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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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Rosen, Peter, et al., editors. "Hemorrhagic Fevers." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307270/all/Hemorrhagic_Fevers.
Hemorrhagic Fevers. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307270/all/Hemorrhagic_Fevers. Accessed April 23, 2019.
Hemorrhagic Fevers. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307270/all/Hemorrhagic_Fevers
Hemorrhagic Fevers [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307270/all/Hemorrhagic_Fevers.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hemorrhagic Fevers ID - 307270 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307270/all/Hemorrhagic_Fevers PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -