CBRNE - Viral Hemorrhagic Fevers Follow-up

  • Author: David C Pigott, MD, RDMS, FACEP; Chief Editor: Robert G Darling, MD, FACEP   more...
 
Updated: Apr 18, 2011
 

Further Inpatient Care

  • Hospitalize patients with suspected or confirmed viral hemorrhagic fever (VHF) infection because of the significant risk for nosocomial spread of the infection.
  • Notification of local and state public health departments and CDC may provide resources for further epidemiologic investigation into the source of the infection.
  • Appropriate barrier precautions should remain in place throughout the hospital course because of the highly pathogenic nature of viral hemorrhagic fever infection and because various causes of viral hemorrhagic fever often are clinically indistinguishable.
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Deterrence/Prevention

  • As the natural reservoirs for Ebola and Marburg virus infection remain unknown, no specific prevention measures are established. Recent studies have suggested that contact with fruits bats may be responsible for some cases of filovirus infection.
  • Efforts are underway in West Africa to educate people in high-risk areas about ways to decrease rodent populations, thereby reducing transmission of Lassa fever.
  • Strict barrier precautions in the treatment of patients with known or suspected viral hemorrhagic fever infection reduce nosocomial transmission.
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Complications

  • Complications from viral hemorrhagic fever (VHF) infection include retinitis, orchitis, encephalitis, hepatitis, transverse myelitis, and uveitis.
  • In patients who recover from Lassa fever infection, deafness is the most common complication. Spontaneous abortion also is common.
  • Renal insufficiency is associated with HFRS infection.
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Patient Education

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Contributor Information and Disclosures
Author

David C Pigott, MD, RDMS, FACEP  Associate Professor of Emergency Medicine, Co-Director of Emergency Ultrasound, Vice Chair for Academic Development, Associate Scientist, UAB Center for Emerging Infections and Emergency Preparedness, University of Alabama School of Medicine

David C Pigott, MD, RDMS, FACEP is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Jerry L Mothershead, MD  Medical Readiness Consultant, Medical Readiness and Response Group, Battelle Memorial Institute; Advisor, Technical Advisory Committee, Emergency Management Strategic Healthcare Group, Veteran's Health Administration; Adjunct Associate Professor, Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences

Jerry L Mothershead, MD is a member of the following medical societies: American College of Emergency Physicians and National Association of EMS Physicians

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Robert G Darling, MD, FACEP  Adjunct Clinical Assistant Professor of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine; Associate Director, Center for Disaster and Humanitarian Assistance Medicine

Robert G Darling, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, American Telemedicine Association, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Thomas W McGovern, MD, to the development and writing of this article.

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Ebola virus. Electron micrograph courtesy of the Centers for Disease Control and Prevention.
Marburg virus. Negative stain image courtesy of the Centers for Disease Control and Prevention.
Mastomys rodent, natural host of Lassa virus. Image courtesy of the Centers for Disease Control and Prevention.
Bunyavirus infection. Ecchymoses encompassing left upper extremity one week after onset of CCHF. Ecchymoses often are accompanied by hemorrhage in other locations: epistaxis, puncture sites, hematemesis, melena, and hematuria. Image provided by Robert Swaneopoel, PhD, DTVM, MRCVS, National Institute of Virology, Sandringham, South Africa.
Apodemus agrarius, the vector of Korean hemorrhagic fever caused by a hantavirus. Photo courtesy of David McClain, MD.
Bunyavirus infection - Hantaan virus. Patient with Korean hemorrhagic fever caused by Hantaan virus demonstrating typical 'sunburn flush' of cheeks, chin, and base of neck. Photo courtesy of John Huggins, PhD.
Bunyavirus infection. A patient with Korean hemorrhagic fever demonstrating conjunctival hemorrhages, facial petechiae, and "sunburn flush" of the cheeks. Photo courtesy of John Huggins, PhD.
Filovirus disease - Ebola fever. Patient with Ebola hemorrhagic fever during 1976 outbreak in Zaire demonstrating palatal petechiae and hemorrhage. Photo courtesy of Joel Breman.
Patient with morbilliform exanthem of dengue fever. Note islands of sparing characteristics for dengue. Photo courtesy Duane Gubler, PhD.
Patient with dengue hemorrhagic fever complicated by ecchymoses. Photo courtesy of Duane Gubler, PhD.
Table. Viral Families Causing Viral Hemorrhagic Fever
Virus FamilyDisease (Virus)Natural DistributionUsual Source of Human InfectionIncubation (Days)
Arenaviridae
ArenavirusLassa feverAfricaRodent5-16
Argentine HF (Junin)South AmericaRodent7-14
Bolivian HF (Machupo)South AmericaRodent9-15
Brazilian HF (Sabia)South AmericaRodent7-14
Venezuelan HF (Guanarito)South AmericaRodent7-14
Bunyaviridae
PhlebovirusRift Valley feverAfricaMosquito2-5
NairovirusCrimean-Congo HFEurope, Asia, AfricaTick3-12
HantavirusHemorrhagic fever with renal syndrome, hantavirus pulmonary syndromeAsia, Europe, worldwideRodent9-35
Filoviridae
FilovirusMarburg and EbolaAfricaUnknown3-16
Flaviviridae
FlavivirusYellow feverTropical Africa, South AmericaMosquito3-6
Dengue HFAsia, Americas, AfricaMosquitoUnknown for dengue HF, 3-5 for dengue
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