Yellow fever

What is Yellow Fever -

Yellow fever(yellow fever, fievre jaune, fiebre amarilla, vomito negro, febris flava) is an acute obligate-transmissible disease with natural focality from the group of viral hemorrhagic fevers. Refers to particularly dangerous infections. Characterized by a severe course with high fever, liver and kidney damage, jaundice, and bleeding from the gastrointestinal tract. The clinical picture of yellow fever was first described during an outbreak in America in 1648. In the 17th-19th centuries, numerous epidemics were recorded in Africa and South America, and outbreaks of the disease in southern Europe. The vector-borne route of transmission of infection through Aedes aegypti mosquitoes was established by K. Finlay (1881), its viral etiology was established by W. Reed and D. Carroll (1901). The natural focality of the disease, the role of monkeys in the circulation of the pathogen in the foci was established by the studies of Stokes (1928) and Soper et al. (1933). In 1936, Lloyd et al. developed an effective vaccine against yellow fever.

What provokes / Causes of Yellow fever:

The causative agent of yellow fever- RNA genomic virus Viscerophilus tropicus of the Flavivirus genus of the Flaviviridae family. The diameter of viral particles is 17-25 nm. It is antigenically related to the Japanese encephalitis and dengue fever viruses. Pathogenic to monkeys, white mice and guinea pigs. Cultivated in developing chick embryos and tissue cultures. It is stored for a long time (more than a year) in a frozen state and when dried, but at 60 ° C it is inactivated within 10 minutes. It quickly dies under the influence of ultraviolet rays, ether, and chlorine-containing drugs in normal concentrations. Low pH values ​​have a detrimental effect on it. Populations at risk of yellow fever The population of 45 endemic countries in Africa and Latin America, totaling more than 900 million people, is at risk. In Africa, an estimated 508 million people living in 32 countries are at risk. The remaining populations at risk live in 13 Latin American countries, with Bolivia, Brazil, Colombia, Peru and Ecuador most at risk. An estimated 200,000 cases of yellow fever occur worldwide each year (30,000 of which are fatal). A small number of imported cases occur in countries free of yellow fever. Although the disease has never been introduced into Asia, the region is at risk because it has the conditions necessary for transmission. Reservoir and sources of infection- various animals (monkeys, marsupials, hedgehogs, possibly rodents, etc.). In the absence of a carrier, a sick person is not dangerous to others. Transmission mechanism- transmission. The carriers are mosquitoes of the genera Haetagogus (on the American continent) and Aedes, especially A. aegypti (in Africa), which have a close connection with human habitation. Vectors breed in decorative ponds, water barrels, and other temporary water reservoirs. They often attack humans. Mosquitoes become infectious within 9-12 days after blood-sucking at ambient temperatures up to 25°C and after 4 days at 37°C. At temperatures below 18 °C, the mosquito loses its ability to transmit the virus. If infected blood comes into contact with damaged skin and mucous membranes, a contact route of infection is possible. Natural receptivity people are high, post-infectious immunity is long-lasting. Main epidemiological features. Yellow fever is classified as a quarantine disease (a particularly dangerous disease) subject to international registration. The highest incidence is recorded in tropical areas, but outbreaks of this disease occur almost everywhere where there are carriers of the virus. The spread of the virus from endemic areas can occur both through sick individuals and through mosquitoes during the transportation of goods. There are two types of foci: natural (jungle) and urban (anthropurgic). The latter more often manifest themselves in the form of epidemics; in this case, the sources of infection are patients during the period of viremia. In recent years, yellow fever has become more of an urban disease and has acquired the features of anthroponosis (transmission occurs through the chain “human - mosquito - human”). If there are conditions for the spread of the pathogen (virus carriers, a large number of carriers and susceptible individuals), yellow fever can become epidemic.

Pathogenesis (what happens?) during Yellow Fever:

Reproduction of the virus that enters the body through a mosquito bite occurs in regional lymph nodes during the incubation period. During the first few days of illness, the virus disseminates through the bloodstream throughout the body, causing damage to the vascular apparatus of the liver, kidneys, spleen, bone marrow, myocardium, brain and other organs. They develop pronounced dystrophic, necrobiotic, hemorrhagic and inflammatory changes. Characterized by multiple hemorrhages in the gastrointestinal tract, pleura and lungs, as well as perivascular infiltrates in the brain.

Symptoms of Yellow Fever:

There are three variants of yellow fever in humans. These are jungle fever (rural type), city fever and an intermediate type. Rural option(yellow jungle fever). In tropical forests (selva), yellow fever occurs in monkeys infected by the bites of “wild” mosquitoes. Infected monkeys can spread the infection by passing it on to healthy mosquitoes. Infected "wild" mosquitoes bite and transmit the virus to people in the forest. This chain leads to isolated cases of infection, mainly in young people working in logging, without leading to epidemics or large outbreaks. The infection can also spread between infected people. Intermediate option infection occurs in humid or semi-humid African savannas and is the dominant form of infection on the continent. There are limited-scale epidemics that differ from the urban variant of the infection. “Semi-domestic” mosquitoes infect both animals and people. During such epidemics, several villages can be affected simultaneously, but the mortality rate with this variant of yellow fever is lower than with urban ones. Urban option infections are accompanied by large-scale epidemics, which are caused by the influx of migrants into urbanized regions with high population densities. "Domestic mosquitoes" (species Aedes aegypti) transmit the virus from person to person; monkeys are not involved in the epidemic chain of transmission of the disease. Incubation period lasts about a week, occasionally up to 10 days. In typical cases, the disease goes through several successive stages. Hyperemia phase. The acute onset of the disease is manifested by a rapid increase in body temperature above 38 °C with chills, headache, myalgia, pain in the back muscles, nausea and vomiting, agitation and delirium. In the dynamics of this phase of the disease, these symptoms persist and intensify. When examining patients, hyperemia and puffiness of the face, neck, shoulder girdle, bright hyperemia of the vessels of the sclera and conjunctiva, photophobia, and lacrimation are noted. Hyperemia of the tongue and oral mucosa is very characteristic. Severe tachycardia persists in severe cases of the disease or is quickly replaced by bradycardia, and initial arterial hypertension is replaced by hypotension. The size of the liver and, less commonly, the spleen increase slightly. Oliguria, albuminuria, and leukopenia occur. Cyanosis, petechiae appear, and symptoms of bleeding develop. At the end of the phase, icterus of the sclera may be noted. The duration of the hyperemia phase is 3-4 days. Short-term remission. Lasts from several hours to 1-2 days. At this time, the body temperature usually decreases (down to normal values), the well-being and condition of the patients improve somewhat. In some cases, with mild and abortive forms, recovery gradually occurs in the future. However, more often, after a short-term remission, high fever occurs again, which can last up to 8-10 days, counting from the onset of the disease. In severe cases, remission is replaced by a period of venous stasis. During this period, there is no viremia, but fever persists, pallor and cyanosis of the skin, icteric staining of the sclera, conjunctiva and soft palate are noted. The patient's condition worsens, cyanosis, as well as jaundice, progress rapidly. Widespread petechiae, purpura, and ecchymosis occur. Hepatolienal syndrome is pronounced. Characterized by vomiting blood, melena, bleeding gums, and organ bleeding. Oliguria or anuria and azotemia develop. Infectious-toxic shock and encephalitis are possible. Infectious-toxic shock, renal and liver failure lead to the death of patients on the 7-9th day of illness. Complications infections can be pneumonia, myocarditis, gangrene of soft tissues or extremities, sepsis as a result of the layering of a secondary bacterial infection. In cases of recovery, a long period of convalescence develops. Post-infectious immunity is lifelong.

Diagnosis of Yellow Fever:

In Ukraine, yellow fever can only occur in the form of imported cases. In clinical differential diagnosis, attention is paid to the sequential change of the main two phases in the development of the disease - hyperemia and venous stasis - with a possible short period of remission between them. Laboratory data The initial stage of the disease is characterized by leukopenia with a sharp shift to the left, neutropenia, thrombocytopenia, at its height - leukocytosis, progressive thrombocytopenia, increased hematocrit, blood nitrogen and potassium. The amount of protein in the urine increases, red blood cells and casts appear. Hyperbilirubinemia and high activity of aminotransferases (mainly AST) are noted. In specialized laboratories, it is possible to isolate the virus from the blood in the initial period, using biological diagnostic methods (infection of newborn mice). Antibodies to the virus are determined using RNGA, RSK, RNIF, indirect hemagglutination inhibition reaction, ELISA.

Treatment of Yellow Fever:

Treatment of yellow fever is carried out according to the same principles as hemorrhagic fever with renal syndrome, in the conditions of infectious diseases departments for working with especially dangerous infections. Causal therapy has not been developed. Convalescent blood plasma, used in the first days of illness, gives a weak therapeutic effect. Forecast: the mortality rate of the disease ranges from 5%-10% to 15-20%, and during epidemic outbreaks - up to 50-60%.

Prevention of Yellow Fever:

Preventive actions are aimed at preventing the introduction of the pathogen from abroad and are based on compliance with the International Health Regulations and the Rules for the sanitary protection of the territory. They destroy mosquitoes and their breeding sites, protect premises from them and use personal protective equipment. Specific tests are carried out at foci of infection immunoprophylaxis with live attenuated vaccine. It is administered to persons of all ages subcutaneously in a volume of 0.5 ml. Immunity develops within one week in 95% of vaccinated people. Immunity develops after 7-10 days and lasts for at least 10 years. Vaccination of children and adults is carried out before leaving for endemic areas (South Africa), where the disease in new arrivals is very severe and has a high mortality rate. Immunization against yellow fever is recommended:- persons traveling on business or tourism (even for a short time), or living in a region where the disease is endemic, - unvaccinated persons traveling from an endemic to a non-endemic region. In accordance with the established rules, a stamp of vaccination against yellow fever must be affixed to the International Certificate, as well as signed and approved by an accredited yellow fever vaccination center. - This vaccination certificate is valid for 10 years, starting from the 10th day after the date of vaccination. - persons at risk of infection due to their professional duties, HIV-infected persons in the asymptomatic stage. In accordance with established rules, a mark on vaccination against yellow fever must be affixed to the International Certificate, as well as signed and approved by an accredited yellow fever vaccination center. This vaccination certificate is valid for 10 years, starting on the 10th day after the date of vaccination. Contraindications to vaccination against yellow fever: General contraindications for yellow fever vaccination are similar to those for any vaccination: - infectious diseases in the active stage, - progressive malignant diseases, - current immunosuppressive therapy. Specific contraindications: - documented allergy to egg whites, - acquired or congenital immunodeficiency. Pregnant women and children under 6 months of age are not recommended to be vaccinated. However, in the event of an epidemic, pregnant women and infants from 4 months of age can be vaccinated. In difficult cases, you should consult a doctor. Precautions for yellow fever vaccination- In persons with allergic diseases, a test is indicated to assess sensitivity to the drug by intradermal administration of 0.1 ml of the vaccine. If there are no reactions within 10 - 15 minutes, the remaining 0.4 ml of vaccine should be administered subcutaneously. - In special cases, a decision may be made to vaccinate patients receiving immunosuppressive therapy. It is best not to vaccinate until 1 month after the end of such therapy and, in any case, you should make sure that the biological indicators are within normal limits. - In difficult cases, you should consult a doctor. Adverse reactions Sometimes, 4-7 days after vaccination, general reactions may occur - headache, malaise, slight increase in body temperature. Activities in the epidemic outbreak Patients are hospitalized in the infectious diseases department. If a sick person is detected on a ship during a voyage, he is isolated in a separate cabin. Disinfection is not carried out in the outbreak. Any vehicle arriving from countries affected by yellow fever must have information about the disinfestation carried out. Unvaccinated persons arriving from endemic areas are subject to isolation with medical supervision for 9 days. If an outbreak of yellow fever occurs, mass immunization of the population begins immediately. List of countries requiring an international certificate of vaccination against yellow fever. 1. Benin 2. Burkina Faso 3. Gabon 4. Ghana 5. Democratic Republic of the Congo 6. Cameroon 7. Congo 8. Ivory Coast 9. Liberia 10. Mauritania 11. Mali 12. Niger 13. Peru (only when visiting jungle areas) 14. Rwanda 15. Sao Tome and Principe 16. Togo 17. French Guiana 18. Central African Republic 19. Bolivia List of countries with zones endemic for this infection, upon entry to which it is recommended to have an international certificate of vaccination against yellow fever : South American countries 1. Venezuela 2. Bolivia 3. Brazil 4. Guyana 5. Colombia 6. Panama 7. Suriname 8. Ecuador African countries 1. Angola 2. Burundi 3. Gambia 4. Guinea 5. Guinea-Bissau 6. Zambia 7. Kenya 8. Nigeria 9. Senegal 10. Somalia 11. Sudan 12. Sierra Leone 13. Tanzania 14. Uganda 15. Chad 16. Equatorial Guinea 17. Ethiopia

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Yellow fever (syn. amaryllosis) is a fairly common and serious disease that leads to disruption of the functioning of some internal organs, in particular the gastrointestinal tract. The causative agent of the disease is an arbovirus, which is transmitted by arthropods. This means that a person can become infected in one of the simplest ways - through a mosquito bite.

The symptoms are dominated by high temperature, hemorrhage from the oral cavity, yellowness of the sclera and signs of severe intoxication. In addition, a large number of other symptoms are expressed.

Diagnosis of the disease is based on laboratory tests of the patient's blood and urine. However, the physical examination of the clinician plays an important role. Treatment is carried out using conservative methods, but in institutions specially designed for dangerous infections.

Etiology

Yellow fever belongs to the category of zooanthroponoses - this means that both people and animals can suffer from this disease.

The source is a tropical adenovirus, which does not exceed forty nanometers in size. It is characterized by the fact that it is quite stable in the external environment and can easily withstand drying or prolonged exposure to low temperatures. Inactivation is observed only at temperatures above sixty degrees for ten minutes, and when boiling - in two seconds. In addition, the pathogenic bacterium is quite susceptible to an acidic environment.

In the human body, the virus can negatively affect the tissues of various internal organs. This is what causes the wide variety of symptoms. Such a microorganism can disrupt the work of:

• lymphatic tissues - it is the lymph nodes that become the first vessel for the proliferation of bacteria when they enter the human body. After the period of maturation of new individuals in lymphocytes is completed, they penetrate into the general bloodstream;
• The liver and kidneys are the first organs that are affected by the pathogen. With a pathological effect on the liver, its cells - hepatocytes - die and increase in size. In cases of effects on the kidneys, there is a significant decrease in the daily volume of urine excreted;
• lungs and spleen - when these organs are damaged, an inflammatory process develops in them. However, the lungs are involved in the pathological process much less frequently;
• brain and bone marrow - the influence of pathogenic bacteria leads to changes in blood composition and the formation of a large number of microscopic internal hemorrhages. This state of affairs requires immediate medical attention;
• myocardium and blood vessels - the influence of the virus leads to the development of a large number of complications from the cardiovascular system.

The second most common cause of infection is direct contact of a healthy person with the blood of an infected person. It is noteworthy that the insect is contagious for about ten days from the moment it bites a sick person. However, infection does not occur at temperatures below eighteen degrees.

It is worth noting that outbreaks of yellow fever are often observed in countries in Africa, Central or South America. In other regions, the disease is diagnosed extremely rarely.

Classification

Depending on the location of the outbreak of infection, two forms of this disease are distinguished:

• rural;
• urban.

In any situation, the carrier is the mosquito. The only difference is that in the first case, fewer people are infected.

As yellow fever progresses, it goes through several stages, which will differ in their symptoms. Thus, among the stages it is worth highlighting:

• first wave of fever;
• remission phase;
• second wave of fever;
• recovery.

Depending on the severity of the pathology, it is divided into:

• light;
• moderate;
• complicated;
• lightning fast.

Symptoms

The incubation period varies from three to six days. However, cases have been recorded when it was ten days.

The first wave of the disease lasts no more than a week. At this time the following symptoms are expressed:

• severe chills - can last from half an hour to three hours;
• a sharp increase in temperature, up to 40 degrees;
• severe headaches;
• unhealthy redness of the skin of the face, shoulders and neck;
• muscle weakness and soreness;
• acquisition of a yellowish tint to the skin and sclera;
• attacks of nausea and vomiting. Sometimes the vomit may contain impurities of pus;
• swelling of the eyelids;
• pain in the back, arms and legs;
• increased heart rate;
• bleeding gums, leakage of blood from the nasal cavity or mouth - due to the presence of such manifestations, the disease is also known as hemorrhagic fever;
• sleep disturbance;

The outcome of the first wave of yellow fever can be either the disease going into remission or death.

The remission phase lasts from three hours to a day and a half. In such cases, clinical signs will be:

• temperature drop to 37 degrees;
• disappearance of facial skin redness, however, the presence will remain;
• reduction in the severity of headaches and muscle pain.

With a mild course of the disease, remission can smoothly flow into recovery, bypassing the second wave. It is worth noting that with a lightning-fast course, this stage is followed by the formation of severe consequences and the death of the patient.

Symptoms of yellow fever characteristic of the second wave:

• increased manifestation of jaundice;
• development of intestinal hemorrhages;
• cough and shortness of breath;
• decreased blood pressure with a weak pulse, less than forty beats per minute;
• an increase in temperature, but the indicators will be slightly lower than in the first wave;
• semi-liquid stools with a tarry consistency;
• the appearance of pinpoint hemorrhages;
• decrease in the daily volume of urine excreted;
• confusion;
• cyanosis of the skin, which replaces jaundice;
• frequent vomiting, and the mass will have the consistency of coffee grounds.

In addition, in the second wave there is often a development of , and , and , which significantly increases the risk of mortality.

Recovery is considered a stage in the progression of the disease, since it proceeds rather slowly. This period can take up to nine days, and normal laboratory tests return only several months after the acute symptoms have subsided. On average, the period of complete recovery lasts one month.

Diagnostics

Establishing the correct diagnosis is based on laboratory tests of the patient’s blood and urine. Nevertheless, the work of the clinician with the patient is not the least important in diagnosis.

Thus, primary diagnosis includes:

• collecting the patient’s life history - to identify the fact of his contact with a carrier of the virus or infected blood;
• a thorough physical examination aimed at palpation of the anterior wall of the abdominal cavity - to detect hepatosplenomegaly, i.e., a simultaneous increase in the size of the liver and spleen. In addition, the doctor must assess the condition of the skin and sclera, as well as measure temperature, blood pressure and pulse;
• a detailed survey of the patient - for the specialist to obtain a complete picture of the course of the disease. The severity of symptoms will allow you to accurately determine the phase of the disease.

Diagnostics using laboratory tests includes:

• general blood test - will show a shift in the leukocyte formula to the left, a decreased level of neutrophils and platelets. In severe cases, leukocytosis is detected. In addition, the concentration of nitrogen and potassium in the blood increases;
• tests to determine blood clotting ability;
• general urine analysis - will indicate an increase in protein, the presence of red blood cells and columnar epithelial cells;
• blood biochemistry - shows an increase in bilirubin and liver enzyme activity;
• PCR tests;
• serological tests, including RNGA, RSK, RTNG, RNIF and ELISA.

Identification of pathogenic bacteria is carried out in specially designed laboratories, due to the special danger of infection. Such diagnostics are performed using bioassays on animals expressed under laboratory conditions.

When yellow fever is detected, instrumental examinations are necessary to confirm the presence of hepatosplenomegaly and internal hemorrhages. Among them are:

• radiography of the sternum;
• histological study of liver biopaths.

Treatment

Establishing a final diagnosis of yellow fever requires immediate placement of the patient in the infectious diseases department. All therapy for the disease comes down to eliminating symptoms and is based on:

• strict bed rest;
• drinking plenty of water;
• taking medications;
• detoxification therapy;
• hemodialysis – with severe liver damage.

There is currently no specific drug treatment for yellow fever. However, clinicians prescribe to their patients:

• anti-inflammatory substances;
• hepatoprotectors and antihistamines;
• antibacterial and diuretics;
• antipyretic drugs;
• antiviral medications.

If the disease is severe, treatment will include:

addition of a secondary infectious process;

intrauterine infection and fetal death - if the patient is a pregnant woman;

increased risk of premature labor or spontaneous abortion.

Prevention

There are two types of preventive measures for yellow fever - specific and nonspecific.

The first category includes a specially designed vaccine against such a disease. Persons living or traveling to countries with an increased prevalence of the disease are subject to immunization. However, there are several contraindications for administering the vaccine, including:

• period of bearing a child;
• age less than nine months;
• persons with immunodeficiency or intolerance to egg white, since such a substance is part of the medicine.

Immunoprophylaxis should be carried out ten days before departure to epidemic regions.

• strengthening the immune system;
• avoiding contact with an infected person;
• protecting your home from mosquitoes, for example, by installing mosquito nets on windows and using various repellents;
• using specially designed insect repellent sprays and ointments in nature.

The prognosis for hemorrhagic fever is favorable only in cases of mild or moderate severity. The severe course of the disease in half of the cases causes dangerous complications that can lead to death.

Yellow fever is an acute hemorrhagic (accompanied by hemorrhage) disease of viral etiology.

Sources of infection with this virus are wild animals, usually opossums and monkeys, as well as people sick with it. Mosquitoes serve as carriers of the causative agent of yellow fever, while the virus is not transmitted directly from person to person. This disease is endemic in Latin America and tropical Africa.

It is estimated that this virus affects about 200 thousand people in the world every year, for 30 thousand of whom the outcome of the disease is fatal. Over the past twenty years, there has been a trend of increasing cases of yellow fever infection, which is due to decreased immunity of the population, urbanization, deforestation, population migration and climate change.

The most effective prevention of the disease today is the yellow fever vaccine.

Symptoms of the disease

The yellow fever virus has an incubation period of about 3-6 days, after which the infection begins to appear.

The disease may have one or two stages. The first stage is characterized by fever, chills, lower back pain, muscle pain, headache, loss of appetite, vomiting or nausea.

For most patients, the disease is limited to only this stage - after 3-4 days, the symptoms of yellow fever disappear. However, in 15% of cases, a day after remission, patients experience a second stage, more toxic than the previous one. At this stage, the body temperature rises again, the body systems are damaged, jaundice begins to develop rapidly, the patient suffers from vomiting and pain in the abdomen.

The characteristic symptoms of yellow fever at this stage are bleeding from the nose, mouth, and eyes. There may be bleeding from the stomach, which manifests itself as blood in the feces and vomit. In addition, at this stage of the disease, kidney function deteriorates. About 50% of patients facing the toxic stage of the disease die after 10-14 days, and the rest in most cases recover without significant organ damage. Only sometimes are complications of the disease possible in the form of pneumonia, myocarditis, gangrene of the extremities or soft tissues. It is also possible to develop sepsis due to the addition of secondary bacterial flora.

Symptoms of yellow fever are similar to those of severe malaria, leptospirosis, viral hepatitis, other hemorrhagic fevers, and poisoning, so diagnosing this disease is very difficult. Yellow fever virus can only be detected by highly trained healthcare professionals through laboratory testing of blood samples or postmortem liver tissue.

Treatment of yellow fever

Specific drugs for the treatment of yellow fever have not been developed to date, so only symptomatic treatment of the disease is possible.

Patients are advised to remain in bed and follow a gentle diet rich in high-calorie foods. Treatment of yellow fever involves massive vitamin therapy, the use of non-steroidal anti-inflammatory drugs (except acetylsalicylic acid), infusion of plasma expanders and adsorbent drugs. In case of severe bleeding, a blood transfusion may be prescribed.

Disease prevention

The yellow fever vaccine is the most important and effective way to prevent this disease. Vaccination is necessary not only for those living in endemic areas, but also for tourists traveling to those areas.

A yellow fever vaccination certificate is required for all travelers to Africa or Latin America. If, for medical reasons, vaccination is contraindicated for a traveler, the exemption from it must be certified by the competent authorities.

The yellow fever vaccine, containing a weakened virus, allows 95% of those vaccinated to develop reliable immunity to the disease within a week, which lasts for 30-35 years, and sometimes for life. Despite the fact that the vaccine is recognized as one of the most highly effective and safe in the history of vaccinology, the yellow fever vaccine has contraindications. This vaccine is not intended for:

• children under 9 months of age in case of regular immunization;
• children under 6 months of age during an epidemic;
• pregnant women - with the exception of outbreaks of the disease;
• persons suffering from severe egg white allergy;
• persons with severe immunodeficiency due to symptomatic HIV/AIDS or other causes, or suffering from diseases of the thymus gland.

An infected person, even with a mild form of yellow fever, poses a danger to others, therefore, in order to prevent further spread of the virus, the patient is provided with maximum protection from mosquito bites. Isolation of the patient is advisable only in the first 4 days, since later he no longer represents a source of infection for mosquitoes.

A non-specific way to prevent yellow fever is mosquito control, which includes destroying mosquito breeding sites, spraying insecticides to kill adult mosquitoes, and adding these chemicals to water sources where mosquitoes begin their development.

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The term yellow fever in medicine refers to a viral infection that is accompanied by damage to various organs and tissues. The carrier of the pathogen is a mosquito, which lives only in some countries. The course of the disease often becomes severe and is accompanied by hemorrhagic syndrome. There is no specific treatment against the infection, but a vaccine has been invented that promotes the production of antibodies and the development of stable but temporary immunity.

Causes

The fever vector is a virus whose genetic material is contained in RNA. It is stable in the external environment and tolerates cold exposure well, but dies at temperatures above 700C or under the influence of ultraviolet irradiation and disinfectants.

The source of infection is animals (marsupials, monkeys, rodents) and people. Fever is transmitted transmissibly (that is, through the bite of mosquitoes that breed near residential buildings). After biting a host, the insects become infectious within a few days. The exact timing depends on both weather and temperature conditions.

It is extremely rare that infection occurs through contact. This is possible when the blood of a sick animal gets on an open wound surface, for example, when processing carcasses.

Yellow fever is prone to epidemics. To do this, it is enough to meet only three conditions:

• presence of virus carriers;
• presence of vectors;
• favorable weather conditions (spread is not possible at temperatures below 18 °C).

There are a number of dangerous countries in which you can become infected. The occurrence of epidemics in other regions is unlikely.

When the disease is yellow fever, the pathogen enters the human bloodstream from the digestive tract of an insect. Then it actively multiplies and accumulates in the lymphatic system. Then it penetrates the general bloodstream and spreads through the vessels, causing their inflammation. The spleen, kidneys, liver, bone marrow, central nervous system and heart are also affected.

Africa is where yellow fever is common

Symptoms

When infected with yellow fever, symptoms begin to appear after a week. In the clinical course of the disease, four phases can be distinguished, which successively replace each other:

• hyperemia;
• short-term improvement;
• venous stasis;
• recovery.

The hyperemia phase is characterized by a sudden significant increase in body temperature. At the same time, intoxication symptoms of yellow fever appear:

• nausea;
• muscle weakness;
• joint pain;
• headache;
• disorders of higher nervous activity (impaired consciousness, delusions and hallucinations).

The patient's appearance also changes. The face and neck become somewhat swollen, there is redness of the skin and minor hemorrhages in the sclera, oral mucosa, and conjunctiva. In some cases, patients begin to experience photophobia and experience increased lacrimation.

The main symptoms are yellowing of the skin, as well as a significant increase in temperature, which is how the disease got its name.

Systemic manifestations include:

• change in rhythm (tachycardia turning into bradycardia);
• decreased blood pressure;
• small volume of daily urine;
• enlarged spleen and liver;
• discoloration of the sclera and skin in a yellowish color.

The first phase lasts about four days, after which there is a short period of improvement. It can last from 2-5 to 24-35 hours. At the same time, there is an objective improvement in well-being against the background of a decrease in temperature. In some cases, immediately after this period the patient recovers, but in severe cases of yellow fever, a short remission is followed by a phase of venous stagnation.

Yellow eyes (progressive jaundice)

In yellow fever, the next phase includes the following symptoms:

• pale skin;
• cyanosis of the lips, as well as peripheral parts of the extremities;
• progressive jaundice;
• pinpoint hemorrhages and purpura;
• significant hepatosplenomegaly.

The patient's condition is much worse than during the hyperemic phase. In connection with hemorrhagic syndrome the following are associated:

• bleeding from the nose, gums;
• gastrointestinal bleeding, manifested by melena and vomiting of coffee grounds;
• hemorrhages in internal organs.

During this period, urine often stops being produced altogether, which increases the intoxication of the body. If the course is favorable, a period of recovery follows, but not all patients with yellow fever manage to survive the phase of venous stagnation. In most cases, after recovery, a stable immune defense is formed.

Diagnostics

Diagnosis of the disease is based on analysis of the epidemic situation and assessment of the clinical picture. A number of instrumental techniques are also used:

• a blood test that can detect a decrease in the level of white blood cells, platelets and neutrophils. Further, there is an increase in the concentration of cellular elements and accumulation of metabolic products (urea, creatinine), as well as an increase in the level of liver enzymes and bilirubin;
• urine analysis may contain protein, red blood cells, columnar epithelium;
• using a serological test, the presence of specific antibodies can be detected;
• The yellow fever virus can be identified in the blood using the PCR technique. Due to the danger of an epidemic, biological material should only be handled in a specialized laboratory.

Treatment

Treatment for yellow fever should be started as soon as possible. To do this, the patient should be placed in a separate box in an infectious diseases hospital.

There is currently no specific therapy aimed at eliminating the virus, so only symptomatic treatment is carried out to alleviate the patient’s condition.

Typically, the following classes of medications are prescribed to treat yellow fever:

• anti-inflammatory steroidal or non-steroidal drugs;
• hemostatic (hemostatic) agents;
• antiallergic drugs;
• detoxification solutions (glucose, salts, dextrans);
• diuretics.

In case of severe renal failure, plasmapheresis is performed. If there is blood loss or a serious bleeding disorder, blood products, including plasma and platelets, are used. In case of secondary bacterial infection, antibacterial agents are prescribed.

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Yellow fever is a viral disease that is transmitted through mosquito bites. This pathology is epidemic in nature (that is, it occurs in outbreaks in certain regions of the country).

This disease is accompanied by hemorrhagic phenomena and damage to internal vital organs. Moreover, all this, as a rule, is accompanied by severe intoxication.

Yellow fever is often popularly called “jaundice.” This is because patients with yellow fever often experience a symptom called jaundice (yellowing of the urine and whites of the eyes).

Outbreaks of yellow fever are most common in regions with tropical or subtropical climates.

Experts distinguish 2 types of the disease:

• endemic - a form that is found in rural areas or jungles;
• epidemiological - the disease is widespread in large cities (sometimes an epidemic can cover several cities or even the entire country at once).

Yellow fever is a fairly dangerous disease. It is for this reason that it is listed internationally as a disease that requires quarantine. If a person needs to travel to a country where there is currently an outbreak of yellow fever, he must present at the border a document indicating that he has been vaccinated against this disease.

Yellow fever is very common in African countries, as well as in southern America. According to WHO, there are currently outbreaks of yellow fever in 45 countries in Africa and 13 countries in South America. It has been noted that the disease is more common in countries with a low level of medicine.

Yellow fever is different in that it has the ability to spread very quickly through the population. Thus, in Sudan in 2012, about 800 people were infected during an outbreak. Moreover, for 120 of them the disease was fatal.

In African and South American countries, outbreaks of the disease occur every year (sometimes more than once).

The only way to avoid yellow fever in these countries is timely prevention.

Yellow fever virus

Yellow fever is caused by a virus that belongs to the Flaviviridae family.

The genome of the yellow fever pathogen contains only RNA and no DNA at all.

This virus does not survive well in the external environment. It very quickly becomes inactive during heat treatment, even if no antibacterial agents are used. It can be active a little longer when dried or frozen.

The virus that causes yellow fever is a pathogenicity group 1 virus, so work with it is usually carried out in the most closed and protected laboratories. This virus can be detected in almost all organs of patients with yellow fever who died 3 days ago.

Causes of pathology

In the wild, the reservoir for infection is usually wild animals, while in urban areas it is sick individuals.

It is currently impossible to determine whether a given animal or person is contagious. As a rule, a person is contagious several hours before the first symptoms of the pathology appear. Moreover, he can infect others for another 3-4 days after the appearance of signs of the disease.

The main carriers of yellow fever are mosquitoes (no matter: urban or wild).

A mosquito can infect a person 10 days after it has sucked blood from a patient. However, this only applies to those regions where the air temperature reaches 25 degrees. In areas where the temperature reaches 30 degrees, mosquitoes can infect after a week, and in places where the temperature exceeds 37 degrees - after 4 days.

At an air temperature of 16-18 degrees, mosquitoes become absolutely safe.

From this we can conclude that in hotter regions, mosquitoes become infectious faster and can infect more people.

It is worth noting that in the absence of mosquitoes in the room, a person with yellow fever is not able to infect others.

Typically, outbreaks occur during the rainy season, as the number of mosquitoes increases significantly during this time.

In the jungle, mosquitoes are not the only carriers of yellow fever. Often other insects also perform this function.

In some cases, infection occurs after a wound comes into contact with blood (for example, in hospitals, if medical instruments are poorly processed, or in a nail salon). Even less often, yellow fever infection occurs in laboratory conditions, when medical workers carry out any work with the causative agent of the disease.

Yellow fever is highly contagious and can affect people no matter what age they are.

In epidemic countries, asymptomatic immunization is often observed. This usually happens if a mosquito bites a person, but the person did not have enough virus to become infected. In this case, the person does not get sick, but his body begins to develop special immunity.

After the patient recovers from yellow fever, his body develops a strong immunity that will protect him for 5-7 years (depending on the individual characteristics of the body).

Pathogenesis

After a mosquito bites a person, the yellow fever virus enters the person's lymphatic system. There, along with the lymph flow, it is transferred to the nearest tissues, where the causative agent of the disease begins to multiply. As a rule, the incubation period is 5-7 days.

After this, the virus enters the bloodstream, from where it spreads to all human organs. Usually this period lasts 3-4 days. Typically, the liver, brain, and adrenal glands are the first areas to be affected by the yellow fever virus. This is due to the fact that these organs are abundantly supplied with blood.

Infection of organs, in turn, leads to degeneration of their cells.

One of the most severe consequences of yellow fever for the human body is hemorrhagic syndrome (a condition in which hemorrhage occurs in the tissue of internal organs). As a rule, this ends in death.

Other complications of the disease include pneumonia, necrosis of kidney tissue, infection and inflammation of the brain and soft tissues.

Tourists traveling to countries where there are outbreaks of yellow fever should definitely visit a doctor if their body temperature rises, as this may indicate the onset of the disease.

In this case, you cannot engage in self-medication and self-diagnosis. Here you only need a doctor’s consultation and, if necessary, urgent hospitalization.

A person should also go to the hospital if they have any other symptoms similar to yellow fever.

The fact is that in its symptoms, yellow fever can resemble some other diseases (for example, hepatitis, leptospirosis or hemorrhagic fevers). It is sometimes difficult even for experienced doctors to distinguish between these pathologies, despite the fact that they have medical laboratories and diagnostic equipment at their disposal.

Unfortunately, at the moment there are no drugs that could cure a patient of yellow fever. The only way to protect yourself from the disease is to get vaccinated. This vaccination is performed only in special cases (for example, if the patient needs to travel to a country where there is currently an outbreak of yellow fever). This is because some patients experience side effects from the yellow fever vaccine. Among these are:

• infection and inflammation of the brain;
• health problems in the presence of weakened immunity;
• Quincke's edema. It usually occurs if the patient has an allergy to chicken eggs that was not discovered before the vaccine was administered.

It is worth noting that these consequences occur extremely rarely in patients, so you should not be afraid of these vaccinations.

In order to reduce the risk of a yellow fever outbreak, the governments of African and South American countries urge their citizens to protect themselves as much as possible from mosquito bites (use special creams, sprays, mosquito nets). For this purpose, mass baiting of mosquitoes and purification of water bodies can also be carried out.

Neighboring countries, as a rule, will carefully check all travelers. This is to ensure that the yellow fever virus does not come from abroad.

Symptoms

Yellow fever is an infectious disease of viral etiology, manifested in humans by hemorrhagic syndrome. Typical for countries in Africa and South America. Transmitted by mosquito bites.

Variants of the clinical picture of yellow fever

In modern medicine, there are three variants of the course of yellow fever: rural type, urban and intermediate.

• Rural type. Characterized by participation in the process of transmission of infection of wild monkeys. Typically, this type affects young people who work in the jungle - logging, harvesting. Epidemics are not developing. The course of the disease is the most aggressive.
• Urban type. A characteristic feature is the development of epidemic foci with a large number of sick people. The main reason for the spread of infection is ordinary mosquitoes. Mild and moderate clinical picture of the disease.
• Intermediate type. Occupies a middle position between the previous two.

Development of the disease

As with any infectious disease, yellow fever is characterized by certain stages in the development of clinical symptoms.

The incubation period lasts on average from 3 to 6 days, with a maximum of 10 days. During this time, the person is not bothered by any symptoms of yellow fever.

The initial or febrile period also lasts from 3 to 6 days. The disease begins acutely with a rise in body temperature to 39-40 degrees, the appearance of a sharp bursting headache, general weakness, repeated vomiting and mental agitation, which can turn into delirium. Externally, there is redness and swelling of the face, neck and upper extremities. Patients avoid light (photophobia), and lacrimation is observed. The face has the characteristic appearance of the so-called “amaryl” mask - hyperemia of the face, neck, redness of the sclera of the eyes, swelling of the eyelids and general puffiness of the face. After a few days, the sclera and skin turn yellow. Gradually, a characteristic hemorrhagic syndrome begins to develop: bleeding from the nose, increased bleeding of the gums and the appearance of blood streaks in the stool. This period of the disease is considered the most life-threatening for the patient.

The period of short-term remission ranges from several hours to two days. Body temperature decreases and general health returns to normal. At this stage, the patient can either be cured or the symptoms recur.

The relapse period lasts several days and most often ends in death. The patient's condition sharply worsens, body temperature rises to 40 degrees and above, widespread jaundice develops with yellowing of the sclera, skin, and visible mucous membranes. Severe thrombohemorrhagic syndrome occurs with the possible development of disseminated intravascular coagulation syndrome: hemorrhages of various sizes appear on the skin, bleeding from the gums and nasal cavity occurs. The stool turns black due to intraintestinal hemorrhages. The functioning of the kidneys is impaired: the amount of urine gradually decreases until complete absence (anuria) and the development of acute renal failure.

If the patient does not die during a relapse, then a period of convalescence occurs. All symptoms of yellow fever gradually disappear, and the function of all internal organs is restored. Lifelong immunity is formed - a person cannot get yellow fever several times in his life.

If any signs of yellow fever appear, you should immediately seek medical help at an infectious diseases hospital. Early treatment will reduce the risk of severe complications.

Diagnostics

An arboviral disease transmitted by insects is called yellow fever. An infected person is susceptible to severe intoxication, fever, damage to internal organs and a number of other manifestations of the disease. A preliminary diagnosis is made by a doctor based on the patient’s complaints, external health status and based on the results of general tests. If a specialist suspects yellow fever, he will prescribe certain tests to confirm a preliminary diagnosis of the disease.

A complete diagnosis to identify the disease includes several stages:

• anamnesis;
• clinical trial;
• laboratory research;
• use of instrumental research methods;
• application of methods for studying antibodies in blood;
• PCR diagnostics;
• biological research.

Anamnesis

The signs of yellow fever are similar to a number of other diseases, so the doctor asks the patient about possible travel to countries where there is a risk of infection. The cause of the illness may be travel to southern countries in the past couple of weeks before the onset of symptoms. In other countries, it is almost impossible to contract yellow fever. If the patient has not had the opportunity to contact carriers of the disease, then the doctor identifies a disease with a similar course and symptoms.

Clinical study

One of the important stages of diagnosis is clinical research. Using clinical data, the doctor makes a preliminary diagnosis. The signs of the disease are taken into account: how the disease began, the degree of development, and the formation of jaundice are determined. The general picture of symptoms helps the doctor determine the extent of damage to internal organs and identify the disease. The specialist does not rule out the similarity of symptoms with other diseases, so he cannot make a final diagnosis based on clinical studies.

Laboratory research

According to laboratory data, a definitive diagnosis can be made and appropriate treatment can be selected. Urine and blood tests can help identify yellow fever in the laboratory. Using the results of the study, the doctor identifies the degree of development of the disease and which parts of the body are damaged. Yellow fever usually leads to the following changes in tests:

• in biochemistry - increased bilirubin and transaminase, increased urea and creatinine levels, increased glucose levels;
• in a general blood test - a decrease in leukocytes, lymphocytes, platelets, an increase in the erythrocyte sedimentation rate, pancytopenia;
• when testing for blood clotting, the level is increased;
• General urine analysis reveals proteinuria, hematuria, cylindruria.

Instrumental research methods

Such methods are used extremely rarely when diagnosing yellow fever. The reason for this is the impossibility of identifying the pathogen. The instrumental method is used to diagnose complications at the 3rd stage of the disease.

Instrumental studies include:

• X-ray examination of the chest organs;
• computed tomography;
• electrocardiography;
• liver biopsy.

Methodology for studying antibodies in a patient’s blood

Enzyme immunoassay is the most important step in making a diagnosis of yellow fever. Since it helps to finally verify and confirm the diagnosis. This test helps identify specific antibodies produced by the body to protect against the virus.

PCR diagnostics

This research method helps to accurately determine the location of the virus in the patient’s body. However, such a diagnosis is carried out only when the test results do not provide an accurate definition of the disease or the disease occurs in an atypical form. The PCR test is an expensive procedure, so it is not used during the period of exacerbation of the epidemic.

Biological research

Biological research methods include the use of white mice to detect disease. Intracerebral infection of an animal is obtained by introducing biological material from the patient into the skull of a mouse. After some time, white mice develop encephalitis. Biological research is mainly carried out for scientific purposes.

All of the above methods for identifying and diagnosing yellow fever are prescribed exclusively by a doctor. It is impossible to make a diagnosis on your own based on the general symptoms of the disease. Since a person who does not have a special medical education cannot make the necessary diagnosis without the results of specific tests due to the similarity of symptoms and the nature of the course of the disease.

Treatment

The main goal of treating yellow fever is to eliminate the unpleasant symptoms caused by poisoning the body with toxins and stop the further development of the pathology.

During treatment, patients must observe strict bed rest and eat large amounts of foods rich in proteins and vitamins. In general, the diet of these patients should be as balanced and high-calorie as possible. Doctors often prescribe vitamin and mineral complexes to this group of patients.

In order to eliminate the symptoms of poisoning, patients are given intravenous injections of adsorbent agents in combination with plasma substitutes.

If pain occurs, patients are allowed to be prescribed painkillers. However, people with yellow fever should avoid medications such as ibuprofen and aspirin, as they may increase the risk of bleeding.

If the patient begins to develop signs of hemorrhage, a blood transfusion may be used to alleviate his condition.

In severe cases of the disease, patients may be prescribed anti-inflammatory drugs (including glucocorticosteroid drugs).

Ribovin (an antiviral agent) and interferon (an immunostimulant) have not been proven effective in treating yellow fever. However, they continue to be used at different stages of disease therapy today.

If the disease is complicated by an infection, the doctor may prescribe antibacterial drugs (usually broad-spectrum).

In addition, medications that relieve unpleasant symptoms can be used in treatment. The group of these drugs and their dosage are determined by the attending physician based on the symptoms experienced by the patient and the individual characteristics of his body.

Treatment of yellow fever should never be done independently at home. This practice can often be found in third world countries.

It is worth noting that a patient with yellow fever is contagious to others, which means that hospitalization is indicated for him.

Since there is no specific treatment for yellow fever, doctors pay more attention to disease prevention, which includes the use of vaccines. This means that in order to avoid the disease, you can simply get a yellow fever vaccine.

Prevention

The yellow fever vaccine is considered one of the most effective and at the same time safe in medicine.

The yellow fever vaccine takes the form of a dry suspension, which contains processed chicken embryos infected with the yellow fever virus. The drug is in ampoules, each of which contains 2-5 doses. The package contains 10 such ampoules.

In order for the product to be as effective as possible, it should be stored at a temperature no higher than 20 degrees and no longer than 2 years from the date of release.

Vaccination against yellow fever is mandatory for all people wishing to visit endemic regions.

This vaccination can be given to all patients starting from 9 months of age. However, vaccination may sometimes be required for children between 4 and 9 months of age. In this case, vaccination is done only if there is a high probability of infection of the child.

Recent immunosuppressive treatment may be a contraindication to the use of the yellow fever vaccine. In this case, the vaccine is allowed only 1 year after therapy. In addition, the vaccine is not given to people who are allergic to chicken eggs, animal vaccinations, or certain types of antibacterial drugs. In this case, the vaccine can be carried out if there are serious indications. However, patients must take antihistamines for a week after vaccination. Yellow fever vaccination is completely contraindicated in patients suffering from HIV/AIDS.

The yellow fever vaccine is administered to the subscapular region at least 10 days before traveling to an endemic region. During these 10 days, the human body will develop a special immunity that can protect it from yellow fever for 10-15 years. Moreover, this effect is achieved in almost 100% of patients.

In some patients, immunity can last for about 30 years, and sometimes for life, however, revaccination should be done every 10 years, regardless of how long the yellow fever vaccine lasts in a particular patient. This practice is especially popular in developed countries.

Nonspecific prevention of yellow fever includes preventing mosquito bites (using ultrasonic mosquito repellents, sprays, creams, mosquito nets, etc.), as well as disinfecting water bodies located near populated areas.

Possible reactions to the vaccine

After 12 hours or a day, redness may occur at the injection site, and a swelling with a diameter of about 3 cm will appear. This reaction is considered normal and, as a rule, disappears after 2-3 days. After 7-10 days, 10-15% of patients experience an increase in body temperature to 38-39 degrees.

All this is accompanied by fatigue, weakness, dizziness, headache and chills. This effect usually lasts no more than 3 days. In a small number of people, these symptoms may be combined with allergic reactions. Pediatric patients may develop inflammation of the brain.

For people over 15 years of age, doctors often offer simultaneous vaccination against yellow fever and cholera. However, in this case, the formation of special immunity may take a little longer.

Children under 14 years of age can receive the yellow fever vaccine only 3-4 weeks after the cholera vaccination. After using other vaccines, vaccination against yellow fever can only be done after 2 months. If the yellow fever vaccination was given to a woman who did not know she was pregnant, then it is not necessary to interrupt it, since it does not affect the development of the fetus, and its infection occurs in only 1 case in 80.

Medicines

One of the dangerous viral diseases is yellow fever. The patient has a high fever, vomiting and bile spillage. An epidemic can lead to the death of fifty percent of patients. Unfortunately, today in modern medicine there are no drugs that can cure yellow fever. The main methods of treatment are aimed at restoring and maintaining the normal functioning of vital organs: the brain, kidneys, blood circulation, and respiratory organs. The doctor diagnoses the disease, identifies the stage of its development and prescribes therapy, which includes: a strict diet, bed rest, taking vitamin preparations and absorbents. A severe form of the disease requires a blood transfusion. There is only one method of combating this dangerous virus – vaccination against yellow fever.

Yellow fever vaccination

A vaccine against a viral disease is considered the most accessible and safe method of combating the disease. Its effect in the body begins after ten days from the date of vaccination and lasts for 10 years. After this period, the vaccine is administered again. Vaccination induces immunity in one hundred percent of those vaccinated. For citizens visiting countries in Africa and South America, mandatory vaccination is carried out to eliminate the risk of contracting yellow fever. After its completion, an appropriate international certificate is issued. Next, the vaccination is registered in the registration forms established by the Health Service. Contraindications include:

• pregnant women;
• children under nine months;
• HIV-infected;
• citizens with allergies to egg whites and antibiotics;
• acute infectious diseases;
• simultaneous administration of a drug against another infectious disease.

Complications of the disease are possible in rare cases and are not severe. The following may appear at the vaccination site: redness of the skin, mild swelling. But such manifestations quickly pass. Local and general reactions to vaccination are possible:

• temperature increase;
• dizziness;
• malaise;
• chills;
• headache.

Usually the reactions go away within one to three days. In extremely rare cases, compaction of the subcutaneous tissue may occur, which is accompanied by itching and pain. Persons susceptible to the development of allergic reactions are prescribed antihistamines. Their reception continues from two to four days.

The yellow fever vaccine is injected subcutaneously into the forearm or outer corner of the shoulder blade. Release form: tablets or ampoules with solvent. Diluted in a ratio of 1:10.

Drugs for the treatment of yellow fever in children

To treat viral fever in young patients, drugs that reduce the symptoms of the disease are used: analgesics, antipyretics, antiemetics and antiviral drugs. The latter includes ribavirin. The use of such a medicine requires special control, otherwise the consequence may be the development of hemolytic anemia, which will lead to death. Therapy may include treatment with: vikasol, dicinone, prednisol, multivitamins.

Children are vaccinated starting at nine months of age. A child's body tolerates vaccination in a milder form than an adult. Possible side effects can be eliminated by:

• antipyretic;
• painkillers.

If you suspect yellow fever, you should contact an infectious disease specialist.

Folk remedies

If symptoms of yellow fever appear, you should immediately consult a doctor, as the disease can cause severe complications. Traditional medicine does not support the treatment of yellow fever with folk remedies, since herbal infusions and decoctions cannot stop the development of the pathology. In third world countries, alternative medicine is widely practiced in the treatment of this disease, but you should not self-medicate.

Traditional methods to reduce symptoms

The use of folk remedies in the treatment of yellow fever is aimed at reducing symptoms. Some decoctions and infusions of medicinal herbs help reduce high fever and help reduce the manifestations of intoxication in the body. To reduce high fever, alternative medicine offers recipes for decoctions of medicinal herbs. The following plants have good antipyretic properties:

• lilac;
• willow (bark is used to prepare decoctions);
• sagebrush;
• parsley and other herbs.

Both decoctions and alcohol tinctures are used. But before you start treating yellow fever with folk remedies, keep in mind that they only reduce the manifestation of symptoms, but do not eliminate the source of the disease and do not prevent its further development.

Reducing the high temperature can only worsen the patient's condition. If your body temperature rises to 40°C, call an ambulance and do not self-medicate. The sooner the correct treatment is prescribed, the higher the chances of a successful recovery and avoiding serious complications.

You can use any folk remedies (even harmless ones at first glance) in the treatment of yellow fever only after consulting a doctor. You should not test the effectiveness of traditional methods on yourself or your family.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.