Overview
Yellow fever is an infection caused by an arbovirus (arthropod-borne virus -- a virus carried by insects). There are over 300 known arboviruses, over 150 of which are known to infect humans; other arboviral diseases include several types of equine encephalitis and other kinds of encephalitis including dengue fever, St. Louis encephalitis, and West Nile virus, The latter three diseases, and yellow fever, are caused by viruses belonging to the "Flaviviridae" family of arboviruses.
Most arboviruses are usually found in nature in birds and small animals, and people are infected accidentally when bitten by carrier insects, or when transfused with blood from an infected donor. Yellow fever and dengue fever are exceptions: these viruses only infect humans, and are carried from person to person by insects. Yellow fever has three stages. Stage I consists of fever, malaise (feeling lousy), headaches, weakness, nausea, and vomiting (sounds like the flu, doesn't it?). In stage II most of the symptoms go away, or at least get somewhat better. Stage III consists of fever, bleeding (anywhere, including the nose or the gums -- the combination of fever and bleeding is called hemorrhagic fever), liver failure with jaundice (thus the term "yellow fever"), kidney failure with very low urine output, low blood protein, and failure of other body systems including the circulatory system.
Like most viral diseases, there are no antibiotics available for yellow fever. Close clinical monitoring and supportive treatment (such as IV fluids to keep the patient hydrated, replacement of depleted blood proteins, and dialysis) may help, but one out of two people with yellow fever die of the disease.
Differential Diagnosis
- Repeated viral infections
–Most common cause of recurrent febrile episodes in childhood
–Start of day care or change of geographic location may be related - Urinary tract infection (UTI)
–May be self-limited but recur especially if underlying anomaly exists - Epstein-Barr virus (EBV)
–May present with recurrent febrile episodes due to one initial infection
Treatment
- Repeated viral illnesses
–Reassurance of the parents
–Advice on antipyretics
–Encourage fluid intake
–Limit of sick exposure if possible - UTI
–Antibiotics based on bacteria and sensitivity
–Prophylactic antibiotics if underlying cause is present - Bacterial infections: Bacteria-specific antibiotic
- JRA, Behçet, or IBD
–Prednisone or immunosuppressive medications - TRAPS
–Prednisone and etanercept - Familial cold urticaria and Muckle-Wells syndrome
–Prednisone may be used
–If amyloidosis is present, colchicine may be required
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