How to Diagnose Yellow Fever

Yellow fever is an infection caused by three viruses in the Flavivirus genus. The reservoirs are monkeys and the vectors are mosquitoes, with humans being incidental hosts. Aedes aegypti is a common vector in cities. Other species of Aedes and Haemagogus are more likely vectors in the rain forest. Yellow fever is found in Africa, South America and the Caribbean. The following steps will show how to diagnose yellow fever.

Difficulty: Challenging

Instructions

1. Obtain the patient's travel history. Recent travel to an endemic area is critical for a diagnosis of yellow fever. Other important factors include vaccination against Yellow fever in the last 10 years and any prior history of leptospirosis, malaria or yellow fever.

2. Expect 85 percent of yellow fever cases to be a mild flu-like illness that self-resolves in three to four days. The remaining cases develop into a more serious illness with an abrupt onset. The flu-like symptoms become more severe and are accompanied by conjunctival injection, facial flushing and pulse-fever dissociation.

3. Perform specific tests for the yellow fever antigen. A monoclonal enzyme immunoassay of the blood serum is a rapid detection method.

4. Isolate the yellow fever virus in a culture. The most sensitive media are mice, mosquitoes and mosquito cell cultures. The cell cultures of mammals such as BHK-21, SW13 and Vero also can be used when combined with polymerase chain reaction immunostaining.

5. Conduct serologic studies to diagnose yellow fever. A serum sample is taken 7 to 10 days after infection. An Immunoglobulin M antibody-capture enzyme-linked immunosorbent assay (MAC-ELISA) confirms the diagnosis with a single positive titer. A four-fold rise in antibodies between the acute and convalescent phases also confirms the diagnosis.

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