Notifiable condition that is endemic in South America, the Caribbean, and Africa. An ongoing outbreak in Brazil has raised the concern of local transmission in other countries, spread by infected returning travellers.
Infection may be asymptomatic or cause a biphasic, highly variable illness ranging from a non-specific mild febrile illness to a potentially fatal haemorrhagic fever.
Molecular or serological testing confirms diagnosis in the context of clinical presentation, epidemiological context, and vaccination history.
As no specific antiviral therapy is available, treatment is supportive. A safe and effective vaccine is available.
A viral haemorrhagic fever caused by a flavivirus transmitted by the Aedes or Haemagogus mosquito. It is endemic in South America, the Caribbean, and Africa, and has been resurging in the last 2 decades. The clinical disease is variable, ranging from a non-specific viral illness to haemorrhagic fever and death.
History and exam
Key diagnostic factors
- presence of risk factors
- constitutional symptoms
- conjunctival injection
- relative bradycardia (Faget's sign)
- biphasic illness
- haemorrhagic diathesis
- signs of renal failure
- signs of hepatic failure
Other diagnostic factors
- abdominal pain
- residence in, or recent travel to, endemic area
- lack of immunisation
- mosquito bite
- travel during rainy and early dry seasons
1st investigations to order
- coagulation screen
- reverse transcription polymerase chain reaction (RT-PCR)
Investigations to consider
- virus isolation
- isothermal nucleic acid amplification assays
unidentified viral haemorrhagic fever
confirmed yellow fever
Helmut Albrecht, MD, DTMH
Heyward Gibbes Distinguished Professor of Internal Medicine
Department of Internal Medicine
University of South Carolina
HA declares that he has no competing interests.
Dr Albrecht would like to gratefully acknowledge Dr Philip A. Yeon, a previous contributor to this monograph. PAY declares that he has no competing interests.
Carlos Franco-Paredes, MD, MPH
Emory University Hospital Midtown
CFP declares that he has no competing interests.
Andrea K. Boggild, MSc, MD, DTMH, FRCPC
Tropical Diseases Unit
Division of Infectious Diseases
Department of Medicine
Toronto General Hospital
University Health Network
AKB declares that she has no competing interests.
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