Timely

You are a hospital administrator and hear about a rash of strange illnesses. A number of travelers and immigrants are presenting about a week after returning from abroad with abrupt onset fever, chills, and general malaise. Some also have weakness, severe headache, muscular back pain, nausea, vomiting, diarrhea, or abdominal pain. Although patients have a high fever, they have a relative bradycardia. Most have a nonproductive cough and a sensation of a lump or "ball" in the back of their throat. Over the following few days, these patients develop worsening stupor, hypotension, conjunctival hemorrhages, and easy bruising. Sites of blood draws keep oozing, though most do not have any overt signs of GI bleed or hematuria. Labs usually show leukopenia, thrombocytopenia, liver enzyme abnormalities, and coagulopathies.

Challenge: What are you worried about?

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