Viruses causing viral hemorrhagic fever (VHF) are highly infectious by the aerosol route, cause high morbidity, and are easily grown in cell culture. RNA viruses causing Ebola and Marburg (filoviruses), Lassa, Argentine, Bolivian, Venezuelan, Brazilian, Rift Valley, and Congo-Crimean hemmorhagic fevers are felt to be possible threats. Common to all these illnesses is an acute febrile illness, characterized by malaise, prostration, and signs of vascular permeability. Findings of conjunctival injection, hypotension, flushing, petechial hemorrhages, and mucous membrane, neurologic, pulmonary, and hematopoietic involvement are seen. Some unique differences among these agents exist. Lassa fever, for example, is characterized by fewer hemorrhagic and neurologic complications. RVF classically presents with retinitis and hepatitis. Congo-Crimean hemorrhagic fever and Marburg/Ebola may cause profound DIC and hemorrhage. The diagnosis is made at a diagnostic laboratory with highest level (BL-4) containment possible (USAMRIID or CDC) using ELISA, reverse transcriptase polymerase chain reaction, cell culture, or the characteristic "shepherd's crook" appearance of the filoviruses on electron microscopy. Treatment involves supportive care, blood product replacement, and convalescent plasma for AHF. Ribavirin may be considered if within 7 days of symptom onset but is not effective against the filoviruses.
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