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Chapter 302: Viral Hemorrhagic Fevers

Amy S. Arrington

INTRODUCTION

Viral hemorrhagic fevers (VHFs) are a diverse group of diseases and include dozens of viruses (Table 302-1). 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.

TABLE 302-1FEATURES OF VIRAL HEMORRHAGIC FEVERS
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TABLE 302-1FEATURES OF VIRAL HEMORRHAGIC FEVERS
Family Virus Disease Geographic Region Epidemiologic Distribution Incubation Period (days) Reservoir/Vector
Arenaviridae Junina Argentine hemorrhagic fever Argentina Pampas Rural 7–16 Rodent: Calomys callosus
Machupoa Bolivian hemorrhagic fever Beni Department, Bolivia Rural 7–16 Rodent: Calomys musculinus
Guanarito Venezuelan hemorrhagic fever Guanarito municipality of Portuguesa State and adjacent regions of Barinas State, Venezuela Rural 7–14 Rodent: Zygodontomys brevicauda
Sabía Sabía-associated hemorrhagic fever Sao Paulo State, Brazil Unknown; presumed rural 8  
Lassaa Lassa fever Nigeria, Sierra Leone, Liberia, Guinea Rural 2–21 Rodent: Matomys species
Lymphocytic choriomeningitis virus Lymphocytic choriomeningitis (LCM) Widespread (domestic, abroad) Rural 8–13 Rodent: Mus domesticus
Bunyaviridae Hantaan and related viruses Hemorrhagic fever with renal syndrome Asia Europe (rare in Africa and the Americas) Rural, urban Rattus-associated disease, and laboratory-acquired 4–42 Rodents: arvicoline and murine genus
Sin Nombre and related viruses (Andesa) Hantavirus pulmonary syndrome Americas Rural 4–35 Rodents: Sigmodontine genus
Crimean-Congo hemorrhagic fevera Crimean-Congo hemorrhagic fever Africa, Asia, southern Europe Rural; contacts with ticks, domestic animals 2–7 Ticks: Hyalomma species
Rift Valley fever Rift Valley fever Africa Rural; contact with mosquitoes, domestic animals 2–7 Mosquito: Aedes species
Filoviridae Marburga Marburg hemorrhagic fever Sub-Saharan Africa Rural 3–16 Cave-dwelling bats (probable)
Ebolaa Ebola hemorrhagic fever Tropical forests, Africa (all strains except Ebola-Reston from Philippines) Rural 3–21 Forest-dwelling bats (probable)
Cuevavirus          
Flaviviridae Dengue Dengue fever, dengue hemorrhagic fever, dengue shock syndrome Africa, Americas (excluding the northern and southern extremes) Urban 4–7 Mosquito: Aedes aegypti, Aedes albopictus
Yellow fever Yellow fever Africa, South America Rural, urban 3–6 Mosquito: Aedes aegypti, other Aedes species
Omsk hemorrhagic fever Omsk hemorrhagic fever Western Siberia Rural agriculture, winter (muskrat and other rodent transmission) 2–4 Tick: Dermacentor species
Kyasanur Forest disease Kyasanur Forest disease Karnataka State, India Rural; forests 2–7 Tick: Haemaphysalis species

aDocumented nosocomial transmission.

PATHOGENESIS AND EPIDEMIOLOGY

The etiologic agents of this syndrome are lipid-enveloped ribonucleic acid (RNA) viruses and include dozens of members from 4 families of viruses: arenaviruses, filoviruses, bunyaviruses, and flaviviruses. All are zoonotic infections and reside in animal reservoirs or insect vectors as opposed to humans, although ...

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