Marburg hemorrhagic fever differential diagnosis: Difference between revisions
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* [[Hepatitis]] | * [[Hepatitis]] | ||
* Other [[viral hemorrhagic fevers]] | * Other [[viral hemorrhagic fevers]] | ||
{| class="wikitable" | {| class="wikitable" | ||
! rowspan=" | ! rowspan="3" | | ||
! rowspan=" | ! rowspan="3" | | ||
! rowspan="3" |Incubation | |||
! rowspan=" | |||
! colspan=" | Period | ||
! rowspan=" | ! colspan="6" |Symptoms | ||
! rowspan="3" |Laboratory | |||
findings | |||
|- | |- | ||
! | ! colspan="5" |Prodromal phase | ||
! | ! rowspan="2" |Illness phase | ||
|- | |- | ||
!Fever | |||
!Headache | |||
!Myalgia | |||
!Abdominal pain | |||
!Hemorrhage | |||
|- | |||
| rowspan="2" |Filoviruses | |||
|Marburg Hemorrhagic Fever | |Marburg Hemorrhagic Fever | ||
| | |5-10 | ||
| | | + | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | | rowspan="2" | | ||
| | * '''Clinically indistinguishable''' | ||
| | * Maculopapular rash on the trunk (chest, back, stomach) | ||
* Multiorgan failure | |||
| rowspan="2" | | |||
|- | |- | ||
| | |Ebola | ||
|2-21 | |2-21 | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | | + | ||
|- | |- | ||
| | | rowspan="3" |Bunyaviruses | ||
|Crimean-Congo hemorrhagic fever (CCHF) | |||
| | |13 | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | | | ||
* Red eyes, a flushed face, a red throat, and petechiae (red spots) on the palate | |||
* changes in mood and sensory perception. | |||
| | | | ||
|- | |- | ||
| | |Hantavirus Infection | ||
| 9 -33 | |||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |||
| | | | ||
* [[Flushing]] of the face | |||
* [[Conjunctival injection|Injection of the conjunctiva]] | |||
* [[Prostration]] | |||
| | | | ||
|- | |- | ||
| | |Rift Valley fever | ||
|2-6 | |||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |||
| | | | ||
* '''Most commonly mild disease''' with recovery in 2 weeks | |||
* Encephalitis, or inflammation of the brain | |||
* Hemorrhagic fever, which occurs in '''less than''' 1% of overall RVF | |||
| | | | ||
|- | |- | ||
| | | rowspan="3" |Arenaviruses | ||
| | |Lassa fever | ||
| | |7-21 | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | | | ||
* '''Deafness''' | |||
* '''Respiratory distress''' | |||
* Repeated vomiting | |||
* Facial swelling | |||
* Pain in the chest, back, and abdomen, and shock.encephalitis | |||
* Hemorrhage only 20% have severe disease | |||
| | | | ||
|- | |- | ||
| | |Lujo hemorrhagic fever | ||
| 7-13 | |||
| | |||
| | | | ||
| | | | ||
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| | | | ||
| | | | ||
| | |||
* Morbilliform rash of the face and trunk | |||
* '''Face and neck swelling''' | |||
* '''Pharyngitis''' | |||
* Diarrhea | |||
| | | | ||
|- | |- | ||
| | |Lymphocytic choriomeningitis (LCM) | ||
| 8-13 | |||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |||
| | | | ||
* Meningitis, encephalitis, meningoencephalitis | |||
* Acute hydrocephalus | |||
* '''Myocarditis''' | |||
| | | | ||
|- | |- | ||
| | | rowspan="3" |Flaviviruses | ||
|Alkhurma hemorrhagic fever (AFD) | |||
|2-4 | |||
|<nowiki>+</nowiki> | |||
|<nowiki>-</nowiki> | |||
|<nowiki>+</nowiki> | |||
| | |<nowiki>-</nowiki> | ||
| | |<nowiki>-</nowiki> | ||
| | |||
| | |||
|- | |||
| | |||
|- | |||
| | |||
| | | | ||
* Neurologic symptoms | |||
* '''Hemorrhagic symptoms only''' in severe form. | |||
* Multi-organ failure | |||
| | | | ||
* Thrombocytopenia, | |||
* Leukopenia | |||
* Elevated liver enzymes | |||
|- | |- | ||
| | |Kyasanur Forest Disease (KFD) | ||
| | |3-8 | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |<nowiki>+</nowiki> | ||
| | |'''<u>Biphasic</u>''' | ||
* Complete recovery by 2 week | |||
* Wave of symptoms in 3 rd week with '''tremors, and vision deficits.''' | |||
| | | | ||
* Pancytopenia | |||
|- | |- | ||
| | |Omsk hemorrhagic fever | ||
| 3-8 | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+</nowiki> | |||
|<nowiki>+</nowiki> | |||
|'''<u>Biphasic</u>''' | |||
* Complete recovery by 2 week | |||
* Wave of symptoms in 3 rd week with '''encephalitis''' | |||
|- | |||
| | |||
| | |||
| | |||
| | |||
| | |||
| | |||
| | | | ||
* Pancytopenia | |||
|} | |} | ||
Treatment should be based on the most likely etiology of fever according to local [[epidemiology]]. If the [[fever]] continues after 3 days of recommended treatment, and if the patient has [[signs]] such as [[bleeding]] or [[shock]], a viral hemorrhagic fever should be considered. It is important to review the patient’s history for any contact with someone who was ill with [[fever]] and [[bleeding]] or who died from an unexplained [[illness]] with [[fever]] and [[bleeding]]. | Treatment should be based on the most likely etiology of fever according to local [[epidemiology]]. If the [[fever]] continues after 3 days of recommended treatment, and if the patient has [[signs]] such as [[bleeding]] or [[shock]], a viral hemorrhagic fever should be considered. It is important to review the patient’s history for any contact with someone who was ill with [[fever]] and [[bleeding]] or who died from an unexplained [[illness]] with [[fever]] and [[bleeding]]. | ||
Revision as of 16:11, 20 October 2017
Marburg hemorrhagic fever Microchapters |
Differentiating Marburg hemorrhagic fever from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief:
Overview
Differentiating Marburg Hemorrhagic Fever from other Diseases
Marburg hemorrhagic fever must be differentiated from other diseases that may cause fever, abdominal pain, diarrhea, vomiting and bleeding such as:
- Malaria
- Typhoid fever
- Shigellosis
- Cholera
- Leptospirosis
- Plague,
- Rickettsiosis
- Relapsing fever
- Meningitis
- Hepatitis
- Other viral hemorrhagic fevers
Incubation
Period |
Symptoms | Laboratory
findings | |||||||
---|---|---|---|---|---|---|---|---|---|
Prodromal phase | Illness phase | ||||||||
Fever | Headache | Myalgia | Abdominal pain | Hemorrhage | |||||
Filoviruses | Marburg Hemorrhagic Fever | 5-10 | + | + | + | + | + |
|
|
Ebola | 2-21 | + | + | + | + | + | |||
Bunyaviruses | Crimean-Congo hemorrhagic fever (CCHF) | 13 | + | + | + | + | + |
|
|
Hantavirus Infection | 9 -33 | + | + | + | - | + |
|
||
Rift Valley fever | 2-6 | + | - | + | - | - |
|
||
Arenaviruses | Lassa fever | 7-21 | + | + | + | - | - |
|
|
Lujo hemorrhagic fever | 7-13 |
|
|||||||
Lymphocytic choriomeningitis (LCM) | 8-13 | + | + | + | - | - |
|
||
Flaviviruses | Alkhurma hemorrhagic fever (AFD) | 2-4 | + | - | + | - | - |
|
|
Kyasanur Forest Disease (KFD) | 3-8 | + | + | + | + | + | Biphasic
|
| |
Omsk hemorrhagic fever | 3-8 | + | + | + | + | + | Biphasic
|
|
Treatment should be based on the most likely etiology of fever according to local epidemiology. If the fever continues after 3 days of recommended treatment, and if the patient has signs such as bleeding or shock, a viral hemorrhagic fever should be considered. It is important to review the patient’s history for any contact with someone who was ill with fever and bleeding or who died from an unexplained illness with fever and bleeding.
Shown below is a table summarizing the typical findings of the differential diagnoses of MHF.
Disease | Findings |
---|---|
Shigellosis & other bacterial enteric infections | Presents with diarrhea, possibly bloody, accompanied by fever, nausea, and sometimes toxemia, vomiting, cramps, and tenesmus. Stools contain blood and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and blood smears, should be made. Presence of leucocytosis distinguishes bacterial infections. |
Typhoid fever | Presents with fever, headache, rash, gastrointestinal symptoms, with lymphadenopathy, relative bradycardia, cough and leucopenia and sometimes sore throat. Blood and stool culture can demonstrate causative bacteria. |
Malaria | Presents with acute fever, headache and sometime diarrhea (children). Blood smears must be examined for malaria parasites. Presence of parasites does not exclude concurrent viral infection. Antimalarial must be prescribed in an attempt at therapy. |
Lassa fever | Disease onset is usually gradual, with fever, sore throat, cough, pharyngitis, and facial edema in the later stages. Inflammation and exudation of the pharynx and conjunctiva are common. |
Yellow fever and other Flaviviridae | Present with hemorrhagic complications. Epidemiological investigation may reveal a pattern of disease transmission by an insect vector. Virus isolation and serological investigation serves to distinguish these virus. Confirmed history of previous yellow fever vaccination will rule out yellow fever. |
Others | Viral hepatitis, leptospirosis, rheumatic fever, typhus, and mononucleosis produce signs and symptoms that may be confused with Ebola in the early stages of infection. |
Table adapted from WHO Guidelines For Epidemic Preparedness And Response: Ebola Haemorrhagic Fever [1] |