CBRNE - Viral Hemorrhagic Fevers Workup
- Author: David C Pigott, MD; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD more...
Because of risks associated with handling infectious materials, perform the minimum necessary laboratory testing for diagnostic evaluation and patient care. Considerations in ordering lab tests are as follows:
A complete blood count often indicates leukopenia and thrombocytopenia (these findings may not be present in Lassa fever)
Elevated hepatic transaminases are observed in viral hemorrhagic fever (VHF) and are predictive of high mortality in Lassa fever infection
Prothrombin time, activated partial thromboplastin time, international normalized ratio, and clotting times are prolonged.
A disseminated intravascular coagulation profile including fibrinogen level, fibrin degradation products, and platelet count may be useful
Most patients are viremic at the time of presentation (Hantavirus is an exception). Specific viral diagnosis can be made using serologic tests, including enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction. Difficult cases may require tissue cultures. During the 2000-2001 Ebola outbreak in Uganda, reverse transcriptase-PCR (RT-PCR) emerged as a very effective means for detecting Ebola virus in patient serum, plasma, and whole blood.
Because of the need for specialized microbiologic containment and handling of these viruses, initiate contact with the Centers for Disease Control and Prevention (CDC; Atlanta, GA) as soon as possible and prior to transport of specimens for virus-specific diagnosis. Specific state and federal statutes govern the shipment of highly infectious disease agents.
The CDC and the US Army Medical Research Institute for Infectious Diseases (USAMRIID; Frederick, MD) are among the 8 Biosafety Level 4 (BSL-4) laboratory facilities in the US with such diagnostic facilities. At least seven more are under construction.
Report all suspected cases of viral hemorrhagic fever (VHF) immediately to local and state public health departments and to the CDC.
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|Virus Family||Disease (Virus)||Natural Distribution||Usual Source of Human Infection||Incubation (Days)|
|Argentine HF (Junin)||South America||Rodent||7-14|
|Bolivian HF (Machupo)||South America||Rodent||9-15|
|Brazilian HF (Sabia)||South America||Rodent||7-14|
|Venezuelan HF (Guanarito)||South America||Rodent||7-14|
|Phlebovirus||Rift Valley fever||Africa||Mosquito||2-5|
|Nairovirus||Crimean-Congo HF||Europe, Asia, Africa||Tick||3-12|
|Hantavirus||Hemorrhagic fever with renal syndrome, hantavirus pulmonary syndrome||Asia, Europe, worldwide||Rodent||9-35|
|Filovirus||Marburg and Ebola||Africa||Fruit bat||3-16|
|Flavivirus||Yellow fever||Tropical Africa, South America||Mosquito||3-6|
|Dengue HF||Asia, Americas, Africa||Mosquito||Unknown for dengue HF, 3-5 for dengue|