After an incubation period of about a week there is a sudden onset of chills, severe headache, myalgia and fever.
The fever reaches a plateau at about day 2, with readings of about 40øC. The patient becomes photophobic. On day five a rash appears, firstly on the trunk and spreading outwards but not affecting the palms and soles. The appearance is of pink macules which become maculopapular and subsequently petechial.
In the second week the patient becomes prostrated, stuporose and deaf, and peripheral gangrene may develop.
In the third week the patient either dies or there is resolution signified by a fall in the temperature.
Mortality can be as high as 60%
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