Incubation period: 14 to 39 days, average 3 weeks
General features:
(1) febrile illness lasting <= 6 months (classified as chronic if > 6 months)
(2) routine cultures are negative
Typical presentation (self-limited flu like syndrome):
(1) sudden onset of fever
(2) chills
(3) headache, which may be severe
(4) myalgias
(5) sweats
(6) cough
(7) arthralgias
Additional manifestations may include:
(1) atypical pneumonia
(2) hepatitis
(3) pericarditis
(4) myocarditis (which may be fatal)
(5) meningoencephalitis or aseptic meningitis
(6) acute febrile illness during pregnancy
(7) maculopapular or purpuric exanthem
(8) polyradiculoneuritis or optic neuritis
(9) gastroenteritis
(10) pancreatitis
(11) diffuse lymphadenopathy
(12) splenic rupture
(13) osteonecrosis
(14) erythema nodosum
(15) syndrome of inappropriate secretion of anti-diuretic hormone
(16) autoimmune reactions including acute hemolytic anemia
Diagnosis can be made by:
(1) serologic testing
(2) PCR
(3) shell vial tissue culture
