eMedicine Specialties > Dermatology > Viral Infections

Viral Hemorrhagic Fevers: Follow-up

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

Follow-up

Further Inpatient Care

  • Patients may require treatment for secondary infections that may arise.
  • Intensive care management may be required for viral hemorrhagic fevers.14

Transfer

  • If hospitals or clinics are not equipped to deal with such infectious diseases, patients should be transferred to facilities with the following:
    • Specialized and skilled staff
    • Appropriate isolation space
    • Sufficient laboratory and testing facilities
  • Patient transfer in infectious disease cases may increase the chances of nosocomial transmission if proper precautions are not taken.

Deterrence/Prevention

  • Prevention involves the following:
    • Avoiding areas with known rodent and arthropod populations, for example, avoiding rodent or insect bites and exposure to an environment contaminated with reservoir excretions or secretions
    • Avoiding contact with potential intermediate hosts, such as livestock or primates
    • Taking safety precautions when coming in contact with potential intermediate hosts, for example, when handling slaughtered livestock or primates for scientific experimentation
    • Preventing nosocomial transmissions by sterilizing equipment, such as needles; decontaminating and disinfecting facilities; isolating patients who are infected; practicing barrier nursing; and implementing safety infectious disease precautions and procedures
    • Avoiding travel to areas known to have viral hemorrhagic fever outbreaks
    • Administering mandatory vaccinations in susceptible populations (including travelers) against all viral hemorrhagic fevers for which a vaccine is available (eg, yellow fever, Argentinian fever) (see Medical Care)
    • Administering postexposure prophylaxis with virus-specific IgG in an attempt to suppress tick-borne flavivirus infections
  • Deterrence involves the eradication of rodent and arthropod vectors.

Complications

  • Rift Valley hemorrhagic fever may lead to blindness in some cases.
  • Individuals who are infected can occasionally have encephalitis due to bunyavirus or flavivirus infections. By the time the patient presents with encephalitis, serum antibody levels are usually detectable.
  • Lassa and Machupo viruses can cause nerve deafness.
  • Multisystem shock leading to death is possible.

Prognosis

  • Survival may be possible with appropriate support care, depending on the virus.

Patient Education

  • Educate travelers and geographically vulnerable groups, especially health care workers, agrarian workers, and rural populations, about the following risks:
    • Transmission via rodent or arthropod bites
    • Potential contamination of food and/or water reservoirs with excretions or secretions
    • Contact with animals that may be intermediate hosts
  • Educate health care workers and others about the detrimental effects of nosocomial transmission and about how such spread can be prevented by implementing infectious disease safety and contact precautions, such as the following:
    • Equipment sterilization
    • Isolation of individuals who are infected
    • Barrier nursing
  • Educate health care workers and others about decontamination procedures, such as the use of hypochlorite or phenolic disinfectants.
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center. In addition, see eMedicine's patient education article Ticks.

Miscellaneous

Medicolegal Pitfalls

  • Although lawsuits are the least of the concerns of hospitals in developing countries, in the United States, nosocomial infections due to lack of safety precautions for the protection of both hospital staff and others are definite invitations for lawsuits.
  • A physician's failure to properly diagnose or refer a traveler who may have contracted one of the various viral hemorrhagic fevers while abroad could result in legal liability.
 


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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References

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  2. Southern PJ. Arenaviridae: the viruses and their replication. In: Fields BN, Knipe DN, Howley PM, et al, eds. Fields Virology. 3rd ed. Philadelphia, Pa: Lippincott-Raven; 1996:1505-19.

  3. Peters CJ, Linthicum KJ. Rift valley fever. In: Handbook of Zoonoses. Boca Raton, Fla: CRC Press; 1994:129-43.

  4. Seo JH, Park KH, Lim JY, Youn HS. Hemorrhagic fever with renal syndrome (HFRS, Korean hemorrhagic fever). Pediatr Nephrol. Jan 2007;22(1):156-7. [Medline].

  5. Feldmann H. Marburg hemorrhagic fever--the forgotten cousin strikes. N Engl J Med. Aug 31 2006;355(9):866-9. [Medline].

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  14. Kothari VM, Karnad DR, Bichile LS. Tropical infections in the ICU. J Assoc Physicians India. Apr 2006;54:291-8. [Medline].

  15. Collier L, Oxford J. Human Virology. 2nd ed. Oxford, England: Oxford University Press; 2000:171-97.

  16. Craighead JE, John E. Pathology and Pathogenesis of Human Viral Disease. San Diego, Calif: Academic Press; 2000:277-93.

  17. Fields BN, Knipe DM. Fundamental Virology. 2nd ed. New York, NY: Raven Press; 1991:19-24.

  18. Gear JH. Clinical aspects of African viral hemorrhagic fevers. Rev Infect Dis. May-Jun 1989;11 Suppl 4:S777-82. [Medline].

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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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