The most evident finding is a moderately ill-appearing person who is mild to moderately dehydrated. Fever, tachycardia, and hepatosplenomegaly are common physical examination findings. Less frequently, lymphadenopathy, jaundice, abdominal tenderness, pulmonary rales, skin rash, meningismus, delirium, aphasia, hemiplegia, facial paralysis, or other neurologic findings may be present.

• The most evident finding is a moderately ill-appearing person who is mild to moderately dehydrated. Fever, tachycardia, and hepatosplenomegaly are common physical examination findings.
• Less frequently, lymphadenopathy, jaundice, abdominal tenderness, pulmonary rales, skin rash, chest pain, photophobia (fear of light),meningismus, delirium, aphasia, hemiplegia, facial paralysis, or other neurologic findings may be present.

Often there is accompanying yellowing of the skin or jaundice. The skin exam can reveal a nonspecific rash. The rash may appear macular, papular, or petechial, and usually begins as the symptoms of the primary attack resolve.

Often there is conjunctivitis (red eyes) and icteric sclarae(yellowing of the white part of the eyes).^[1]

Pulmonary rales( less frequently)

Abdominal tenderness( less frequently)

• Meningismus( less frequently)
• Delirium( less frequently)
• Aphasia( less frequently)
• Hemiplegia( less frequently)
• Facial paralysis or other neurologic findings may be present. ( less frequently)