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Dermatologic Manifestations of Viral Hemorrhagic Fevers Differential Diagnoses

  • Author: Amira M Elbendary, MBBCh, MSc; Chief Editor: William D James, MD  more...
Updated: Feb 05, 2016

Diagnostic Considerations

Other considerations include the following:

  • 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

Differential Diagnoses

Contributor Information and Disclosures

Amira M Elbendary, MBBCh, MSc Visiting Research Fellow, Ackerman Academy of Dermatopathology; Teaching Assistant, Department of Dermatology, Kasr Alainy University Hospital, Cairo University, Egypt

Amira M Elbendary, MBBCh, MSc is a member of the following medical societies: Medical Dermatology Society, Bloom’s Syndrome Association, Egyptian Medical Syndicate, International Dermoscopy Society

Disclosure: Nothing to disclose.


Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey P Callen, MD Professor of Medicine (Dermatology), 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, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: XOMA; Biogen/IDEC; Novartis; Janssen Biotech, Abbvie, CSL pharma<br/>Received honoraria from UpToDate for author/editor; Received honoraria from JAMA Dermatology for associate editor and intermittent author; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for i inherited these trust accounts; for: Celgene; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble; Amgen.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.


Ally N Alai, MD, FAAD Former Professor, Department of Dermatology, Clinical Faculty and Preceptor, Department of Family Practice, University of California, Irvine, School of Medicine; Former Professor 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; Expert Consultant, California Department of Consumer Affairs; Expert Reviewer, California Department of Registered Nursing

Ally 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.

Eiman N Anvari, DO, MSc Resident Physician, Department of Radiology, Philadelphia College of Osteopathic Medicine

Eiman N Anvari, DO, MSc is a member of the following medical societies: American College of Physicians, American Medical Student Association/Foundation, and American Osteopathic Association

Disclosure: Nothing to disclose.

Arash M Saemi, MD Resident Physician, Department of Radiology, Dartmouth-Hitchcock Medical Center

Arash M 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.

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Table 1. Geographic Distribution of Viral Hemorrhagic Fevers
Virus Family and GenusType of Hemorrhagic FeverReservoir HostGeographic Distribution










Lassa (West Africa)

Brazilian or Sao Paulo







West Africa





Hantaan virus



Rift Valley





Mosquito and contact with infected blood in slaughter houses

Contact with infected rodents and their excreta

Crimea, Central Africa, South Africa, Iraq, Pakistan, Turkey, Iran, Afghanistan, Russia

Africa, Egypt

Korea, Eastern Europe, Russia, Scandinavia

North, Central, and South America

















Tropical Africa, South America

Entire tropical zone

India, Southeast Asia









Infected monkeys were implicated but no known definite reservoir



West Africa

Table 2. Viral Hemorrhagic Fever Mortality Rates
Virus Family and Type of VHFMortality Rate, %

Argentinian and Bolivian

Lassa (West African)

Venezuelan and Sao Paulo






Korean and Seoul

Rift Valley












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