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Viral hemorrhagic fever is a severe, sometimes fatal, multisystem syndrome characterized by diffuse vascular damage and dysregulation; hemorrhage does not necessarily occur; when it does, it is rarely a sufficient cause for demise. The etiologic agents of this syndrome are zoonotic, lipid-enveloped ribonucleic acid (RNA) viruses and include dozens of members from 4 families of viruses: arenaviruses, bunyaviruses, filoviruses, and flaviviruses (Table 307-1). These agents are localized geographically and are associated with specific vector hosts or reservoirs,1-5 although imported cases and infections caused by laboratory accidents and nosocomial transmission can occur outside their respective ranges.6 The diseases they cause are either endemic or episodic with both annual cycles and longer secular trends. Some are associated with high lethality and potential for person-to-person transmission. The challenges for clinicians evaluating suspect cases are to exclude more likely conditions that are potentially life-threatening and treatable (especially malaria and typhoid fever); narrow the differential diagnosis based on the travel history; institute appropriate precautions for the diseases in the narrowed differential that are associated with person-to-person transmission; and seek expert guidance for diagnostic confirmation and treatment guidelines.

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Table 307-1. Features of Viral Hemorrhagic Fevers

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