Dermatologic Manifestations of Viral Hemorrhagic Fevers Follow-up
- Author: Amira M Elbendary, MBBCh, MSc; Chief Editor: William D James, MD more...
Further Inpatient Care
Patients may require treatment for secondary infections that may arise. Intensive care management may be required for viral hemorrhagic fevers.
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.
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.
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. 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.
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 VHF||Mortality Rate, %|
Argentinian and Bolivian
Lassa (West African)
Venezuelan and Sao Paulo
Korean and Seoul
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. 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.
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%.
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.
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|Virus Family and Genus||Type of Hemorrhagic Fever||Reservoir Host||Geographic Distribution|
Lassa (West Africa)
Brazilian or Sao Paulo
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|
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
|Virus Family and Type of VHF||Mortality Rate, %|
Argentinian and Bolivian
Lassa (West African)
Venezuelan and Sao Paulo
Korean and Seoul