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| {{DiseaseDisorder infobox |
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| Name = Viral hemorrhagic fever |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| ICD10 = A96-A99 |
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| {{CMG}}
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| {{EH}} | | {{Viral hemorrhagic fever}} |
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| The '''[[Virus|viral]] [[Hemorrhage|hemorrhagic]] [[fever]]s''' ('''VHFs''') are a diverse group of animal and human illnesses that are caused by five distinct families of [[RNA viruses]]: the [[Arenaviridae]], [[Filoviridae]], [[Bunyaviridae]], [[Togaviridae]], and [[Flaviviridae]]. All types of VHF are characterized by fever and bleeding disorders and all can progress to high fever, shock and death in extreme cases. Some of the VHF agents cause relatively mild illnesses, such as the Scandinavian ''[[nephropathia epidemica]]'', whilst others, such as the African [[Ebola virus]], can cause severe, life-threatening disease.
| | {{CMG}}; '''Associate Editor-In-Chief:''' |
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| Also known as:
| | {{SK}} Viral haemorrhagic fever, hemorrhagic fever, haemorrhagic fever, VHF |
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| *[[Crimean-Congo hemorrhagic fever]] ([[CCHF]])
| | ==[[Viral hemorrhagic fever overview|Overview]]== |
| *[[Ebola hemorrhagic fever]]
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| *[[Hantavirus Pulmonary Syndrome]]
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| *[[Hemorrhagic fever with renal syndrome]] ([[HFRS]])
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| *[[Lassa Fever]]
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| *[[Marburg hemorrhagic fever]]
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| ===== References ===== | | ==[[Viral hemorrhagic fever historical perspective|Historical Perspective]]== |
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| http://www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/vhf.htm
| | ==[[Viral hemorrhagic fever pathophysiology|Pathophysiology]]== |
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| http://www.cdc.gov/ncidod/diseases/virlfvr/virlfvr.htm
| | ==[[Viral hemorrhagic fever causes|Causes]]== |
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| ==Etiologic agents== | | ==[[Viral hemorrhagic fever differential diagnosis|Differentiating Viral Hemorrhagic Fever from other Diseases]]== |
| The Arenaviridae include the viruses responsible for [[Lassa fever]] and [[Argentine hemorrhagic fever|Argentine]], [[Bolivian hemorrhagic fever|Bolivian]], and [[Venezuelan hemorrhagic fever]]s. The Bunyaviridae include the members of the ''[[Hantavirus]]'' genus that cause [[hemorrhagic fever with renal syndrome]] (HFRS), the [[Crimean-Congo hemorrhagic fever]] (CCHF) virus from the ''[[Nairovirus]]'' genus, and the [[Rift Valley fever]] (RVF) virus from the ''[[Phlebovirus]]'' genus. The Filoviridae include [[Ebola virus|Ebola]] and [[Marburg virus]]es. Finally, the Flaviviridae include [[dengue]], [[yellow fever]], and two viruses in the [[tick-borne encephalitis]] group that cause VHF: [[Omsk hemorrhagic fever]] virus and [[Kyasanur Forest disease]] virus.
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| ==Clinical and treatment aspects== | | ==[[Viral hemorrhagic fever epidemiology and demographics|Epidemiology and Demographics]]== |
| '''''Signs and symptoms''''' of VHFs include (by definition) [[fever]] and [[bleeding diathesis]]. Manifestations of VHF often also include flushing of the face and chest, [[petechiae]], frank bleeding, [[edema]], [[hypotension]], and shock. Malaise, [[myalgia]]s, headache, vomiting, and diarrhea occur frequently. Definitive diagnosis is usually made at a reference laboratory with advanced [[biocontainment]] capabilities.
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| '''''Medical management''''' of VHF patients may require intensive supportive care. Antiviral therapy with intravenous [[ribavirin]] may be useful in Bunyaviridae and Arenaviridae infections (specifically Lassa fever, RVF, CCHF, and HFRS due to Old World Hantavirus infection) and can be used only under an experimental protocol as a [[US FDA]] approved [[investigational new drug]] (IND). [[Convalescent plasma]] may be effective in Argentine or Bolivian hemorrhagic fevers (also available only as IND). The only licensed vaccine for a VHF is the 17D [[yellow fever vaccine]]. Experimental vaccines for other VHFs are not readily available.
| | ==[[Viral hemorrhagic fever risk factors|Risk Factors]]== |
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| Prophylactic (preventive) ribavirin may be effective for some Bunyaviridae and Arenaviridae infections (again, available only as IND).
| | ==[[Viral hemorrhagic fever natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| '''''VHF isolation''''' guidelines dictate that all VHF patients (with the exception of dengue patients) should be cared for using strict contact precautions, including hand hygiene, double gloves, gowns, shoe and leg coverings, and faceshield or goggles. Lassa, CCHF, Ebola, and Marburg viruses may be particularly prone to nosocomial (hospital-based) spread. Airborne precautions should be utilized including, at a minimum, a fit-tested, HEPA filter-equipped respirator (such as an N-95 mask), a battery-powered, air-purifying respirator, or a positive pressure supplied air respirator to be worn by personnel coming within six feet of a VHF patient. Multiple patients should be cohorted (sequestered) to a separate building or a ward with an isolated air-handling system. Environmental decontamination is typically accomplished with hypochlorite or phenolic disinfectants. <ref >{{cite book|author=Woods, Lt Col Jon B. (ed.)|title=[http://www.usamriid.army.mil/education/bluebookpdf/USAMRIID%20BlueBook%206th%20Edition%20-%20Sep%202006.pdf ''USAMRIID’s Medical Management of Biological Casualties Handbook'']|edition=6th ed.|publisher=[[USAMRIID|U.S. Army Medical Institute of Infectious Diseases]], Fort Detrick, Maryland|year=April 2005|pages = 143-144}}</ref>
| | ==Diagnosis== |
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| ==Pathophysiology==
| | [[Viral hemorrhagic fever history and symptoms|History and Symptoms]] | [[Viral hemorrhagic fever physical examination|Physical Examination]] | [[Viral hemorrhagic fever laboratory findings|Laboratory Findings]] | [[Viral hemorrhagic fever other diagnostic studies|Other Diagnostic Studies]] |
| The diversity of clinical features seen among the VHF infections probably originates from varying mechanisms of pathogenesis. An immunopathogenic mechanism, for example, has been identified for [[dengue hemorrhagic fever]], which usually occurs among patients previously infected with a heterologous dengue serotype. An influential theory explaining this phenomenon is called “antibody-dependent enhancement.” In contrast, [[disseminated intravascular coagulation]] (DIC) is thought to underlie the hemorrhagic features of Rift Valley, Marburg and Ebola fevers. In most VHFs, however, the etiology of the coagulopathy is most likely multifactorial (e.g., hepatic damage, consumptive coagulopathy, primary marrow dysfunction, etc).
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| The reasons for variation among patients infected with the same virus are unknown but stem from a complex system of virus-host interactions. Moreover, why some infected persons develop full-blown VHF while others do not also remains an unresolved issue. Virulence of the infecting agent clearly plays an important role. The “VHF syndrome” (capillary leak, bleeding diathesis and hemodynamic compromise leading to shock) occurs in a majority of patients manifesting disease from filoviruses, CCHF and the South American hemorrhagic fever viruses, while it occurs in a small minority of patients with dengue, RVF and Lassa fever.
| | ==Treatment== |
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| ==Biowarfare/bioterrorism potential==
| | [[Viral hemorrhagic fever medical therapy|Medical Therapy]] | [[Viral hemorrhagic fever primary prevention|Primary Prevention]] | [[Viral hemorrhagic fever secondary prevention|Secondary Prevention]] | [[Viral hemorrhagic fever cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Viral hemorrhagic fever future or investigational therapies|Future or Investigational Therapies]] |
| The VHF viruses are spread in a variety of ways. Some may be transmitted to humans through a respiratory route. Although evidence for a history of “weaponization” (development into a [[biological weapon]]) does not exist for many of these viruses, all are considered by military medical planners to have a potential for aerosol dissemination, weaponization, or likelihood for confusion with similar agents that might be weaponized. <ref >Woods, ''Op. cit., pg 145.</ref>
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| ==Notable VHF outbreaks== | | ==Case Studies== |
| *[[Mékambo]] in [[Gabon]] is the site of several outbreaks of [[Ebola]] hemorrhagic fever.
| | [[Viral hemorrhagic fever case study one|Case #1]] |
| *[[Orientale, Congo]] villages of Durba and Watsa were the epicenter of the 1998–2000 outbreak of Marburg hemorrhagic fever.
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| *[[Uige Province]] in [[Angola]] is the site of world's worst haemorrhagic fever [[epidemic]], which occurred in [[2005]].
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| * The ongoing VHF outbreak in the village of [[Mweka, Democratic Republic of the Congo]] (DRC) that started in August, 2007, and that has killed 103 people (100 adults and three children), has been shown to be caused (at least partially) by the [[Ebola]] virus.
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| *Some experts believe that the [[Black Death]] of the [[Middle Ages]] may have been caused by a VHF and not by the [[bubonic plague]].<ref>"Black Death did not kill indiscriminately." January 29, 2008, Will Dunham. Reuters.</ref>
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| ==See also== | | ==Related Chapters== |
| *[[Biological agent]] | | *[[Biological agent]] |
| *[[Biopreparat]] | | *[[Biopreparat]] |
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| *[[List of viruses]] | | *[[List of viruses]] |
| *Dr. [[Matthew Lukwiya]] (1957-2000) | | *Dr. [[Matthew Lukwiya]] (1957-2000) |
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| ==Sources==
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| {{reflist}}
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| *[http://www.hpa.org.uk/infections/topics_az/VHF/menu.htm Health Protection Agency]
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| *''This article includes information that originally came from US Government publications and websites and is in the public domain.''
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| {{Viral diseases}} | | {{Viral diseases}} |
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| | [[Category:Disease]] |
| [[Category:Viral diseases]] | | [[Category:Viral diseases]] |
| [[Category:Hemorrhagic fevers]] | | [[Category:Hemorrhagic fevers]] |
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| [[de:Hämorrhagisches Fieber]] | | [[de:Hämorrhagisches Fieber]] |
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| [[es:Fiebre hemorrágica viral]] | | [[es:Fiebre hemorrágica viral]] |
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| [[eu:Sukar hemorragiko]] | | [[eu:Sukar hemorragiko]] |
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| [[fr:Fièvre hémorragique virale]] | | [[fr:Fièvre hémorragique virale]] |
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| [[ja:出血熱]] | | [[ja:出血熱]] |
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| [[pl:Gorączka krwotoczna]] | | [[pl:Gorączka krwotoczna]] |
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| [[ru:Геморрагическая лихорадка]] | | [[ru:Геморрагическая лихорадка]] |
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| [[sl:Virusna hemoragična mrzlica]] | | [[sl:Virusna hemoragična mrzlica]] |
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| [[fi:Verenvuotokuume]] | | [[fi:Verenvuotokuume]] |
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| [[sv:Blödarfeber]] | | [[sv:Blödarfeber]] |
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| [[vi:Sốt xuất huyết]] | | [[vi:Sốt xuất huyết]] |
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| {{WH}} | | {{WH}} |
| {{WS}} | | {{WS}} |
| {{jb1}}
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