Yellow fever and rheumatic disease 4/5 (1)

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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

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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