Viral Hemorrhagic Fever: Causes, Symptoms, Treatment and more

Introduction

Distinct families of single-stranded RNA viruses cause viral Haemorrhagic Fever.

These viruses are:

• Arenaviridae

• Filoviridae

• Bunyaviridae 

• Flaviviridae 

Viral hemorrhagic fevers in India are dengue,  Kyasanur forest disease, and Crimean Congo haemorrhagic fever.

Data have confirmed that 1,23,106 dengue cases were identified in India in the year 2021.

There needs to be more awareness of the VHF and ways to prevent them because no vaccination is available. 

What is viral hemorrhagic fever?

Viral Hemorrhagic fever is caused by distinct virus families. Humans are not the natural reservoir of these viruses. 

The natural reservoir of these viruses includes animal and insect hosts.

Human-to-human transmission of Ebola, Marburg and Crimean-Hemorrhagic fever are due to direct contact with infected blood and body fluids. 

According to the Centers for Disease Control and Prevention (CDC), some of these viruses causing Hemorrhagic Fever, like Ebola, Marburg, Lassa, and Junin, are category A bioweapon agents because of their high death rate and ease of person-to-person transmission.

Viral hemorrhagic fevers affect multiple organ systems of the body. The cardiovascular system is damaged, and the body cannot function properly in VHF. No cure or vaccine is available for most of the VHFs.

Some of the important facts about virus causing VHF are:

• These are enveloped RNA viruses.

• Physical and chemical methods like heat, gamma rays, detergents, solvents and bleach can destroy these.

• They exist in animals and insects and are restricted to the area where the host lives.

• The virus spreads to people who come in contact with the infected animal or insect.

• VHF outbreaks are difficult to prevent.

Pathogenesis of Viral Hemorrhagic disease or VHF

The vascular bed is attacked, which causes microvascular damage and changes in vascular permeability. Direct damage to the target organs, inflammation and immune response are involved in the pathogenesis of viral hemorrhagic fever. 

Macrophages release cytokines and chemokines. This alters vascular permeability, triggering DIC (disseminated intravascular coagulation).

This condition affects many organs.

Viral Hemorrhagic fever Symptoms

The symptoms of viral hemorrhagic fever are:

• Nausea

• Vomiting 

• Fever

• Muscle pain

• Joint pain

• Malaise/discomfort

• Weakness 

• Headache 

• Body pain

• Chest pain

• Abdominal pain

• Diarrhea

• Dizziness 

• Photophobia/ sensitivity to light

• Hyperesthesia (increased sensitivity to touch). 

• Flushing of the face and head

• Periorbital edema 

• Retro-orbital pain

• Redness in eyes

• Rashes

• Proteinuria

• Petechiae (a small red spot which appear due to bleeding)

• Bleeding in internal organs

• Bleeding under the skin

• Bleeding from eyes and ears

• Bleeding from the mouth 

• Bleeding from gums

• Low blood pressure

• Shock

Nervous system malfunction like:

• Delirium (confusion) 

• Seizures

• Coma

• Kidney failure

• Liver failure

Diagnosis of viral hemorrhagic fever

The viral hemorrhagic fever diagnosis is confirmed based on:

• Symptoms

• Travel history to the endemic area.

• Laboratory investigations:

Leukopenia: Low number of WBC in brain

Thrombocytopenia: Low platelet count

DIC: Virus causing increased vascular permeability leads to bleeding.

Liver function test: Elevation of ALT (Alanine transaminase) /AST (Aspartate transaminase).

Coagulation studies

Urine culture for bacterial infection

Serological testing 

Cell culture 

Viral hemorrhagic fever treatment

The viral hemorrhagic fever treatment includes:

• Fluid

• Vasopressor

• Specific antiviral therapy

• Management of superadded bacterial infection

• Replacement of clotting factor

• For Lassa virus – Ribavirin, favipiravir and LASV-specific monoclonal antibodies. 

• For Crimean-Congo hemorrhagic fever – Antivirals are given. Those working with animals should use insect repellent. Contact should be strictly avoided with blood and other bodily fluids from infected animals/humans.

• Ebola virus disease and Marburg hemorrhagic fever - Treatment involves supportive care. 

• In Dengue, treatment involves supportive care.

Complications of VHFs

The complications of Viral hemorrhagic fever or VHF include:

• Edema 

• Internal bleeding 

• Breathing complications

• Shock 

• Multiorgan failure

• Death

How to prevent VHFs?

Here are a few important aspects to be considered to prevent VHFs:

Vaccination: Sanofi developed a live attenuated vaccine, “Dengvaxia” which was licensed in 2015. WHO recommends this only for adults with a history of prior dengue virus infection due to potential safety concerns and increased risk of hospitalisation.

India has joined the efforts of vaccine development to develop two dengue vaccine candidates, LAV, TetraVax-DV, licensed from the US NIH to Indian pharmaceutical companies and the other is protein-based tetravalent dengue subunit vaccine, DSV4.

The availability of vaccines is ensured in the near future.

Tips to prevent mosquito bites.

It is important to prevent mosquito bites. “Mosquitoes Bite – Keep them away”

• Use insect repellent

• Wear long sleeve shirts and pants

• Use mosquito net

• Dump standing water

• Screen on door and windows

• Tightly cover water storage containers

• Fill tree holes with foam

• Apply larvicides

• Cut down weeds

• Keep your lawn clean.

Tips for handling rodents

• Avoid contact with rodents.

• Dispose of food that is accessible to rodents.

• Prevent entry of rodents into the house. Use traps.

• Seal up holes and gaps to prevent the entry of rodents.

• Avoid areas infested with rodents like droppings, etc

Prevention of VHFs outbreaks includes

• Isolation 

• Avoid contact with animals, and rodents.

• Avoid tick bites

• Avoid contact with rodent urine and feces

• Avoid contact with infected blood

Take-Home Points

To prevent VHFs, one of the important considerations is to prevent mosquito bites. The article has mentioned ways to prevent mosquito bites.

If you are suffering from dengue, you should take papaya leaf extract along with the treatment to improve your health, and platelets count and reduce hospital stay.

Fruits are an important part of our diet and play an important role in boosting immunity.