Clinical Manifestations and Diagnosis

The early days of onset of most arboviral infections are usually accompanied by fevers, aching, and general malaise, and cannot be distinguished from early stages of other very common diseases such as influenza, malaria, measles, pneumonias, meningitis, other respiratory afflictions, and even Lassa fever and smallpox. As diseases progress in their course, specific later manifestations may provide aid in differential diagnosis. Such specific manifestations include rashes, eruptions, nausea and vomiting, diarrhea, cough, and encephalitis.

Sporadic cases in a population may be quite impossible to diagnose specifically. But as epidemics progress, specific features may appear and provide the clue to diagnosis. Malaria in the tropics and influenza in temperate regions and the tropics serve as "coverup" or "umbrella" diagnoses that often block out recognition of arbovirus illness.

Definitive diagnosis demands the assistance of experienced virologists working in adequate laboratory diagnostic facilities. There exist only a few dozen such facilities in the world, supported by the World Health Organization, governments, armed forces military establishments, and, in a few instances, private philanthropy. Such laboratories usually combine laboratory diagnostic methodology and facilities for carrying out field epidemiological studies.

Specific diagnosis can only rarely benefit the patient, but is of vital importance in alerting health departments of the presence of a potentially threatening epidemic. Appropriate control procedures directed at the vectors can then be applied on an emergency basis. In the special case of yellow fever, mass immunization of exposed populations can successfully halt an epidemic in its tracks. Such an immunization campaign is usually combined with emergency mosquito control.

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