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Pediatric Yellow Fever Clinical Presentation

  • Author: David J Cennimo, MD, FAAP, FACP, AAHIVS; Chief Editor: Russell W Steele, MD  more...
 
Updated: Jun 24, 2015
 

History

The clinical spectrum of yellow fever (YF) ranges from a minimally symptomatic flulike illness to a catastrophic illness complicated by hemorrhage and organ failure (primarily the liver and kidney). It develops in a number of distinct phases (not all of which invariably occur).

The incubation period typically lasts 3-6 days. No prodromal symptoms occur.

The infection period of infection lasts 3-4 days. Viremia is present. Susceptible biting mosquitoes can be infected with YF. Symptoms typically begin abruptly with fever, chills, malaise, prostration, headache, dizziness, myalgia (particularly lumbosacral area), anorexia, nausea, and vomiting.

The remission period lasts 2-24 hours. Symptoms and fever abate.

The abortive phase may extend over 1 day or longer. Recovery occurs without further symptoms.

The period of intoxication may last 3-5 days. Liver failure, hemorrhagic diathesis, and kidney failure occur. This period develops in approximately 15% of all cases. This stage is fatal in 1-50% of cases that develop toxicity. Previous symptoms and new symptoms include fever with high temperatures, chills, anxiety, confusion, lethargy, prostration, jaundice, epistaxis, anorexia, epigastric pain, nausea, vomiting, hematemesis, melena, lumbosacral pain, and decreased urine output. Complications include bacterial pneumonia and sepsis.

The period of convalescence may last days to weeks. The patient recovers completely, without sequelae. Complications may include protracted weakness and fatigability.

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Physical Examination

The Pan American Health Organization has published a case definition for YF to aid in surveillance. By this definition, YF is an illness characterized by acute onset of fever followed by jaundice within 2 weeks of the onset of first symptoms plus 1 of the following:

  • Bleeding from the nose, gums, gastrointestinal (GI) tract, or skin
  • Death within 3 weeks of illness onset

A case of YF is classified as suspected if it meets the clinical definition or if other causes of fever or jaundice are excluded. A suspected YF case can be confirmed by laboratory testing or by being epidemiologically linked to a laboratory-confirmed case or outbreak.

Data to be reported to public health authorities include patient-specific identifier, age or date of birth, location, laboratory results, vaccination history, outcome of infection (alive, dead, unknown), case classification, and date of death (if dead).

Physical examination findings are nonspecific and may include the following:

  • Fever
  • Pulse - Slow, inversely proportional to temperature (Faget sign)
  • Anxiety, lethargy, prostration, confusion, coma
  • Facies - Flushed
  • Conjunctival injection
  • Abdominal tenderness
  • Hemorrhagic manifestations - Epistaxis, gingival bleeding, hematosis, melena, hematuria
  • Urine output - Decreased
  • Shock
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Complications

Complications of YF include the following:

  • Organ failure - Liver (secondary to hepatic necrosis), kidney (secondary to parenchymal injury and acute tubular necrosis), heart (secondary to parenchymal injury)
  • Hemorrhagic diathesis - YF virus directly injures the liver, kidney, and heart; a hemorrhagic diathesis progressing to disseminated intravascular coagulation (DIC) is not uncommon in the toxic form of the disease, because of hepatic damage, thrombocytopenia, and perhaps other factors
  • Secondary infections, particularly bacterial pneumonia
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Contributor Information and Disclosures
Author

David J Cennimo, MD, FAAP, FACP, AAHIVS Assistant Professor of Medicine and Pediatrics, Adult and Pediatric Infectious Diseases, Director, Disease Processes, Prevention, and Therapeutics, Director, Pediatric Infectious Diseases Fellowship, Rutgers New Jersey Medical School

David J Cennimo, MD, FAAP, FACP, AAHIVS is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Medical Association, Infectious Diseases Society of America, Medical Society of New Jersey, Pediatric Infectious Diseases Society, HIV Medicine Association, American Academy of HIV Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Amy J Behrman, MD Associate Professor, Department of Emergency Medicine, Director, Division of Occupational Medicine, University of Pennsylvania School of Medicine

Amy J Behrman, MD is a member of the following medical societies: American College of Physicians, American College of Occupational and Environmental Medicine

Disclosure: Nothing to disclose.

Patrick B Hinfey, MD Emergency Medicine Residency Director, Department of Emergency Medicine, Newark Beth Israel Medical Center; Clinical Assistant Professor of Emergency Medicine, New York College of Osteopathic Medicine

Patrick B Hinfey, MD is a member of the following medical societies: American Academy of Emergency Medicine, Wilderness Medical Society, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

William H Shoff, MD, DTM&H Director, PENN Travel Medicine; Associate Professor, Department of Emergency Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine

William H Shoff, MD, DTM&H is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM Associate Professor, Education Officer, Department of Emergency Medicine, Hospital of the University of Pennsylvania; Director of Education and Research, PENN Travel Medicine

Suzanne Moore Shepherd, MD, MS, DTM&H, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American Society of Tropical Medicine and Hygiene, International Society of Travel Medicine, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
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This female Aedes aegypti mosquito is shown here after landing on a human host. The A aegypti mosquito is a known transmitter of both dengue fever and yellow fever. A aegypti is sometimes referred to as the yellow fever mosquito. The viruses are transferred to the host when bitten by a female mosquito. Image courtesy of the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO).
 
 
 
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