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Key Features

  • Diverse group of illnesses that results from infection with one of several single-stranded RNA viruses (members of the families Arenaviridae, Bunyaviridae, Filoviridae, and Flaviviridae)

  • Dengue, yellow fever, and hantaviruses are discussed separately

  • The likelihood of acquiring hemorrhagic fevers among travelers is low

  • Lassa fever (an Old World arenavirus)

    • Associated with rodents

    • Virus is shed in urine and droppings

    • Transmission occurs to humans either by direct contact with urine and droppings or by ingestion or inhalation of aerosolized particles

  • Lujo virus is another Old World arenavirus first described in a 2008 during nosocomial outbreak

  • Junin virus (cause of Argentine hemorrhagic fever) and other members of the New World Arenaviridae (Machupo virus, Sabia virus, Guanarito virus, Whitewater Arroyo virus) have similar modes of transmission

  • Crimean-Congo hemorrhagic fever

    • Transmitted from ticks and livestock animals

    • Human-to-human transmission can occur in the community or hospital setting by contact with infected body secretions

    • The geographic distribution is widespread with cases reported from Africa, Asia, Middle East, and Eastern Europe, with increased incidence recently in the East Mediterranean region

    • In 2002, Turkey reported the largest outbreak with over 2500 cases and almost 10,000 to date

  • Rift Valley fever

    • Transmitted by exposure to infected animal products or bite of an infected mosquito or other infected insect)

    • Risk factors include

      • Male sex

      • Working with abortive animal tissue

      • Slaughtering, skinning, or sheltering animals

      • Drinking raw milk

    • Outbreaks reported in Africa, Madagascar, and Arabian Peninsula

  • Severe fever with thrombocytopenia syndrome (SFTS)

    • A new bunyavirus, a phlebovirus, associated with fever and thrombocytopenia

    • Identified in 2010 in Central and Northeastern China

    • Differential diagnosis includes anaplasmosis, hemorrhagic fever with renal syndrome, or leptospirosis

    • A mortality of 12% was noted among the first 171 patients

    • Transmission can occur via contact with blood and possibly via aerosol

  • Heartland virus

    • Similar to the SFTS virus

    • Virus appears to be amplified in deer and raccoons

    • Transmission occurs via the Lone Star tick (Amblyomma americanum)

    • Virus appears to be amplified in deer and raccoons

    • As of July 2017, more than 30 cases are reported in states in the Midwestern and southern United States

Clinical Findings

  • Incubation period varies between species, ranging from 2 to 21 days

  • The early phase of a viral hemorrhagic fever is indistinguishable from other viral illnesses

  • Due to lack of specific symptoms on presentation, viral hemorrhagic fevers are an important cause to consider in fever of unknown origin in children in endemic areas

  • The late phase is more specific and is characterized by organ failure, altered mental status, and hemorrhage

  • Exanthems and mucosal lesions can occur

  • In advanced stages of Lassa fever and Lujo virus infection the following can develop:

    • Significant edema

    • Pleural effusion

    • Fewer hemorrhagic manifestations compared to Ebola virus disease

    • Hearing loss in various degrees is most common complication of Lassa fever infection

  • In Crimean-Congo hemorrhagic fever

    • Patients have more prominent hemorrhagic manifestations

    • Red eyes, flushed face, red throat, and petechiae that progress to severe ...

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