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Yellow fever (A95.9) (yellow jack, yellow plague)
Definition
Yellow fever is a tropical disease caused by an acute viral infection. Rheumatic pain, most in the back, is part of the disease.
- People who have weakened immune systems, who when using immunosuppressive drugs against rheumatic disease may not always use topical vaccine.
Disease Cause
- Flavivirus
Contamination
- Usually transferred via mosquito bites or ticks.
Occurrence
- Central / South America + Africa (incl. Kenya). Not in Asia
Incubation
- 3-6 days
Symptoms
- Initial stage
- Fever 40 degrees C and sweats
- Strong headache
- Muscle pain, especially in the back
- Conjunctivitis (eye inflammation)
- Nausea and vomiting
- Relative bradycardia (slow pulse, despite fever)
- Remission (Refreshment) on 3. or 4. Day with falling fever. The disease can still flare up with new fever and risk of organ damage
- Liver damage stage (at 15%)
- Hepatitis with icterus (jaundice) and vomiting
- Nephritis (renal inflammation) with proteinuria
- Mucosal haemorrhages, nosebleeds and gastrointestinal bleeding
- Mortality in a toxic phase is approx. 20%
Rheumatic symptoms
- Muscle pain, especially in the back
- Vaccine is important preventive, but it is a "live vaccine" that cannot be used during treatment with anti-rheumatic anti-rheumatic drugs
Diagnosis
- Blood tests
- Slightly low number of white blood cells and platelets, lymph / monocytosis. High liver enzymes, bilirubin, proteinuria
- Virus RNA in blood sample with PCR Technology is the best method
- IgM increase after a few days detectable
Complications
- Hepatic / renal failure
- Meningo-encephalitis (brain inflammation)
- Multiorganic failure
Course
From light flu-like course to fatal outcome
Differential Diagnoses
- Hepatitis
- Malaria
- Rikettsia
- Morbus Weil (Leptospirose)
- Dengue fever
- Hemorrhagic fever
Treatment
- Quarantine / isolation in mosquito-insulated rooms on suspicion (6 days incubation),
- Anti-viral treatment (eg with ribavirin) is attempted
Medical prognosis / life expectancy
- Yellow fever in children before 14. years of age is rarely deadly
- In adults up to 50% mortality
- Leave lifelong immunity
Prevention
Live vaccine (weakened "live" virus)
- Vaccine effect starts after 10 days
- Immunosuppressed patients at high doses of cortisone, cytostatics or Biological treatment should generally not have such "live" vaccine
- Since 1996 is 13 serious complications reported, of which 6 lethal vaccine complications
Literature
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