Hemorrhagic Fevers

Hemorrhagic Fevers is a topic covered in the 5-Minute Emergency Consult.

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Hemorrhagic fever describes a multisystem syndrome of vasocapillary permeability and/or organ dysfunction. Viral hemorrhagic fever (VHF) is caused by a distinct group of viruses, but the initial phase resembles influenza-like illness. Hemorrhagic stages typify the minority of patients and the later phases of disease.

Risk Factors

  • Travel in endemic region
  • Biologic warfare
  • Close animal contact, insect bite or ingestion


  • VHF causes endothelial damage and increase vascular permeability, hemorrhage, and may proceed to shock
  • VHF shock state is both hypovolemic and distributive, and is often very difficult to reverse. Hypotension can progress swiftly, and indicates very high mortality.
  • DIC appears to be a regular feature of Marburg and Crimean-Congo hemorrhagic fever but is less frequent with Arenavirus infections.
  • Dengue hemorrhagic fever is immune mediated and is usually the result of secondary infection. It is among the most common causes for VHF.


  • RNA viruses that have zoonotic life cycles in specific geographic areas
  • Short incubation period (<10–21 days)
  • More common VHF vectors:
    • Filoviruses: Fruit bat reservoir, unclear mode of transmission (sub-Saharan Africa)
      • Ebola
      • Marburg
    • Arenaviruses: Rodent reservoir, aerosolized rodent excreta (sub-Saharan Africa).
      • Lassa
      • South American hemorrhagic fevers
    • Flaviviruses: Human reservoir, via mosquito (tropics, increasingly worldwide)
      • Dengue (common cause of VHF)
      • Yellow fever
    • Bunyaviridae: Rodent reservoir, via tick or mosquito (Europe, South Asia, Africa)
      • Rift Valley fever
      • Crimean-Congo hemorrhagic fever
    • Hantaviridae: Rodent reservoir, aerosolized rodent excreta (Southwest USA)
      • Hemorrhagic fever with renal syndrome
      • Hantavirus pulmonary syndrome

  • Potential biowarfare threat:
    • Aerosols (with exception of dengue) and body fluids highly infectious
    • High morbidity/mortality in some cases
    • Replicate well in cell culture, permitting weaponization

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