Sudden onset of fever, chills, and malaise, with extreme prostration and weight loss. The fever typically lasts 7 days. In survivors, the skin will eventually begin to shed or peel. Other symptoms are headache, myalgia, and inflammation of the eyelid and eye membrane, intestine, and liver. Excessive effusions from internal organs occurs, followed by pulmonary interstitial edema and renal dysfunction.
Renal failure is common.
Some patients become jaundiced. Within 7 to 10 days, patients who will survive begin to recover. Recovery can take 5 weeks or more, and is marked by prostration, weight loss, and amnesia for the period of acute illness. Complications during convalescence can include recurrent hepatitis, as well as inflammation of the spinal cord, bone marrow, eyes, testes, and parotid gland. Patients who are at greatest risk of dying experience diffuse or extensive hemorrhage into the skin, mucous membranes, internal organs, stomach, and intestines.