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INITIAL SYMPTOMS:
Severe flu-like illness with fever, vomiting, diarrhea, low back and limb pain, prostration, conjunctivitis, and sore throat; [CCDM]
This tickborne viral infection may cause marked leukopenia and thrombocytopenia. Hemorrhages and shock are seen in severe cases. Patients may have low back and limb pain, conjunctivitis, cervical lymphadenopathy, sore throat, and papulovesicular eruptions may occur. Some patients have a biphasic course with neurological symptoms (severe headache, mental disturbances, tremors, and visual deficits) developing 1-2 weeks after the initial febrile period. The case-fatality rate varies from 3-5%. A vaccine is available. Ticks are reservoirs. Rodents, shrews, and monkeys are amplifiers. [CCDM, p. 43-6] Findings may include hemorrhage, thrombocytopenia, encephalitis, myocarditis, pneumonitis, and retinal lesions. [Guerrant, p. 444-6, 514] Patients initially have a flu-like illness with vomiting. The first phase of illness may also include lymphadenopathy, hepatosplenomegaly, petechiae, and hemorrhages. After a 1-2 week remission, neurological symptoms develop. Lab findings include elevated liver enzymes. Hemorrhagic pulmonary edema occurs in 40% of cases and acute renal failure in severe cases. [PPID, p. 1897]
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