Many infections are asymptomatic. A typical case begins after an incubation period averaging 10 days (range, 2 to 30 days), with abrupt onset of headache, spiking fever, chills, and severe muscle pain. The most characteristic feature of this phase of the disease is the development of redness of the eyes due to dilation of small blood vessels. In mild cases, which are the most common, symptoms usually subside within a week and all signs and symptoms of illness are gone in a month or so. Severe cases follow a similar course except after 1 to 3 days of feeling well, symptoms recur sometimes accompanied by bleeding from various sites, confusion, and evidence of severe heart, brain, liver, and kidney damage. This biphasic course of the illness is characteristic of cases that come to medical attention.

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