Viral hemorrhagic fever

Viral hemorrhagic fever (e.g., Ebola) Flu-like symptoms, internal bleeding 2 to 21 days... 

It is a hantavirus that produces a viral hemorrhagic fever. It is normally found in Central and Eastern Asia. The natural reservoir is the striped field mouse (Apodemus agrarius) and the virus is shed in their urine. Infection occurs after inhalation of dust contaminated with excreta from infected mice or from aerosol of animal blood or fluids. Does not produce disease in animals. This is a biosafety level 3 agent. 

It is a viral hemorrhagic fever normally found in South Asia. The natural reservoirs are ticks, monkeys, rodents, and porcupines. Ticks remain infective for life. This is a biosafety level 4 agent. 

Suggested Alternatives for Differential Diagnosis Leptospirosis, malaria, salmonella infection, lupus, typhoid fever, shigellosis, meningococcemia, yellow fever and other viral hemorrhagic fevers, rickettsial infections, thrombocytopenic purpura, acute leukemia, disseminated intravascular coagulation, hemolytic uremic syndrome. 

A single case of disease by an uncommon agent (smallpox, some viral hemorrhagic fevers)... 

Guides for Emergency Response Biological Agent or Weapon Viral Hemorrhagic Fevers (VHFs)... 

Differential Diagnosis Thrombocytopenia (a condition in which there is an abnormally small number of platelets in the circulating blood) and an elevated aspartate aminotransferase (AST) may provide a clue to suggest CCHF is the culprit in the febrile (denoting or relating to fever) patient seen early in the course of infection. Other viral hemorrhagic fevers, meningococcemia, rickettsial diseases, and similar conditions may resemble full-... 

Caution With some noteworthy exceptions, there is no cure or established drug treatment for viral hemorrhagic fever. All the VHF agents, except for dengue fever, are infectious by aerosol in the laboratory. 

For prevention of some types of viral hemorrhagic fevers, there is pre-exposure prophylaxis in the form of yellow fever vaccinations, and some vaccines are available as IND... 

Isolation Control The U.S. Centers for Disease Control and Prevention (CDC), and the World Health Organization, have produced a manual, Infection Control for Viral Hemorrhagic Fevers in the African Health Care Setting. The manual is available at the CDC Web site http //www.cdc.gov/ncidod/dvrd/spb/mnpages/vhfmanual.htm and can be downloaded. Factors covered in this lengthy manual are include ... 

Biological Agents BACTERIA (Anthrax, Brucellosis, Cholera, Plague, Tularemia). VIRUSES (Crimean-Congo Hemorrhagic Fever, Rift Valley Fever, Smallpox, Venezuelan Equine Encephalitis (VEE), Viral Hemorrhagic Fever (Ebola)). TOXINS (Botulinum, Ricin, Staphylococcal Enterotoxin B (SEB), Trichothecene Mycotoxins/T-2). 

Ribavirin An antiviral drug used in treatment of viral hemorrhagic fevers. 

Draws lessons from case studies involving chlorine gas, anthrax, ricin, viral hemorrhagic fevers, and more... 

Disease caused Other viral hemorrhagic fevers... 

Rift Valley fever is characterized by high fever and the development of hemorrhagic areas under the skin. Only a small number of cases (<1%) go on to develop the more serious viral hemorrhagic fever syndrome that causes death in 50% of those who manifest this syndrome. The syndrome is associated with mucosal bleeding or hemorrhaging, liver and kidney failure, and shock before death. Some infections can be complicated with encephalitis and a variety of ocular defects.3... 

Treatment — As with all viral hemorrhagic fevers, supportive therapy must be given, dependent on the complications experienced by patients. Treatment would be intravenous ribavarin for 4 to 6 days. While no human studies to date verify the efficacy of this treatment, cell and rodent studies attest to its efficacy. An effective inactivated vaccine that can be administered in three doses is available. Protective antibodies appear before 14 days and last 1 year. Annual boosters must be given.3... 

Hemorrhagic areas under skin Fewer than 1% develop more serious viral hemorrhagic fever syndrome leading to mucosal bleeding, liver and kidney failure, and shock before death... 

Second we have the issne of bioterrorism. There are many other potential threats smallpox, anthrax, tularemia, plague, a family of viral hemorrhagic fevers, among others. In addition, there are a limitless number of virulent bacteria that might be constructed employing the modem techniqnes of genetic engineering. 

Intravenous ribavirin decreases mortality in patients with Lassa fever and other viral hemorrhagic fevers if started early. High concentrations inhibit West Nile virus in vitro, but clinical data are lacking. Clinical benefit has been reported in cases of severe measles pneumonitis and certain encephalitides, and continuous infusion of ribavirin has decreased virus shedding in several patients with severe lower respiratory tract influenza or parainfluenza infections. At steady state, cerebrospinal fluid levels are about 70% of those in plasma. 

Centers for Disease Control and Prevention (CDC). (1995). Update Management of patients with suspected viral hemorrhagic fever—United States. Morbidity and Mortality Weekly Report, 44, 475-479. 

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