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Viral Hemorrhagic Fevers
Surjith Vattoth, MD, FRCR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Viral hemorrhagic fevers (VHFs); hemorrhagic fever (HF)
              • Synonyms

                • Hemorrhagic viral fevers
              • Definitions

                • Zoonotic diseases caused by enveloped RNA viruses
                • Severe multisystem syndrome with characteristic overall vascular system damage & ↓ self-regulating ability of body
                • Symptoms often accompanied by hemorrhage; however, bleeding by itself rarely life-threatening
                • VHFs caused by viruses of 4 families: Arenaviridae, Bunyaviridae, Filoviridae, Flaviviridae
                • Arenaviridae: Lassa (Lassa fever), lymphocytic choriomeningitis, Junin (Argentine HF), Machupo (Bolivian HF), Guanarito (Venezuelan HF), Sabia (Brazilian HF), Chapare (Chapare HF), Lujo (Lujo HF) viruses
                • Bunyaviridae: Hantavirus, Crimean-Congo HF, & Rift Valley fever viruses
                • Filoviridae: Ebola & Marburg viruses
                • Flaviviridae: Dengue, yellow fever, Omsk HF, Kyasanur forest disease (KFD), & Alkhurma HF viruses
                  • Alkhurma HF virus, seen in Saudi Arabia/Egypt, is variant of KFD seen in Karnataka State in India
                • HF viruses highest biosafety level 4 (BSL-4) pathogens
                • VHFs caused by non-BSL-4 viruses are dengue hemorrhagic fever (DHF) & yellow fever
                • Part of 6 dangerous Centers for Disease Control and Prevention (CDC) category A bioterrorism agents
                  • Anthrax, botulism, plague, smallpox, tularemia, VHFs (Filovirus-Ebola, Marburg; Arenavirus-Lassa, Machupo)
                • Infected natural hosts of VHFs do not develop symptoms, but humans can be severely affected
                  • Human immune system crucial role in pathogenesis

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Baruah S et al: Dengue fever presenting with cervicodorsal acute spinal spontaneous subdural hematoma-case report and review of literature. World Neurosurg. 122:272-7, 2019
                                          2. Kutty RK et al: Burden of dengue-related neurosurgical emergencies during an epidemic: a tertiary care experience. Asian J Neurosurg. 14(1):211-8, 2019
                                          3. Viral hemorrhagic fevers (VHFs). Centers for Disease Control and Prevention (CDC) website. https://www.cdc.gov/vhf/index.html. Updated January 29, 2014. Accessed June 6, 2019.
                                          4. Dalugama C et al: Dengue fever complicated with Guillain-Barré syndrome: a case report and review of the literature. J Med Case Rep. 12(1):137, 2018
                                          5. Öztoprak B et al: Is the brain spared in Crimean-Congo haemorrhagic fever? An MR-SWI study to reveal CNS involvement. Eur Radiol. 28(9):3893-901, 2018
                                          6. Bopeththa BVKM et al: Post encephalitic parkinsonism following dengue viral infection. BMC Res Notes. 10(1):655, 2017
                                          7. Florczak-Wyspiańska J et al: Yellow fever vaccine-associated neurotropic disease (YEL-AND) - A case report. Neurol Neurochir Pol. 51(1):101-5, 2017
                                          8. Schönrich G et al: Exploring the immunopathogenesis of viral hemorrhagic fever in mice with a humanized immune system. Front Immunol. 8:1202, 2017
                                          9. Soni BK et al: MRI features in dengue encephalitis: a case series in South Indian tertiary care hospital. Indian J Radiol Imaging. 27(2):125-8, 2017
                                          10. Chertow DS et al: Severe meningoencephalitis in a case of ebola virus disease: a case report. Ann Intern Med. 165(4):301-4, 2016
                                          11. Grahn A et al: Imported case of lassa fever in Sweden with encephalopathy and sensorineural hearing deficit. Open Forum Infect Dis. 3(4):ofw198, 2016
                                          12. Haemorrhagic fevers, Viral. World Health Organization (WHO) website. https://www.who.int/topics/haemorrhagic_fevers_viral/en/. Accessed June 7, 2016.
                                          13. Rebai I et al: Postencephalitic parkinsonism and selective involvement of substantia nigra in childhood. Brain Dev. 37(1):153-7, 2015
                                          14. Karunamoorthi K: Yellow fever encephalitis: an emerging and resurging global public health threat in a changing environment. In Tkachev S et al: Encephalitis. Rijeka: InTech. 207-30, 2013
                                          15. Bui-Mansfield LT et al: Imaging of hemorrhagic fever with renal syndrome: a potential bioterrorism agent of military significance. Mil Med. 176(11):1327-34, 2011
                                          16. Zapata JC et al: Lymphocytic choriomeningitis virus (LCMV) infection of macaques: a model for Lassa fever. Antiviral Res. 92(2):125-38, 2011
                                          17. Jang H et al: Viral parkinsonism. Biochim Biophys Acta. 1792(7):714-21, 2009
                                          18. Alavi-Naini R et al: An unusual intracerebral hemorrhage. Can J Infect Dis Med Microbiol. 15(3):175-7, 2004
                                          19. Slenczka WG: The Marburg virus outbreak of 1967 and subsequent episodes. Curr Top Microbiol Immunol. 235:49-75, 1999
                                          20. Bechtelsheimer H et al: [The "Marburg-virus"-hepatitis. Studies in man and guinea pigs.] Virchows Arch A Pathol Pathol Anat. 351(4):273-90, 1970
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Viral hemorrhagic fevers (VHFs); hemorrhagic fever (HF)
                                                      • Synonyms

                                                        • Hemorrhagic viral fevers
                                                      • Definitions

                                                        • Zoonotic diseases caused by enveloped RNA viruses
                                                        • Severe multisystem syndrome with characteristic overall vascular system damage & ↓ self-regulating ability of body
                                                        • Symptoms often accompanied by hemorrhage; however, bleeding by itself rarely life-threatening
                                                        • VHFs caused by viruses of 4 families: Arenaviridae, Bunyaviridae, Filoviridae, Flaviviridae
                                                        • Arenaviridae: Lassa (Lassa fever), lymphocytic choriomeningitis, Junin (Argentine HF), Machupo (Bolivian HF), Guanarito (Venezuelan HF), Sabia (Brazilian HF), Chapare (Chapare HF), Lujo (Lujo HF) viruses
                                                        • Bunyaviridae: Hantavirus, Crimean-Congo HF, & Rift Valley fever viruses
                                                        • Filoviridae: Ebola & Marburg viruses
                                                        • Flaviviridae: Dengue, yellow fever, Omsk HF, Kyasanur forest disease (KFD), & Alkhurma HF viruses
                                                          • Alkhurma HF virus, seen in Saudi Arabia/Egypt, is variant of KFD seen in Karnataka State in India
                                                        • HF viruses highest biosafety level 4 (BSL-4) pathogens
                                                        • VHFs caused by non-BSL-4 viruses are dengue hemorrhagic fever (DHF) & yellow fever
                                                        • Part of 6 dangerous Centers for Disease Control and Prevention (CDC) category A bioterrorism agents
                                                          • Anthrax, botulism, plague, smallpox, tularemia, VHFs (Filovirus-Ebola, Marburg; Arenavirus-Lassa, Machupo)
                                                        • Infected natural hosts of VHFs do not develop symptoms, but humans can be severely affected
                                                          • Human immune system crucial role in pathogenesis

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Baruah S et al: Dengue fever presenting with cervicodorsal acute spinal spontaneous subdural hematoma-case report and review of literature. World Neurosurg. 122:272-7, 2019
                                                                                  2. Kutty RK et al: Burden of dengue-related neurosurgical emergencies during an epidemic: a tertiary care experience. Asian J Neurosurg. 14(1):211-8, 2019
                                                                                  3. Viral hemorrhagic fevers (VHFs). Centers for Disease Control and Prevention (CDC) website. https://www.cdc.gov/vhf/index.html. Updated January 29, 2014. Accessed June 6, 2019.
                                                                                  4. Dalugama C et al: Dengue fever complicated with Guillain-Barré syndrome: a case report and review of the literature. J Med Case Rep. 12(1):137, 2018
                                                                                  5. Öztoprak B et al: Is the brain spared in Crimean-Congo haemorrhagic fever? An MR-SWI study to reveal CNS involvement. Eur Radiol. 28(9):3893-901, 2018
                                                                                  6. Bopeththa BVKM et al: Post encephalitic parkinsonism following dengue viral infection. BMC Res Notes. 10(1):655, 2017
                                                                                  7. Florczak-Wyspiańska J et al: Yellow fever vaccine-associated neurotropic disease (YEL-AND) - A case report. Neurol Neurochir Pol. 51(1):101-5, 2017
                                                                                  8. Schönrich G et al: Exploring the immunopathogenesis of viral hemorrhagic fever in mice with a humanized immune system. Front Immunol. 8:1202, 2017
                                                                                  9. Soni BK et al: MRI features in dengue encephalitis: a case series in South Indian tertiary care hospital. Indian J Radiol Imaging. 27(2):125-8, 2017
                                                                                  10. Chertow DS et al: Severe meningoencephalitis in a case of ebola virus disease: a case report. Ann Intern Med. 165(4):301-4, 2016
                                                                                  11. Grahn A et al: Imported case of lassa fever in Sweden with encephalopathy and sensorineural hearing deficit. Open Forum Infect Dis. 3(4):ofw198, 2016
                                                                                  12. Haemorrhagic fevers, Viral. World Health Organization (WHO) website. https://www.who.int/topics/haemorrhagic_fevers_viral/en/. Accessed June 7, 2016.
                                                                                  13. Rebai I et al: Postencephalitic parkinsonism and selective involvement of substantia nigra in childhood. Brain Dev. 37(1):153-7, 2015
                                                                                  14. Karunamoorthi K: Yellow fever encephalitis: an emerging and resurging global public health threat in a changing environment. In Tkachev S et al: Encephalitis. Rijeka: InTech. 207-30, 2013
                                                                                  15. Bui-Mansfield LT et al: Imaging of hemorrhagic fever with renal syndrome: a potential bioterrorism agent of military significance. Mil Med. 176(11):1327-34, 2011
                                                                                  16. Zapata JC et al: Lymphocytic choriomeningitis virus (LCMV) infection of macaques: a model for Lassa fever. Antiviral Res. 92(2):125-38, 2011
                                                                                  17. Jang H et al: Viral parkinsonism. Biochim Biophys Acta. 1792(7):714-21, 2009
                                                                                  18. Alavi-Naini R et al: An unusual intracerebral hemorrhage. Can J Infect Dis Med Microbiol. 15(3):175-7, 2004
                                                                                  19. Slenczka WG: The Marburg virus outbreak of 1967 and subsequent episodes. Curr Top Microbiol Immunol. 235:49-75, 1999
                                                                                  20. Bechtelsheimer H et al: [The "Marburg-virus"-hepatitis. Studies in man and guinea pigs.] Virchows Arch A Pathol Pathol Anat. 351(4):273-90, 1970