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Management of patients with Viral Hemorrhagic Fever (VHF)

By: Dr. D.S. Merchant Introduction:
Viral hemorrhagic fever (VHF) is the illness caused by geographically restricted viruses. Many viruses cause this illness but four viruses including Lassa, Marburg, Ebola, and Crimean-Congo hemorrhagic fever (CCHF) has potential of presenting in outbreak and has potential of person-to-person transmission. Among these four viruses, CCHF is endemic in certain parts of Afghanistan & Northern Pakistan.

In September & October of each year we do get referral of patients with diagnostic possibility of CCHF. Since most physicians have little or no experience with these viruses, uncertainty often arises when VHF is diagnostic possibility.

These guidelines review the clinical and epidemiologic features of CCHF, provide recommendations on diagnosis, investigation, and care of patients, and suggest measures to prevent secondary transmission.

Crimean-Congo Hemorrhagic fever:
CCHF virus is an enveloped, single-stranded Bunyaviridae. Many wild and domestic animals act as reservoirs for the virus, including cattle, sheep, goats, and hares. Ixodid (hard) ticks act both as a reservoir, and vector for CCHF virus.

CCHF is endemic in Eastern Europe, particularly Soviet Union, Northwest China, Central Asia, Indian subcontinent, Middle East and Africa.

Transmission: Humans become infected by being bitten by ticks or by crushing ticks, often while working with domestic animals or livestock. Contact with blood, secretions, or excretions of infected animals or humans may also transmit infection. In endemic areas, the disease may occur most often in the spring or summer.

Nosocomial Transmission is well described in reports from Pakistan, Iraq, Dubai, and South Africa. Available evidence suggests that blood and other body fluids are highly infectious, but simple precautions, such as barrier nursing, effectively prevent secondary transmission.

Clinical Features: The incubation period is about 2-9 days. Initial symptoms include fever, headache, myalgia, arthralgia, abdominal pain & vomiting. Sore throat, conjunctivitis, jaundice, photophobia, and various sensory and mood alterations may develop. A patechial rash is common and may precede a gross and obvious hemorrhagic diathesis.

The estimated case-fatality rate is 15-70%. Symptoms & signs supporting the diagnosis of VHF are pharyngitis, conjunctivitis, and later hemorrhage & shock.

Laboratory features: Deranged LFT, leucopenia, thrombocytopenia, and anemia.

Diagnosis: Suspected on basis of epidemiologic risk factors, clinical features and non-specific laboratory abnormalities. Illness is confirmed by isolating the virus by PCR from blood during the first week of illness or by demonstrating IgM antibody or a fourfold rise in IgG. Antibody may not appear in blood until the second week of illness.

Treatment: Ribavirin 30 mg / kg loading dose then 16 mg/kg q6h x 4 days then 8 mg/kg q6h x 6 days. Supportive care and may require intensive care.

Prophylaxis for high risk contacts is Ribavirin 600 mg po q6 h x 7 days.

Article Source: http://www.lifeweightloss.com

Dr. D.S. Merchant is a Gold Medalist in (Anatomy & Histology)
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