Dermatologic Manifestations of Viral Hemorrhagic Fevers Treatment & Management

Updated: May 21, 2018
  • Author: Amira M Elbendary, MBBCh, MSc; Chief Editor: William D James, MD  more...
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Treatment

Medical Care

Supportive care

Rapidly transfer the patient to a hospital with minimal trauma in order to prevent trauma to the fragile capillary bed.

The judicious use of sedative, pain-relieving, and amnesic medications can be helpful in managing malaise, confusion, myalgia, and hyperesthesia. Intramuscular injections and the use of aspirin and other anticoagulant drugs should be avoided.

Adequate hydration reduces the death rate, and oral rehydration may not be adequate.

Intensive supportive care is necessary for most cases of viral hemorrhagic fever. General supportive care principles apply to the treatment of hemodynamic, hematologic, pulmonary, and neurologic manifestations of viral hemorrhagic fever. Supportive care entails maintaining the patient's oxygen status and blood pressure and balancing fluid and electrolyte levels. Blood, platelet, and plasma replacement and management can be crucial, depending on the case. Convalescent plasma infusions may be effective in Argentinian hemorrhagic fever, if they are administered within the first 8 days of onset.

In Dengue fever, for which the main pathology is capillary leakage, brisk infusion with crystalloids should be instituted, followed by colloids or albumin if there is no response.

In Hantavirus infection, acute renal failure recovery may be accompanied by severe polyuria that should be managed carefully with close observation of fluid balance and electrolytes values.

Antiviral therapy with ribavirin may be useful in several viral hemorrhagic fevers, especially those caused by Arenaviruses. Although ribavirin inhibits viral DNA and RNA synthesis, it is not sensitive to the replication mechanisms of all RNA viruses. Ribavirin is proven effective in the treatment of Lassa fever and Congo-Crimean hemorrhagic fever. [66] It is somewhat effective in the treatment of other arenavirus and Hantavirus infections, in which it decreases mortality rates when used early in the course of the disease. Additionally, discovery of compounds with antiflaviviral activity have shown promise. Currently, several ribavirin analogues are undergoing clinical trials. [67]

Interferon-alfa has shown promising results in Arenaviral infections in vitro as an adjunctive therapy with ribavirin. [68]

Transfer

Patients may require treatment for secondary infections that may arise. Intensive care management may be required for viral hemorrhagic fevers. [69]

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.

Vaccination

Vaccination may be considered. The only approved vaccine is for yellow fever. The WHO Strategic Advisory Group recommends a single primary dose for most travelers; a booster dose of the vaccine is no longer required, as the vaccine was found to confer sustained immunity and lifelong protection against yellow fever disease. [70]

Nonapproved vaccines include that developed for Argentinian viral hemorrhagic fever. This vaccine is a live-attenuated, investigational vaccine. It also seems to offer protection against Bolivian viral hemorrhagic fever. Both inactivated and live-attenuated vaccines for RVF are under investigation. [71] No vaccines are currently available for filovirus infection or dengue. Preliminary results suggest potential for successful prevaccination and postvaccination exposure against Ebola and Marburg viruses. [13, 72, 73]

Caregiver exposure

Persons percutaneously or mucocutaneously exposed to blood, excretions, or secretions of individuals who are infected should wash the affected areas with soap and water. Affected mucous membranes should be irrigated with water or sodium chloride solution.

Further reading

Additional information is available from the Centers for Disease Control and Prevention. See Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting and Questions and Answers on Ebola.

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Consultations

Consultation with the following specialists may be warranted:

  • Infectious disease specialist

  • Hematologist

  • Pathologist

  • Internal medicine specialist

  • Other specialists as necessary

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Diet

Fluid and electrolyte balance should be maintained.

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Activity

Malaise and myalgia, among other symptoms, dictate bed rest restrictions.

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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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