Difference in clinical presentation between the first and second phases of Kyasanur Forest disease: an experience from a teaching hospital in South India

Kyasanur forest disease (KFD) is a biphasic tick-borne disease which occurs during the post-monsoon season. The patient may visit the hospital in either of the phases, and it is essential to differentiate between the two phases as the management considerations in both phases are different. This is a retrospective review of patients diagnosed with KFD who were treated by the Infectious Disease Department between September 2019 and May 2020. A total of 14 cases (16 admissions) were diagnosed during the study period by reverse-transcriptase polymerase chain reaction assay. Of these, nine cases came to our hospital during the first phase and seven (including two-readmissions) came to our hospital during the second phase. The manifestations in the first phase included high-grade fever (100%), myalgia (67%), conjunctival suffusion (33%), palatal eruptions (78%), gastrointestinal manifestations (67%), leucopenia (100%), thrombocytopenia (89%), elevated transaminases (89%), elevated creatine phosphokinase (100%) and activated partial thromboplastin time (APTT) (100%). Manifestations in the second phase were fever (57%), headache (100%), blurring of vision (29%), neck signs (71%), leukocytosis (71%), thrombocytopenia (14%), elevated transaminases (40%) and APTT (20%). The clinical symptomatology and laboratory manifestations are different in each of the two phases and can be easily identified by primary care physicians.