Flu-like illness with cough, conjunctivitis, stomatitis, and flushing of the face and trunk; pneumonia and CNS disease in some patients;
This tickborne viral infection is similar to Kyasanur forest disease and 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 developing meningoencephalitis 1-2 weeks after the initial febrile period. The case-fatality rate varies from 1-3%. A vaccine is available. Ticks are reservoirs. Animal hosts include native water voles and muskrats. Muskrats can directly transmit the infection to humans. [CCDM, p. 43-5] Tick-borne hemorrhagic fevers (Crimean-Congo, Kyasanur Forest, and Omsk) are typically biphasic illnesses that begin with flu-like symptoms and end with hepatomegaly and bleeding diathesis (petechiae, thrombocytopenia, and DIC). [PPID, p. 3277] The heart is occasionally affected. [Cecil, p. 2151]
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