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Dermatologic Manifestations of Viral Hemorrhagic Fevers Follow-up

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

Further Inpatient Care

Patients may require treatment for secondary infections that may arise. Intensive care management may be required for viral hemorrhagic fevers.[54]

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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.

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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.

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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. Patients may develop bacterial sepsis or respiratory failure from fluid resuscitation. Multisystem shock leading to death is possible.

In a study analyzing 277 survivors of the Ebola epidemic in Sierra Leone, clinical sequelae were noted and include arthralgia in 76% of patients, new ocular symptoms in 60% of cases, uveitis in 18% of patients, and auditory symptoms in 24% of cases.[55] A higher viral load at time of presentation was significantly associated with uveitis and with the development of new ocular symptoms. Late-onset encephalitis, alopecia, paraesthesia, depression or anxiety, and polyarthritis were also reported.[56, 57]

Severe rhabdomyolysis, acute kidney injury, and immune thrombocytopenia are complications reported following dengue virus infection.[58, 59, 60]

In Crimean-Congo hemorrhagic fever (CCHF), cardiac hypokinesia, pericardial effusion, T-wave changes, myocardial involvement, and bundle-branch block are complications reported.[61]

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Prognosis

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

Table 2. Viral Hemorrhagic Fever Mortality Rates (Open Table in a new window)

Virus Family and Type of VHFMortality Rate, %
Arenaviridae



Argentinian and Bolivian



Lassa (West African)



Venezuelan and Sao Paulo



 



10-30



30-40



33



Bunyaviridae



Korean and Seoul



Rift Valley



Congo-Crimean



HPS



 



5-15



1



10-50



15-50



Flaviviridae



Yellow



Dengue



 



< 1



5



Filoviridae



Marburg



Ebola



 



23-25



25-100



The estimated case fatality rate for the recent Ebola outbreak was 76.4%. The proportion of total deaths in Guinea, Sierra Leone, and Liberia was 21.6%, 35.8%, and 42.5%, respectively. The highest risk of dying was among healthcare workers in areas with intense transmission and countries with insufficient bed capacities. Other factors that enhanced the spread and magnitude of this outbreak were the insufficient enforcement of public health regulations and deplorable healthcare delivery infrastructure in war-ravaged regions.[62]  In the recent Ebola virus disease outbreak in Sierra Leone, it was found that chest pain, symptoms of confusion, coma and viral load greater than 106 copies/mL were significantly associated with a poor prognosis. Viral load was the most important factor that affected the survival of patients from the disease.[63]

A total of 278 human cases were confirmed with Rift Valley fever in the recent outbreak in South Africa in 2010-2011, with 25 deaths.

Children can develop dengue hemorrhagic shock syndrome (DHSS), a complication with a mortality rate of 4-12%.

 

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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 patient education resources, see the Bites and Stings Center, as well as Ticks.

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Contributor Information and Disclosures
Author

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.

Coauthor(s)

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.

Acknowledgements

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
Arenaviridae



Guanarito



Junin



Machupo



Lassa



Sabia



 



Venezuelan



Argentinian



Bolivian



Lassa (West Africa)



Brazilian or Sao Paulo



 



Rodents



 



Venezuela



Argentina



Bolivia



West Africa



Brazil



Bunyaviridae



Nairovirus



Phlebovirus



Hantaan virus



 



Crimean-Congo



Rift Valley



Korean



HPS



 



Ticks



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



Flaviviridae



Flavivirus



Flavivirus



Flavivirus



Flavivirus



 



Yellow



Dengue



Chikungunya



Omsk



 



Mosquito



Mosquito



Mosquito



Tick



 



Tropical Africa, South America



Entire tropical zone



India, Southeast Asia



Siberia



Filoviridae



Marburg



Ebola



 



Marburg



Ebola



 



Infected monkeys were implicated but no known definite reservoir



 



Africa



West Africa



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



Argentinian and Bolivian



Lassa (West African)



Venezuelan and Sao Paulo



 



10-30



30-40



33



Bunyaviridae



Korean and Seoul



Rift Valley



Congo-Crimean



HPS



 



5-15



1



10-50



15-50



Flaviviridae



Yellow



Dengue



 



< 1



5



Filoviridae



Marburg



Ebola



 



23-25



25-100



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