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Viral Hemorrhagic Fevers (VHF)

Viral Hemorrhagic Fevers (VHF)

Diagnosis

1.
Early: severe febrile illness, decr’d blood pressure, postural hypotension, petechiae, easy bleeding, flushing of face and chest, non-dependent edema

2.
Late: headache, photophobia, pharyngitis, cough, N/V/D, abd pain, G.I. bleeding, hyperesthesia, dizziness, confusion, tremor, malaise, myalgias

3.
Labs: thrombocytopenia (exception: Lassa) and leukopenia (exception: Lassa, Hantaan, some severe CCHF cases); proteinuria and/or hematuria are common, is rule for Argentine HF, Bolivian HF, and HFRS

4.
Specific virologic techniques to detect

5.
Significant numbers of military persons affected at same time suggests VHF
History

1.
Ebola virus found in Sudan & Zaire in 1976; subsequently in 1979 & 1995 in Zaire

2.
Marburg disease found 3 times in Africa, once in Germany

3.
Argentine hemorrhagic fever (AHF), caused by Junin virus, described in 1955 in corn harvesters

4.
Bolivian hemorrhagic fever, caused by related Machupo virus, described subsequent to AHF in NE Bolivia

5.
Congo-Crimean hemorrhagic fever (CCHF) is tick-borne disease, occurs in Crimea and in Africa, Europe and Asia

6.
Hantavirus prior to WW II in Manchuria along Amur River, later among UN troops during Korean conflict, and in Korea, Japan, and China
Pathophysiology

1.
Due to RNA viruses: Filoviridae, Ebola and Marburg viruses; Arenaviridae, Lassa fever, Argentine and Bolivian HF; Bunyaviridae, Hantavirus genus, Congo-Crimean HF (CCHF) virus from Nairovirus genus, Rift Valley fever; and Flaviviridae, e.g. Yellow fever virus, Dengue HF fever virus

2.
Spread via respiratory portal of entry

3.
Infective dose: 1-10 organisms

4.
Incubation: 4-21 d

5.
Duration: death, 7-16 d

6.
Lethality: high for Zaire strain
Prevention

1.
RVF inactivated vaccine

2.
Ribavirin effective for Lassa fever, Rift Valley fever, CCHF, HF-renal syndrome
Isolation/Decontamination

1.
Contact precautions for healthcare workers

2.
Hypochlorite or phenolic disinfectants

3.
Isolation measures and barrier nursing procedures
Treatment

1.
Passive antibody for AHF, BHF, Lassa fever, CCHF

2.
Ribavirin (CCHF, arenaviruses) 30 mg/kg IV initial dose, 15 mg/kg IV q6h x 4 d, 7.5 mg/kg IV q8h x 6 d

3.
Supportive care for hemodynamic, hematologic, pulmonary, neurologic manifestations of VHF
Disposition

1.
Admit; contact precautions & isolation

2.
Avoid IM injections, aspirin, anticoagulant drugs

3.
Notify CDC & local health dept
 

* Material is taken from the PEPID database
* Copyrighted material – All Rights Reserved
* For more information visit http://www.pepid.com

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