Chapter 29: Viral Hemorrhagic Fevers   [open pdf - 56KB]

The VHF agents are a taxonomically diverse group of RNA viruses that cause serious diseases with high morbidity and mortality. Their existence as endemic disease threats or their use in biological warfare could have a formidable impact on unit readiness. Significant human pathogens include the arenaviruses (Lassa, Junin, and Machupo viruses, the agents of Lassa fever and Argentinean and Bolivian hemorrhagic fevers, respectively). Bunyavirus pathogens include RVF virus, the agent of Rift Valley fever; C-CHF virus, the agent of Crimean- Congo hemorrhagic fever; and the hantaviruses. Filovirus pathogens include Marburg and Ebola viruses. The flaviviruses are arthropod-borne viruses and include the agents of yellow fever, dengue, Kyasanur Forest disease, and Omsk hemorrhagic fever. A viral hemorrhagic fever should be suspected in any patient who presents with a severe febrile illness and evidence of vascular involvement (subnormal blood pressure, postural hypotension, petechiae, easy bleeding, flushing of the face and chest, nondependent edema), and who has traveled to an area where the virus is known to occur, or where intelligence suggests a biological warfare threat. Patients with viral hemorrhagic fevers generally benefit from rapid, nontraumatic hospitalization to prevent unnecessary damage to the fragile capillary bed. Aspirin and other antiplatelet or anticlottingfactor drugs should be avoided. Secondary and concomitant infections including malaria should be sought and aggressively treated. The management of bleeding includes administration of fresh frozen plasma, clotting factor concentrates and platelets, and early use of heparin to control DIC. Fluids should be given cautiously, and asanguineous colloid or crystalloid solutions should be used. Multiple organ system support may be required. Ribavirin is an antiviral drug with efficacy for treatment of the arenaviruses and bunyaviruses. Passively administered antibody is also effective in therapy of some viral hemorrhagic fevers. The only licensed vaccine available for VHF agents is for yellow fever. Experimental vaccines exist for Junin, RVF, hantaan, and dengue viruses, but these will not be licensed in the near future.

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Textbook of Military Medicine: Medical Aspects of Chemical and Biological Warfare, p. 591-602
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