Symptoms include abrupt high fever, headache and severe malaise and tiredness. Severe watery diarrhoea, abdominal pain and cramping, nausea and vomiting. The appearance of patients has been described as showing “ghost-like” drawn features, deep-set eyes, expressionless faces, and extreme lethargy. Many patients develop severe haemorrhagic manifestations and fatal cases usually have some form of bleeding, often from multiple areas. In fatal cases, death occurs most often between 8 and 9 days after symptom onset, usually preceded by severe blood loss and shock.