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Viral Hemmorhagic Fevers

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Etiologic Agents
The following agents can all cause viral hemmorhagic fever (VHF)
  • Arenaviradae (Lassa, Junin, Machupo, Guanarito, and Sabia),
  • Filoviradae (Marburg and Ebola),
  • Bunyaviradae (Congo-Crimean hemmorhagic fever virus and hantaviruses)
  • Flaviradae (yellow fever and Dengue)

 

Epidemiology
  • Highly infectious after aerosolization.
  • Infectious dose can be as low as 1-10 organisms.
  • Risk of person-to-person transmission depends on virus.

 

Clinical
  • Incubation period is 4 – 21 days, depending on virus.
    Clinical presentation would vary by viral agent; however, dominant clinical features of all are a consequence of microvascular damage and changes in vascular permeability.
  • Fever, myalgia, and prostration may evolve to shock, generalized mucous membrane hemmor­hage, and neurologic, hematopoietic, or pulmonary involvement.

 

Laboratory Diagnosis
  • Viral isolation should be handled in a Biosafety Level 3 or 4 facility and may take 3 – 10 days.
  • ELISA or reverse transcriptase PCR available for most VHF viruses.

 

Patient Isolation
  • Isolation room with contact precautions.

 

Treatment
  • Ribavirin (30 mg/kg IV x 1, then 15 mg/kg IV q 6 h x 4 days, 7.5 mg/kg IV q 8 x 6 days) may be helpful for Congo-Crimean hemorrhagic fever or arenaviruses.

 

Prophylaxis
  • Licensed vaccine available only for yellow fever.
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