5] Yellow fever is biphasic with a flu-like illness for 3-4 days followed in 15% to 25% of cases by a fulminant illness with a case-fatality rate of 20% to 50%. In the second stage, complications may include jaundice, shock, bleeding diathesis, hepatorenal syndrome, cerebral edema, and myocarditis. [ID, p. 2110-11] Findings include hepatomegaly, conjunctivitis, somnolence, and arrhythmias. Albuminuria is a consistent finding that distinguishes the disease from other causes of hepatitis. Patients have seizures and coma in the late stages, and CSF shows increased protein without pleocytosis. [PPID, p. 1938] Death on the 7th to 10th day is preceded by delirium, shock, stupor, and coma. [Guerrant, p. 802-6] |
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