Case series of Yellow fever in referral hospitals in Addis Ababa, Ethiopia

Abstract

Background: Yellow fever is one of the most critical acute viral hemorrhagic diseases which is transmitted by the bites of infected Aedes mosquitoes. The clinical course of Yellow fever has three phases; infection, remission, and intoxication. As Yellow Fever is not easily diagnosed, an adequate diagnosis constitutes the first line of defence.

Case 1: A 14 years old male patient experienced nausea and vomiting of ingested matter of three episodes with intermittent fever, generalized headache and bleeding from his nose and mouth, and coffee-colored vomiting of three episodes on 07/02/2020. Decreased air entry over the right lower 1/3 of the posterior lung field and lethargy. Bilirubin total-6.9 mg/dl, Bilirubin direct- 5.1 mg/dl  with elevated liver enzymes, creatinine-7.7mg/dl, blood urea nitrogen-36.6 mg/dl, prothrombin time-14.7 Sec and white blood cells- 8000/microliter. Case 2: A 48-years-old male patient experienced vomiting of ingested matter of frequent episodes, had an intermittent fever, yellowish discolouration of his eyes, bleeding from his nose and mouth, and change in mental status and he also had decreased urine output. Icteric sclera; and severe tenderness over the right upper quadrant of his abdomen, diffuse edema on the left proximal lower extremity. Bilirubin total-13.9 mg/dl, Bilirubin direct- 9.6 mg/dl with elevated liver enzymes, creatinine-11.7mg/dl, blood urea nitrogen-209 mg/dl, Prothrombin time -15.2 Sec and white blood cells- 18,600/microliter. Case 3: A 55 years old female patient experienced headache, high-grade fever, vomiting of ingested matter, loss of appetite and fatigue associated with flank pain. The patient expired at the emergency department on 15/02/2020. Blood pressure-75/50 mmHg, pulse rate -102 beats/min, respiratory rate- 24 breath/min, temperature- 35.5 degree centigrade, Glasgow coma scale - 5/15.White blood cells- 5,700/microliter, haemoglobin-13gm/dl, red blood cells -4,670,000/microliter and platlet-177,000/microliter. The first two cases were tested for Yellow fever in real-time and case 2 was found to be positive for yellow fever virus.

Conclusion: One has to weigh all the possible conditions that can manifest with the patient’s symptoms and signs in turn this guides the clinicians to provide the necessary medic and it prevents further health danger in the community in case of epidemic-prone diseases.