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Viral Hemorrhagic Fever – Causes, Symptoms & Treatment

Viral hemorrhagic fever (VHF) refers to a group of severe infectious diseases caused by various viruses that can lead to life-threatening bleeding disorders and organ failure.

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Things worth knowing about "Viral hemorrhagic fever"

Viral hemorrhagic fever (VHF) refers to a group of severe infectious diseases caused by various viruses that can lead to life-threatening bleeding disorders and organ failure.

What is viral hemorrhagic fever?

Viral hemorrhagic fever (VHF) is an umbrella term for a group of severe, often life-threatening viral diseases caused by viruses from several different families. The hallmark features are high fever, pronounced bleeding tendencies, and damage to internal organs. The best-known pathogens include the Ebola virus, the Marburg virus, the Lassa virus, and the viruses responsible for dengue fever and yellow fever.

Causes and transmission

VHF diseases are caused by RNA viruses belonging to four distinct virus families:

Filoviridae: Ebola virus, Marburg virus
Arenaviridae: Lassa virus, Junin virus
Bunyaviridae: Hantavirus, Crimean-Congo hemorrhagic fever virus
Flaviviridae: Dengue virus, yellow fever virus

Transmission routes vary depending on the pathogen:

Direct contact with infected blood or body fluids (e.g., Ebola, Marburg)
Insect bites, particularly from mosquitoes or ticks (e.g., dengue fever, yellow fever, Crimean-Congo fever)
Contact with infected rodents or their excretions (e.g., Lassa fever, hantavirus)

Symptoms

The illness typically begins with non-specific symptoms that can rapidly worsen:

High fever, chills
Severe headache, muscle aches, and joint pain
General weakness and fatigue
Vomiting, diarrhea, abdominal pain
Skin rash
In advanced stages: bleeding from mucous membranes, internal bleeding, and organ failure

Not all patients develop prominent bleeding signs. The severity of the course depends strongly on the pathogen and the immune status of the affected individual.

Diagnosis

Diagnosis requires specialized laboratory methods, as VHF diseases are clinically difficult to distinguish from other febrile illnesses:

PCR tests (polymerase chain reaction) to detect viral genetic material
ELISA tests to detect pathogen-specific antibodies or antigens
Blood count analysis: thrombocytopenia (low platelet count), leukopenia (low white blood cell count)
Liver and kidney function tests to assess organ damage

Diagnostics must be carried out in specialized laboratories under maximum biosafety conditions (biosafety level 4, BSL-4).

Treatment

Specific approved therapies exist only for a few VHF pathogens. Management is primarily symptomatic and supportive:

Stabilization of fluid and electrolyte balance through intravenous infusions
Management of bleeding disorders (e.g., transfusion of blood products)
Intensive care monitoring in severe cases
Antiviral medications: Ribavirin for Lassa fever and certain other VHF pathogens; Remdesivir and monoclonal antibodies (e.g., atoltivimab/maftivimab/odesivimab) for Ebola virus disease
Vaccination: approved vaccines exist for yellow fever (highly effective) and Ebola (rVSV-ZEBOV-GP, Ervebo®)

Prevention and infection control

Due to the high risk of contagion, strict isolation and hygiene measures apply:

Strict isolation of infected patients in specialist high-level isolation units
Use of personal protective equipment (PPE) by healthcare workers
Protection against mosquitoes and ticks in endemic areas (repellents, protective clothing, mosquito nets)
Avoiding contact with wild animals and rodents in risk areas
Travel vaccinations (e.g., yellow fever) before visiting endemic regions

References

World Health Organization (WHO): Haemorrhagic fevers, Viral. Fact Sheet. Available at: https://www.who.int/news-room/fact-sheets (2024)
Robert Koch Institute (RKI): Viral haemorrhagic fevers – RKI Advisory. Available at: https://www.rki.de (2023)
Feldmann H, Sprecher A, Geisbert TW: Ebola. New England Journal of Medicine, 382:1832–1842 (2020)

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