Clinical Manifestations and Diagnosis

The incubation period following exposure varied from 5 to 7 days. In six cases for which data are available, death occurred between days 7 and 16. The onset was indicated by malaise, myalgia, and often prostration (Martini 1971). Vomiting frequently occurred by the third day, and conjunctivitis by the fourth, by which time the temperature had reached 40°C. A rash occurred on the fifth day, was macular in type, and progressed usually to a maculo-papular rash that later coalesced into a more diffuse rash. In severe cases, a diffuse dark livid erythema developed on face, trunk, and extremities. An enanthem of the soft palate developed at the same time as the rash. Spleen and liver were not palpable. Lymph node enlargement was noted in the nuchal region and the axillae. A diarrhea appeared, often with blood in the stools. The South African cases differed only in that there were no enanthem and no lymph node enlargement.

The above description was declared by several clinicians to make diagnosis easy. This may be true when there is a clustering of cases, and epidemiologists are on the alert; however, in much of Africa, the occurrence of single cases, however severe, would not be likely to arouse suspicion. Moreover, during the first 5 to 6 days, the symptoms could be mistaken for those of many other diseases. Laboratory diagnosis is accomplished by means of immunofluorescence techniques, by electron microscopic examination of a serum sample from a patient, which has been centrifuged and placed on a grid (Wulff et al. 1978), and by inoculation of laboratory animals. None of these methods is readily accessible in the usual field situation; yet early diagnosis is imperative in order to abort a possible developing epidemic.

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