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Viral Hemorrhagic Fever
Aka: Viral Hemorrhagic Fever, Hemorrhagic Fever Syndrome
- See Also
- Bioterrorism
- Pathophysiology
- Natural host species are specific to certain geographic regions
- Natural outbreaks typically start in these regions
- However, person to person spread may occur in new regions if patients travel
- Transmission
- Natural exposure to body fluids
- Bioterrorism exposure to aerosolized infectious agent
- Causes
- Arena Virus (Arenaviridae, Rodent Reservoir)
- Lassa Fever
- Junin
- Machupo
- Lujo
- Sabia
- Chapare
- Bunyavirus (Bunyaviridae)
- Rift Valley Fever
- Crimean Congo Hemorrhagic FeverVirus
- Hantavirus Hemorrhagic Fever
- Flavivirus (Flaviviridae)
- Yellow Fever
- Dengue Fever
- Omsk Hemorrhagic Fever
- Kyasanur Forest Disease
- Filovirus (Filoviridae, Bat Reservoir)
- Ebola Virus
- Marburg Hemorrhagic Fever
- Findings
- Incubation: 2-21 days
- Bleeding
- Conjunctival Injection
- Mucosal Bleeding (gums, Gastrointestinal Tract)
- Hemoptysis
- Epistaxis
- Hemoptysis
- Bloody Diarrhea
- Petechiae, Purpura and Ecchymosis
- Other findings
- Fever
- Headache
- Myalgias
- Arthralgias
- Rash
- Encephalitis
- Abdominal Pain
- Vomiting
- Diarrhea
- Diagnosis: Hemorrhagic Fever Syndrome (WHO)
- Fever <3 weeks AND
- Severely ill patient AND
- Two hemorrhagic findings (without known host predisposing factors)
- Hemorrhagic or Purpuric rash
- Epistaxis
- Hematemesis
- Hemoptysis
- Blood in stools
- Complications
- Multiorgan Failure
- Hepatic Failure
- Renal Failure
- Hemorrhagic Shock
- Septic Shock
- Management: General
- See Specific causes
- Strict patient isolation
- Personal Protective Equipment for care givers
- Supportive care
- Monoclonal Antibody treatments have been developed for several hemorrhagic fevers
- Management: Ribavirin (Virazole)
- Indications
- Lassa Fever
- Arenaviridae
- Bunyaviridae
- Ribavirin Protocol
- Load 30 mg/kg (up to 2 g) IV
- Then 16 mg/kg (up to 1 g) IV every g hours for 4 days
- Then 8 mg/kg (up to 500 mg) IV every 8 hours for 6 days
- References
- Black, Martin, DeVos (2018) Crit Dec Emerg Med 32(8): 3-12
- Gladwin (2014) Clinical Microbiology Made Ridiculously Simple, MedMaster, Miami, p.306-7, 398
- Rathjen (2021) Am Fam Physician 104(4): 376-85 [PubMed]