Fever, hemorrhagic A94

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 23.02.2023

Synonym(s)

Haemorrhagic fever; Hemorrhagic Fever

Definition
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A group of highly contagious, febrile infectious diseases, usually caused by viruses and accompanied by bleeding in the skin and mucous membranes, which are often fatal.

Classification
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Hemorrhagic fevers are caused by viruses, some of which are related to each other. These include:

Flaviviridae family:
- Yellow fever
- Dengue fever
- Omsk fe ver (OHF)
- Kyasanur-Forest disease
Family of Bunyaviridae:
- Togaviridae family
- Chikungunya fever
Arenaviridae family:
- Lassa fever
- Argentine hemorrhagic fever (Junin)
- Bolivian he morrhagic fever (Machupo)
- Venezuelan he morrhagic fever (Guanarito)
- Brazilian hemorrhagic fever (Sabia).
Filoviridae family:
- Ebola disease
- Marburg virus disease.

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Occurrence/Epidemiology
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The pathogens are not native to Central Europe and North America. They usually originate from Africa, South America or South East Asia and are introduced by migrants or travellers who have become infected abroad. The pathogens originally come from animals (pets, rodents, monkeys) and are usually transmitted to humans by mosquitoes and ticks. Lassa fever is also transmitted by contact with infected animal excrement.

Manifestation
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The time between infection and outbreak of the disease is usually about one week, but the incubation period can be between 2 and 21 days in the case of Ebola. During the incubation period they are not transmitted to other people, but as soon as the disease breaks out it can - depending on the type of disease - be transmitted to other people by droplet infection or blood contact rarely or very often.

Clinical features
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Accommodation/General: High fever (> 38.5 °C), liver and kidney dysfunction, also edema. These oedemas can occur both as internal bleeding and as bleeding in the tissue (petechiae or flat bleeding), caused by so-called capillary leakage. In many cases, stool and urine are also bloody. Shock, circulatory collapse, cramps and paralysis are not uncommon.

Integument: conjunctival hyperemia, periorbital oedema, erythema of skin and mucous membranes on the face, neck, chest, palate, pharynx, tendency to gum and petechial bleeding.

Diagnosis
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It is not possible to clearly identify these diseases by their symptoms. Virological examinations are absolutely necessary. Procedure: In case of suspicion blood tests by specialized institutes, e.g. the Robert Koch Institute in Berlin or the Bernhard Nocht Institute for Tropical Medicine in Hamburg.

Therapy
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There are hardly any successful drug treatments for most haemorrhagic fevers, only a vaccination against yellow fever exists. Prevention through insect repellent is most helpful.

Prophylaxis
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Most hemorrhagic fevers are dangerous to life-threatening. Since they are also infectious and there is a risk of infection, the German Infection Protection Act (IfSG) stipulates a general obligation to report diagnosed diseases or deaths caused by viral haemorrhagic fever. A quarantine may also be necessary.