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CASE-REPORT

Severe Rift Valley Fever May Present with a Characteristic Clinical Syndrome

Rift Valley fever (RVF) virus is an emerging pathogen that is transmitted in many regions of sub-Saharan Africa, parts of Egypt, and the Arabian peninsula. Outbreaks of RVF, like other diseases caused by hemorrhagic fever viruses, typically present in locations with very limited health resources, where initial diagnosis must be based only on history and physical examination. Although general signs and symptoms of human RVF have been documented, a specific clinical syndrome has not been described. In 2007, a Kenyan outbreak of RVF provided opportunity to assess acutely ill RVF patients and better delineate its presentation and clinical course. Our data reveal an identifiable clinical syndrome suggestive of severe RVF, characterized by fever, large-joint arthralgia, and gastrointestinal complaints and later followed by jaundice, right upper-quadrant pain, and delirium, often coinciding with hemorrhagic manifestations. Further characterization of a distinct RVF clinical syndrome will aid earlier detection of RVF outbreaks and should allow more rapid implementation of control.

Received November 6, 2009. Accepted for publication November 23, 2009.

Special thanks to Dr. Mohamed A. Sheikh whose commitment and gracious hospitality allowed this work to be performed in Ijara District Hospital, Northeastern Province, Kenya. Also, thanks to Public Health Officers Said Dahir and Hasan Hussein in Northeastern Province, Kenya for their invaluable assistance in navigating Ijara District and gathering data.

Financial support: Funding for these studies and their analysis was provided in part by National Institutes of Health Grants U01AI45473 and U54AI057160.

Authors' addresses: Summerpal S. Kahlon, formerly Department of Medicine, University of Texas Medical Branch, Galveston, TX, currently, Melbourne Internal Medicine Associates, Melbourne, FL, E-mail: summerpal.kahlon{at}mima.com. Clarence J. Peters, Departments of Microbiology and Immunology and Pathology, University of Texas Medical Branch, Galveston, TX, E-mail: cjpeters{at}utmb.edu. James LeDuc, Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, E-mail: jwleduc{at}utmb.edu. Eric M. Muchiri and Samuel Muiruri, Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya, E-mails: ericmmuchiri{at}gmail.com and muiruri1001{at}yahoo.ca. M. Kariuki Njenga, Global Disease Detection Program, Centers for Disease Control and Prevention, Kenya, E-mail: Knjenga{at}ke.cdc.gov. Robert F. Breiman, IEIP, CDC/KEMRI, Nairobi, Kenya, E-mail: rbreiman{at}ke.cdc.gov. A. Clinton White Jr, Division of Infectious Diseases, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, E-mail: acwhite{at}utmb.edu. Charles H. King, Center for Global Health and Diseases, CWRU School of Medicine, Cleveland, OH, E-mail: chk{at}cwru.edu.

*Address correspondence to Charles H. King, Center for Global Health and Diseases, CWRU School of Medicine, 10900 Euclid Avenue, Cleveland, OH 44106-7286. E-mail: chk{at}cwru.edu