Pediatric Viral Hemorrhagic Fevers Workup

Updated: Apr 02, 2018
  • Author: Martha L Muller, MD; Chief Editor: Russell W Steele, MD  more...
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Workup

Laboratory Studies

Characteristic hematologic abnormalities in viral hemorrhagic fever (VHF):

  • Leukopenia

  • Leukocytosis

  • Thrombocytopenia

  • Hemoconcentration

  • Occasionally, disseminated intravascular coagulation

Elevated hepatocellular enzyme levels and hypoalbuminemia are typically present.

Proteinuria is a universal finding.

Enzyme-linked immunosorbent assays for virus-specific immunoglobulin M (IgM) and immunoglobulin G (IgG) are the best serologic tests for etiologic diagnosis because of their sensitivity, although antibody may not be detected during the acute stages of Marburg and Ebola virus infections. [37]

Direct examination of blood and tissues (eg, skin biopsies) for viral antigen by enzyme immunoassay and for virions by electron microscopy are specific and sensitive.

Polymerase chain reaction (PCR) on serum during the acute stages of infection has been successfully applied for viral hemorrhagic fever. [38] It is usually more sensitive but also more subject to artifact and contamination than more established methodologies.

Viral cultures of blood and tissues have been performed at the Centers for Disease Control and Prevention.

Recently, MassTag PCR has been applied to the differential diagnosis of these illnesses. Further, panels for real-time PCR identification of filoviruses, arenaviruses, and New World hantaviruses have been developed. [39]

Various assays for CCHF have been evaluated. [40]

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Procedures

Skin biopsy may provide material for electron microscopy or immunoassay.

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