eMedicine Specialties > Dermatology > Viral Infections

Viral Hemorrhagic Fevers: Differential Diagnoses & Workup

Author: Arash Michael Saemi, MD, Department of Internal Medicine, Naval Medical Center San Diego
Coauthor(s): Nili N Alai, MD, FAAD, Assistant Clinical Professor, Department of Dermatology, Clinical Faculty and Preceptor, Department of Family Practice, University of California, Irvine; Clinical Faculty and Preceptor, Department of Family Practice Residency Training, Downey Medical Center; Medical Director, The Skin Center at Laguna; Expert Medical Reviewer, Medical Board of California
Contributor Information and Disclosures

Updated: Oct 1, 2008

Differential Diagnoses

Drug Eruptions
Henoch-Schönlein Purpura (Anaphylactoid Purpura)
Measles, Rubeola
Meningococcemia
Rocky Mountain Spotted Fever
Rubella

Other Problems to Be Considered

Rickettsial infections - Tick bite fever, epidemic typhus, and Q fever
Bacterial infections
Various septicemias - Meningococcal, staphylococcal, and streptococcal infections; typhoid; and plague
Leptospirosis, relapsing fever
Protozoal infection - Falciparum malaria and trypanosomiasis
Other viral infections - Hepatitis, Chikungunya, Sindbis, herpes, and influenza
Infectious mononucleosis
Other hemorrhagic fevers
Acute anemia
Acute leukemias, especially promyelocytic leukemia
Disseminated intravascular coagulation
Encephalitis
Hemolytic uremic syndrome
Thrombotic thrombocytopenic purpura
Meningitis
Pleural effusion
Sepsis

Workup

Laboratory Studies

  • Although the clinical findings can suggest a hemorrhagic fever, laboratory studies are required to identify disease, to distinguish it from other conditions, and to confirm its etiology.
  • As a rule, clinical blood and/or urine tests reveal leukopenia (except in Lassa fever, Hantaan viral fever, and some severe cases of CCHF), thrombocytopenia (except in Lassa fever), and proteinuria and/or hematuria (in Argentinian viral hemorrhagic fever, Bolivian viral hemorrhagic fever, and hemorrhagic fever with renal syndrome [HFRS]; common in other viral hemorrhagic fevers). Such tests include the following:
    • Full blood count determination
    • Red cell and sedimentation rate analysis
    • White cell differential count determination
    • Platelet count
    • Tests for parasites, malaria, trypanosomiasis, or relapsing fever
    • Coagulation studies
    • Liver and kidney function tests
    • Bacterial culture and virus isolation from feces and urine samples
    • Electron microscopic examination of blood and urine samples
    • Positive tourniquet test in dengue fever (This test may also be helpful in other viral hemorrhagic fevers).
    • The specific diagnosis is based on viral isolation or the demonstration of seroconversion, that is, the presence of specific immunoglobulin M (IgM) antibody or a 4-fold increase in the antibody titer.
  • Specialized infectious disease containment is required for the safe handling of these viruses. Biochemical tests are available for the rapid detection of viral antigen during viremia or in postmortem specimens. Such tests include the following:
    • Immunofluorescence antibody (IFA) tests can be performed.
    • Reversed (or indirect) passive hemagglutination (RPHA) tests may be helpful.
    • Acute serum samples can be tested by using a polymerase chain reaction (PCR).
    • Enzyme-linked immunosorbent assays (ELISA) can be used to detect specific IgM or immunoglobulin G (IgG) antibodies or viral antigens in acute serum samples from patients with Lassa fever, Argentinian fever, RVF, CCHF, or yellow fever. Lassa- and Hantavirus-specific IgM antibodies are often detectable during acute illness.
    • Tests for viral genetic material are favored in diagnoses of acute arenaviral infections.
    • Virus cultivation and identification techniques require 3-10 days or longer for definitive identification. Viral isolation is a lengthy process, especially in Hantaan, Ebola, Marburg, and Congo-Crimean fevers.
    • Postmortem immunocytochemical analyses can be used to identify the viral phenotype.

Imaging Studies

  • Electron microscopy of the infected tissue may be helpful.

More on Viral Hemorrhagic Fevers

Overview: Viral Hemorrhagic Fevers
Differential Diagnoses & Workup: Viral Hemorrhagic Fevers
Treatment & Medication: Viral Hemorrhagic Fevers
Follow-up: Viral Hemorrhagic Fevers
References
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Further Reading

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Keywords

viral hemorrhagic fever, Ebola virus, dengue fever, Marburg virus, yellow fever, VHFs, Arenaviridae, Bunyaviridae, Filoviridae, Flaviviridae, Guanarito, Junin, Machupo, Lassa, Sabia, Nairovirus, Phlebovirus, Hantavirus, Flavivirus, Marburg, Ebola, Venezuelan fever, Argentinian fever, Bolivian fever, West African fever, Brazilian fever, Sao Paulo fever, Crimean-Congo fever, Congo-Crimean hemorrhagic fever, CCHF, Rift Valley fever, RVF, Korean fever, Seoul fever, Chikungunya fever, Omsk fever, dengue hemorrhagic shock syndrome, DHSS, Kyanasur Forest disease, Kyasanur Forest disease, arthropods, rodents

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Contributor Information and Disclosures

Author

Arash Michael Saemi, MD, Department of Internal Medicine, Naval Medical Center San Diego
Arash Michael Saemi, MD is a member of the following medical societies: American College of Physicians, Radiological Society of North America, Sigma Xi, and Society of Interventional Radiology
Disclosure: Nothing to disclose.

Coauthor(s)

Nili N Alai, MD, FAAD, Assistant Clinical Professor, Department of Dermatology, Clinical Faculty and Preceptor, Department of Family Practice, University of California, Irvine; Clinical Faculty and Preceptor, Department of Family Practice Residency Training, Downey Medical Center; Medical Director, The Skin Center at Laguna; Expert Medical Reviewer, Medical Board of California
Nili N Alai, MD, FAAD is a member of the following medical societies: American Academy of Dermatology and American Society for MOHS Surgery
Disclosure: Nothing to disclose.

Medical Editor

James Fulton Jr, MD, PhD, Center for Cosmetic Dermatology; Consultant, Vivant Pharmaceuticals, LLC
James Fulton Jr, MD, PhD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Society for Laser Medicine and Surgery, Dermatology Foundation, International Society of Cosmetic and Laser Surgeons, and Skin Cancer Foundation
Disclosure: vivant pharmaceuticals Ownership interest Consulting

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Genetech Honoraria Consulting; Celgene Honoraria Consulting

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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