CBRNE - Viral Hemorrhagic Fevers Workup

Updated: Mar 31, 2021
  • Author: David C Pigott, MD, RDMS, FACEP; Chief Editor: Zygmunt F Dembek, PhD, MS, MPH, LHD  more...
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Approach Considerations

Most patients with viral hemorrhagic fever (VHF) 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 (PCR). Difficult cases may require viral isolation in tissue culture.

Following the 2014 West Africa Ebola outbreak, reverse transcriptase PCR (RT-PCR) emerged as the most common method for detecting Ebola virus in patient serum, plasma, and whole blood. Novel antigen-capture ELISA techniques have also been developed in response to this outbreak.

Real-time reverse-transcription polymerase chain reaction (RT-PCR) remains the gold standard for quantitative, sensitive, and specific detection of Crimean-Congo hemorrhagic fever (CCHF) virus; however, these assays have sensitivity issues due to the genetic diversity of different CCHF viral strains. [1]

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 10 Biosafety Level 4 (BSL-4) laboratory facilities in the US with such diagnostic facilities.

Report all suspected cases of VHF immediately to local and state public health departments and to the CDC.


Laboratory Studies

Because of risks associated with handling infectious materials, perform the minimum necessary laboratory testing for diagnostic evaluation and patient care.

A complete blood count often indicates leukopenia and thrombocytopenia (these findings may not be present in Lassa fever). Significant electrolyte and metabolic disturbances have been reported in the recent Ebola virus disease outbreak, including hypokalemia, hypocalcemia, hyponatremia, elevated creatinine and elevated anion gap acidosis. [24]  

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.