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Hemorrhagic Fever – Symptoms and Treatment

Hemorrhagic fever refers to a group of severe viral diseases characterized by high fever and abnormal bleeding. Learn about causes, symptoms, and treatment options.

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Things worth knowing about "Hemorrhagic Fever"

Hemorrhagic fever refers to a group of severe viral diseases characterized by high fever and abnormal bleeding. Learn about causes, symptoms, and treatment options.

What is Hemorrhagic Fever?

Hemorrhagic fever (also: viral hemorrhagic fever, VHF) is a collective term for a group of potentially life-threatening infectious diseases caused by several distinct virus families. The term “hemorrhagic” derives from the Greek word for bleeding and describes the hallmark feature of these illnesses: a pronounced tendency for the body to bleed. These diseases primarily affect people in tropical and subtropical regions of Africa, South America, and Asia.

Causes and Pathogens

Hemorrhagic fevers are caused by various RNA viruses. The most important pathogens belong to the following virus families:

Filoviridae: Ebola virus, Marburg virus
Arenaviridae: Lassa virus, Junin virus (Argentine hemorrhagic fever)
Bunyaviridae / Nairoviridae: Crimean-Congo hemorrhagic fever virus, Hantaviruses
Flaviviridae: Dengue virus, Yellow fever virus

Transmission varies depending on the pathogen and may occur through direct contact with infected blood or body fluids, through animal vectors (e.g., mosquitoes, ticks), or through contact with infected animals (e.g., rodents in Lassa fever).

Symptoms

Clinical signs vary by pathogen, but several features are common across the group:

High fever, often with sudden onset
Severe fatigue and muscle aches
Headache
Nausea, vomiting, and diarrhea
Bleeding signs: Skin hemorrhages (petechiae, ecchymoses), mucosal bleeding, internal bleeding
Organ failure (liver, kidneys) in severe cases
Shock and elevated mortality in advanced disease

The incubation period ranges from 2 to 21 days depending on the virus involved.

Diagnosis

Diagnosis requires a careful travel and exposure history as well as specialized laboratory testing, since these pathogens are highly infectious and must be handled in maximum containment (Biosafety Level 4) laboratories. Key diagnostic methods include:

PCR (Polymerase Chain Reaction): Direct detection of the virus in blood
ELISA: Detection of antibodies or viral antigen
Complete blood count and coagulation parameters to assess disease severity
Liver and kidney function tests

If a hemorrhagic fever is suspected, immediate patient isolation and notification of public health authorities are mandatory.

Treatment

Specific antiviral therapy is available for only a limited number of pathogens:

Ribavirin: Effective against Lassa fever and certain other arenaviruses as well as hantaviruses
Favipiravir and monoclonal antibodies (e.g., Atoltivimab/Maftivimab/Odesivimab): Approved or under investigation for Ebola virus disease
Vaccination: Licensed vaccines exist for yellow fever and Ebola

Otherwise, treatment is primarily supportive: fluid replacement, blood pressure stabilization, management of clotting disorders, and intensive care in severe cases.

Prevention and Protective Measures

Given the limited treatment options for most hemorrhagic fevers, prevention is of paramount importance:

Travel vaccinations (e.g., yellow fever vaccine) before visiting endemic regions
Insect protection (repellents, mosquito nets) in risk areas
Avoiding contact with wild animals and their excretions
Strict use of personal protective equipment (PPE) for healthcare workers
Mandatory disease reporting to public health authorities

References

World Health Organization (WHO): Haemorrhagic fevers, Viral. Fact Sheet. Available at: https://www.who.int (2023)
Robert Koch Institut (RKI): Viral haemorrhagic fevers. RKI Advisory. Available at: https://www.rki.de (2023)
Feldmann H, Geisbert TW. Ebola haemorrhagic fever. Lancet. 2011;377(9768):849-862. doi:10.1016/S0140-6736(10)60667-8

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