Severe Rift Valley Fever May Present with a Characteristic Clinical Syndrome

Summerpal S. Kahlon Departments of Medicine, Immunology, and Pathology, University of Texas Medical Branch, Galveston, Texas; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; International Emerging Infections Program—Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya; Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio

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Clarence J. Peters Departments of Medicine, Immunology, and Pathology, University of Texas Medical Branch, Galveston, Texas; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; International Emerging Infections Program—Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya; Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio

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James LeDuc Departments of Medicine, Immunology, and Pathology, University of Texas Medical Branch, Galveston, Texas; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; International Emerging Infections Program—Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya; Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio

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Eric M. Muchiri Departments of Medicine, Immunology, and Pathology, University of Texas Medical Branch, Galveston, Texas; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; International Emerging Infections Program—Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya; Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio

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Samuel Muiruri Departments of Medicine, Immunology, and Pathology, University of Texas Medical Branch, Galveston, Texas; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; International Emerging Infections Program—Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya; Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio

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M. Kariuki Njenga Departments of Medicine, Immunology, and Pathology, University of Texas Medical Branch, Galveston, Texas; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; International Emerging Infections Program—Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya; Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio

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Robert F. Breiman Departments of Medicine, Immunology, and Pathology, University of Texas Medical Branch, Galveston, Texas; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; International Emerging Infections Program—Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya; Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio

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A. Clinton White Jr Departments of Medicine, Immunology, and Pathology, University of Texas Medical Branch, Galveston, Texas; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; International Emerging Infections Program—Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya; Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio

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Charles H. King Departments of Medicine, Immunology, and Pathology, University of Texas Medical Branch, Galveston, Texas; Division of Vector Borne and Neglected Tropical Diseases, Ministry of Public Health and Sanitation, Nairobi, Kenya; International Emerging Infections Program—Kenya, Centers for Disease Control and Prevention, Nairobi, Kenya; Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio

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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.

Author Notes

*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@cwru.edu

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@mima.com. Clarence J. Peters, Departments of Microbiology and Immunology and Pathology, University of Texas Medical Branch, Galveston, TX, E-mail: cjpeters@utmb.edu. James LeDuc, Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, E-mail: jwleduc@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@gmail.com and muiruri1001@yahoo.ca. M. Kariuki Njenga, Global Disease Detection Program, Centers for Disease Control and Prevention, Kenya, E-mail: Knjenga@ke.cdc.gov. Robert F. Breiman, IEIP, CDC/KEMRI, Nairobi, Kenya, E-mail: rbreiman@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@utmb.edu. Charles H. King, Center for Global Health and Diseases, CWRU School of Medicine, Cleveland, OH, E-mail: chk@cwru.edu.

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