clinical features

Last reviewed 01/2018

Following an incubation of 14 to 26 days, there is a 'flu- like illness, characterised by:

  • headache and fever - predominant
  • raised temperature - 38 to 41 degrees centigrade
  • chills, malaise, anorexia
  • respiratory and gastrointestinal symptoms occur late with dry cough, chest pain, crackles after about 5 days
  • hepatosplenomegaly is common with biochemical evidence of hepatitis
  • entire course rarely exceeds 2 weeks - usually, 3 to 6 days - may resolve spontaneously
  • endocarditis may result - especially of the aortic valve

About 20% of cases, often in the elderly, have a protracted form which may last for 4 weeks. A granulomatous hepatitis occurs in one third of these. Significant features are:

  • absence of respiratory features and headache
  • presence of hepatomegaly and right upper quadrant pain