eMedicine Specialties > Emergency Medicine > Infectious Diseases

Yellow Fever: Differential Diagnoses & Workup

Author: Emily M Nichols, MD, Clinical Assistant Instructor, State University of New York Downstate, Kings County Hospital Center, Brooklyn
Coauthor(s): Aleksandr Gleyzer, MD, FAAEM, Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center; Attending Physician, Department of Emergency Medicine, Kings County Medical Center and Brooklyn Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Oct 22, 2009

Differential Diagnoses

Arenavirus infection: Lassa fever, South American viral hemorrhagic fevers
Leptospirosis in Humans
Bunyavirus infection: Crimean-Congo hemorrhagic fever
Malaria
Dengue Fever
Other flaviviruses, such as West Nile virus
Disseminated Intravascular Coagulation
Other viral hemorrhagic fever infection (ie, Marburg, Ebola)
Disseminated Intravascular Coagulation
Sepsis/multiorgan system dysfunction
Ebola virus infection
Viral encephalitides, such as Japanese encephalitis
Hepatitis

Other Problems to Be Considered

Crimean-Congo hemorrhagic fever
Rift valley fever
Typhoid fever
Typhus
Sepsis/multiorgan system dysfunction
DIC
Other viral hemorrhagic fevers
Other flaviviruses

Workup

Laboratory Studies

  • A complete blood count (CBC) often indicates leukopenia and thrombocytopenia. Leukopenia is an early manifestation of disease.3
  • Liver function test results may indicate elevated direct bilirubin and hepatic transaminases.Levels begin to rise as early as 2-3 days into the viremic phase.3
  • Prothrombin time, activated partial thromboplastin time, international rationalized ratio (INR), and clotting times are prolonged invariably.
  • Diminished levels of factor VIII, fibrinogen, and platelets, along with the presence of fibrin split products, indicate the presence of disseminated intravascular coagulation (DIC).
  • Albuminuria usually is noted with proportional rises in BUN and creatinine levels.
  • Serologic tests such as enzyme-linked immunosorbent assay (ELISA) aid in making an exact diagnosis. Confirmation is difficult because of cross-reactivity with other viruses, particularly in Africa where multiple flaviviruses exist.3
    • Laboratory diagnosis of yellow fever in travelers depends principally on serological testing of serum immunoglobulins. Immunoglobulin M (IgM) testing by ELISA is the preferred method of testing. This assay is 95% sensitive when serum specimens are collected 7-10 days after the onset of illness.
    • Paired acute and convalescent sera indicate the diagnosis.
    • Polymerase chain reaction can be used to identify viral ribonucleic acid (RNA) during acute infection, but clinical experience is limited.
  • Immunohistochemical staining of tissues (liver, heart, or kidneys) for the yellow fever antigen would also provide a definitive diagnosis.3 One should not attempt a liver biopsy during infection because of the risk of complications from hemorrhage.

Other Tests

  • ECG may identify prolongation of PR and QT intervals.1

More on Yellow Fever

Overview: Yellow Fever
Differential Diagnoses & Workup: Yellow Fever
Treatment & Medication: Yellow Fever
Follow-up: Yellow Fever
Multimedia: Yellow Fever
References
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References

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Further Reading

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Keywords

yellow fever symptoms, yellow fever vaccine, flavivirus, , group B arbovirus, attenuated 17D vaccine, flaviviral infections, dengue, Japanese encephalitis, tick-borne encephalitis, hemorrhagic fever, acute febrile illnesses with arthropathy

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Contributor Information and Disclosures

Author

Emily M Nichols, MD, Clinical Assistant Instructor, State University of New York Downstate, Kings County Hospital Center, Brooklyn
Emily M Nichols, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and National Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Aleksandr Gleyzer, MD, FAAEM, Assistant Professor, Department of Emergency Medicine, State University of New York Downstate Medical Center; Attending Physician, Department of Emergency Medicine, Kings County Medical Center and Brooklyn Veterans Affairs Medical Center
Aleksandr Gleyzer, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and International Society of Travel Medicine
Disclosure: Nothing to disclose.

Medical Editor

Dan Danzl, MD, Chair, Department of Emergency Medicine, Professor, University of Louisville Hospital
Dan Danzl, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Kentucky Medical Association, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark L Plaster, MD, JD, Executive Editor, Emergency Physicians Monthly
Mark L Plaster, MD, JD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: M L Plaster Publishing Co LLC Ownership interest Management position

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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