Emerging

Viral Hemorrhagic Fever

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Viral Hemorrhagic Fever, Hemorrhagic Fever Syndrome

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