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Dermatologic Manifestations of Viral Hemorrhagic Fevers Workup

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

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 cell 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.
  • Reverse transcriptase loop-mediated isothermal amplification (RT-LAMP) can be used for the rapid detection of Marburg virus. [46]
  • Reverse-transcription polymerase chain reaction has high sensitivity and specificity to detect the Ebola virus genome. False-negative results may be present in the first 3 days of illness, and repetition of the test may be required. [47]
Next

Other Tests

Electron microscopy of the infected tissue may be helpful.

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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 Genus Type of Hemorrhagic Fever Reservoir Host Geographic 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 VHF Mortality 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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