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Two days after returning from a short trip to Venezuala, an otherwise healthy 48-year-old male arrives at your office complaining of fever, chills, nausea, vomiting, malaise, and arthralgias. On exam he was toxic appearing febrile, and you note abdominal tenderness, icterus, and multiple erythematous papular lesions on his lower extremities. Because of his recent tropical travel, you immediately send him by ambulance to the ER. There, staff physicians suspect a case of VHF and contact the local health department. During the course of his deteriorating clinical course in the intensive care unit, the patient developed severe coagulopathy and died. Autopsy revealed necrotic portions of the liver and histologic findings consistent with yellow fever. Yellow fever antigens were noted in blood samples, and the diagnosis was confirmed by PCR. What infection control and decontamination procedures should you have followed? In this case of a febrile individual with a rash and with recent travel abroad, what is your DDX?

Extreme contagiousness, virulence, and mortality rates make VHFs among the most feared diseases of humankind (Fig. 13–1). Since the first documented case of a Marburg in 1967, VHFs have been identified all over the world and have observable naturally occurring outbreaks. No documented use of VHFs as bioweapons has yet occurred; however, it is commonly accepted that the United States, Russia, and probably other governments have successfully developed weaponized versions of VHFs. What is known about the epidemiology, transmission, clinical presentation, and prevention of VHFs is therefore based on naturally occurring epidemics and bioweapons research.

Figure 13–1

Electron micrograph image of Lassa virus.

Courtesy of the CDC.

VHFs are caused by four distinct families of RNA viruses. Filoviridae, which includes Ebola and Marburg viruses; Arenaviridae, which include the etiologic agents of Argentine, Bolivian, and Venezuelan hemorrhagic fevers, Machupo and Lassa fever; Bunyaviridae, which includes the Congo-Crimean hemorrhagic fever virus (CCHFV) and the Rift Valley fever (RVF); and finally, Flaviviridae, which includes dengue and yellow fever viruses. With the important exception of filovirus, whose animal reservoirs are speculative, VHFs are zoonotic.

Table 13–1 Timeline of Ebola and Marburg

Of Note...

September 2004: A Case of Lassa Fever in New Jersey

A businessman returning from ...

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