A petechial rash often appears in the throat quickly followed by haematemesis, nosebleeds, melaena conjunctival injection and haemorrhages and haernaturia. Despite high viraemia, there is often a marked neutrophilia. Some patients gradually recover after 10 to 20 days, but in many death occurs on the seventh to ninth day, following a period of shock, oliguria and, sometimes, respiratory distress syndrome. The use of tribavirin is complicated in these patients by its tendency to cause significant anaemia, mainly due to haemolysis. Laboratory facilities are also available for carrying out patient management pathology tests in secure laboratory facilities, staffed by specially-trained pathologists.
Convalescence is often slow, with debility lasting for some weeks after recovery.
The use of insecticides such as pyrethroids to de-tick farm animals is important. In many endemic areas this is a requirement before animals are transported or delivered for slaughter. Simple tick avoidance by humans includes the use of insect repellents and adequate clothing and footwear, as well as inspection for adherent ticks during washing and when changing clothes. Excellent infection control measures are important in protecting against hospital-acquired cases. This should be borne in mind when feverish patients with evidence of bleeding require resuscitation or intensive care.