Comments
INITIAL SYMPTOMS:
Flu-like illness with headache, fever, conjunctival injection, GI symptoms, flushing of the face and trunk, and petechiae of skin and soft palate; bleeding in severe infections; [CCDM]
FINDINGS:
About 20-30% of Junin infections are severe, and patients in the second week have epistaxis, hematemesis, melena, hematuria, gingival bleeding, and neurological symptoms (confusion, tremors, convulsions, cranial nerve palsies, and coma). Other findings are bradycardia, shock, leukopenia, thrombocytopenia, and proteinuria. [CCDM, p. 47] Other symptoms are dizziness, hyperesthesias, epigastric pain, back pain, lethargy, and in complicated cases hemorrhagic diathesis and/or delirium, coma, and convulsions. Weakness is prominent during the prolonged recovery. [ID, p. 2136-7] Acute renal failure is uncommon, but may occur as a consequence of shock and acute tubular necrosis. [Guerrant, p. 456] Most prominent findings (+++) are bleeding and neurological. Heart and lungs may be affected (+ and ++). Not typically noted (0) are rash, jaundice, and kidney disease. [Cecil, 2151] Pulmonary edema and infiltrates from vascular leaks may occur. [PPID 7th Ed., p. 2299]
EPIDEMIOLOGY
The case fatality rate ranges from 15%-30% in untreated cases. The viruses are carried by wild rodents and transmitted by rodent feces or saliva. Field workers are at increased risk if exposed to dispersed rodent feces, e.g., by harvesting machines. Also at risk are laboratory workers and workers exposed to aerosols from farming or grain processing. [CCDM, p. 49]
For updated text and symptoms of infectious diseases, see iddx.com.