Medical

Yellow Fever (Black Vomit, Yellow Jack). Diagnosis, Treatment, and Immunization.

Yellow fever is alive and well, and has a world changing history. A deadly outbreak in Philadelphia is the reason the capital is in Washington D.C. Mosquitoes spreading yellow fever, along with malaria, were a primary cause of the United States gaining control of the Panama Canal from France.

Female Aedes mosquitoes transmit zika, chikungunya, and dengue viruses, the same mosquito that transmits yellow fever. This mosquito is in tropical and subtropical South America and Africa. In Polynesia, the same genus of mosquito spreads Human Lymphatic Filariasis.

Interestingly, Carlos Finlay, a Cuban doctor first proposed that mosquitoes spread Yellow fever in 1881. The American physician, with the Army hospital named in his honor, Major Walter Reed in 1901, was largely given credit for eradicating yellow fever, although Reed himself cited Finlay several times as being the person responsible for the theory that mosquitos were the vector for yellow fever.

Signs and Symptoms:

Initially:

  • Symptoms usually begin 3-5 days after bitten. Up to 50% of those bitten have no symptoms.
  • Sudden onset of temperature ranging from 102°-104° F, This is atypical for virus’ that rarely increase temperatures above 102°.
  • Chills, muscle pain and aching, generalized headache.
  • Redness of the eyes (conjunctiva injection).
  • Nausea and vomiting.
  • Fatigue, irritability, restlessness.
  • Initial rapid heart rate then uncharacteristic slowing after approximately 24 hours.

Second Phase:

  • Symptoms may resolve completely after 1-3 days in mild cases.
  • If severe, the fever and symptoms can resolve in 3-5 days and then reoccur hours or days later. With the reoccurrence of a fever, the eyes yellow (jaundice), there can be stomach pain and vomiting of blood, bleeding of the gums, and extreme confusion. This phase can resolve completely in approximately 1 week or progress.

Third Phase (Malignant yellow fever):

  • Extreme confusion with hallucinations, seizures, unrelenting hiccups, damage to major organs. If symptoms progress to this stage, the immune system is so compromised that pneumonia and other bacterial infections may complicate treatment.
  • Approximately 1 in 10 people die.

Diagnosis:

  • The diagnosis is based on the clinical symptoms and being in an area of outbreak.
  • The hallmark of yellow fever is a sudden fever, after being in an endemic area within the last 3-6 days, slowing of the heart rate (usually increased with an elevated temperature in most other diseases), and an initial reddening of the whites of the eyes prior to turning yellow.
  • Lab tests are available, but not necessary for the initial evaluation.

Treatment:

  • It is imperative that an infected individual be isolated so a mosquito will not bite them and transfer yellow fever to those nearby. It is generally thought that a single mosquito’s range is only a few feet to 2.5 miles.
  • The idea is to recognize the symptoms and seek medical treatment if possible.
  • Treatment is initially supportive, meaning fluids and rest.
  • Monitor temperature, blood pressure, and heart rate at least every 3-4 hours and document this.
  • Entering the severe phase, lab work, cultures, and hospitalization is required to look for and treat secondary infections and organ damage.

Prevention:

  • As in all mosquito carried diseases DEET or an appropriate repellent should be used frequently.
  • Mosquito netting.
  • Remove standing water. This was the main method of eradicating mosquitoes during the building of the Panama Canal.
  • Avoid of vacate areas of outbreak.
  • If going to an endemic area, check the CDC, WHO, or NIH websites to find out about areas of outbreaks.
  • Vaccines are available for those greater than 9 months of age, is relatively safe and readily available, and is highly recommended if traveling to an endemic area. If pregnant, discuss vaccinations with a knowledgeable physician. Note: The yellow fever vaccine should be given at least one month prior to traveling to an endemic area. For related story go to : https://internationaltraveladvisor.wordpress.com/2016/07/05/my-world-yellow-fever/
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