Yellow fever natural history

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

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Natural History, Complications and Prognosis

Natural History

• 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.

Complications

The possible complications are:

• Coma
• Death
• Disseminated intravascular coagulation (DIC)
• Kidney failure
• Liver failure
• Parotitis
• Secondary bacterial infections
• Shock

Prognosis

Historical reports have claimed a mortality rate of between 1 in 17 (5.8%) and 1 in 3 (33%). The WHO factsheet on yellow fever, updated in 2001, states that 15% of patients enter a "toxic phase" and that half of that number die within ten to fourteen days, with the other half recovering.

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