Advertisement

Viral Hemorrhagic Fevers

  • Thomas W. Geisbert
  • Aileen M. Marty
  • Peter B. Jahrling
Chapter

Abstract

A 15-year-old European boy, who had been in Kenya for 1 month, was admitted to the hospital with a 3-day history of headache, malaise, anorexia, fever, and vomiting. Throughout the course of the illness, he developed copious bloody diarrhea, hypotension, leukocytosis, thrombocytopenia, and prolonged prothrombin and partial thromboplastin times consistent with disseminated intravascular coagulation (DIC). Despite intensive supportive therapy, which included antibiotics, steroids, heparin, fresh plasma, and blood transfusions, his condition steadily deteriorated, and he died on the 11th day of illness. Based on the characteristic clinical picture, provisional diagnoses were either viral hemorrhagic fever or, less likely, typhoid fever with “extreme toxicity.” An autopsy was performed soon after death. Postmortem examination showed extensive petechial and purpuric hemorrhage in the skin, conjunctiva, and gastrointestinal mucosa. Blood-tinged pleural, pericardial, and peritoneal effusions were copious, and retroperitoneal edema was striking. The lungs and tracheobronchial tree were hemorrhagic. Multiple petechial hemorrhages were observed on the epicardium, renal cortex and pelvis, and urinary bladder. Marburg virus was isolated from fluids and tissues and was identified in tissues by immunohistochemistry, electron microscopy, and immunoelectron microscopy (1).

Keywords

Disseminate Intravascular Coagulation Yellow Fever Viral Hemorrhagic Fever Hemorrhagic Fever With Renal Syndrome Rift Valley Fever 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Geisbert TW, Jaax NK. Marburg hemorrhagic fever: report of a case studied by immunohistochemistry and electron microscopy. Ultrastruct Pathol 1998;22:3–17.PubMedCrossRefGoogle Scholar
  2. 2.
    Jahrling PB. Viral hemorrhagic fevers. In: Sidell FR, Takafuji ET, Franz DR, eds. Textbook of Military Medicine: Medical Aspects of Chemical and Biologic Warfare. Borden Institute, Washington, DC, 1997, pp. 591–603.Google Scholar
  3. 3.
    Jahrling PB, Geisbert TW, Dalgard DW, et al. Preliminary report: isolation of Ebola virus from monkeys imported to the USA. Lancet 1990;335:502–505.PubMedCrossRefGoogle Scholar
  4. 4.
    Centers for Disease Control and Prevention. Category A agents. Available at: http://www.bt.cdc.gov/Agent/agentlist.asp (accessed November 18,2002).
  5. 5.
    Williams P, Wallace D. Unit 731, Japan’s Secret Biological Warfare in World War II. Free Press, New York, 1989, pp. 38–40.Google Scholar
  6. 6.
    Alibek K, Handelman S. Biohazard: The Chilling True Story of the Largest Covert Biological Weapons Program in the World. Told from the Inside by the Man Who Ran It. Random House, New York, 1999.Google Scholar
  7. 7.
    Center for Nonproliferation Studies. Chemical and biological weapons: possession and programs past and present. November 2000. Available at: http://cns.miis.edu/research/cbw/possess.htm (accessed November 18,2002).Google Scholar
  8. 8.
    Miller J, Engelberg S, Broad WJ. Germs: Biological Weapons and America’s Secret War. Simon & Schuster, Waterville, ME, 2001.Google Scholar
  9. 9.
    Bazhutin NB, Belanov EF, Spiridonov VA, et al. Vliianie sposobov eksperimental’ nogo zarazheniia virusom Marburg naosobennosti protekaniia bolezni u zelenykh martyshek (Russian) [The effect of the methods for producing an experimental Marburg virus infection on the characteristics of the course of the disease in green monkeys.] Vopr Virusol 1992;37:153–156.PubMedGoogle Scholar
  10. 10.
    P’yankov OV, Sergeev AN, P’yankova OG, Chepurnov AA. Eksperimental’ naia likhoradka ebola u makak rezusov (Russian) [Experimental Ebola fever in macaca rhesus.] Vopr Virusol 1995;40:113–115.Google Scholar
  11. 11.
    Johnson E, Jaax N, White J, Jahrling P. Lethal experimental infections of rhesus monkeys by aerosolized Ebola virus. Int J Exp Pathol 1995;76:227–236.PubMedGoogle Scholar
  12. 12.
    Lub MI, Sergeev AN, P’iankov OV, P’iankova OG, Petrishchenko VA, Kotlyarov LA. Nekotorye patogeneticheskie kharakteristiki zabolevaniia obez’ian, aerogenno infitsirovannykh virusom Marburg. (Russian) [Certain pathogenetic characteristics of a disease in monkeys infected with the Marburg virus by an airborne route.] Vopr Virusol 1995;40:158–161.PubMedGoogle Scholar
  13. 13.
    Stephenson EH, Larsen EW, Dominik JW. Effect of environmental factors on aerosol-induced Lassa virus infection. J Med Virol 1984;14:295–303.PubMedCrossRefGoogle Scholar
  14. 14.
    Kenyon RH, McKee KT, Zack PM, et al. Aerosol infection of rhesus macaques with Junin virus. Intervirology 1992;33:23–31.PubMedGoogle Scholar
  15. 15.
    Global Proliferation of Weapons of Mass Destruction: Hearings Before the Permanent Subcommittee on Investigations of the Committee on Governmental Affairs, United States Senate, 104th Congress, 1st2nd Session (1996). Available at http://www.fas.org/irp/congress/1995_rpt/aum/part0.5.htm (accessed on November 19,2002).
  16. 16.
    Federation of American Scientists. Chemical and Biological Arms Control Program. Weapons of Mass Destruction Around the World. Report on North Korea. Biological Systems. Available at http://www.fas.org/nuke/guide/dprk/bw/index.html (accessed November 20,2002).
  17. 17.
    Borio L, Inglesby T, Peters CJ, et al., and The Working Group on Civilian Biodefense. Hemorrhagic fever viruses as biological weapons. JAMA 2002;287:2391–2405. Available at http://jama.ama-assn.org/issues/v287n18/ffull/jst20006.html (accessed November 20,2002).PubMedCrossRefGoogle Scholar
  18. 18.
    Peters CJ, Jahrling PB, Khan AS. Patients infected with high-hazard viruses. Arch Virol 1996; 11(suppl):141–168.Google Scholar
  19. 19.
    McCormick JB, Webb PA, Krebbs JW, Johnson KM, Smith E. A prospective study of epidemiology and ecology of Lassa fever. J Infect Dis 1987;155:437–444.PubMedCrossRefGoogle Scholar
  20. 20.
    Birmingham K, Kenyon G. Lassa fever is unheralded problem in West Africa. Nat Med 2001;7:878.PubMedCrossRefGoogle Scholar
  21. 21.
    Freedman DO, Woodall J. Emerging infectious diseases and risk to the traveler. Med Clin North Am 1999;83:865–883.PubMedGoogle Scholar
  22. 22.
    Schmitz H, Kohler B, Laue T, et al. Monitoring of clinical and laboratory data in two cases of imported Lassa fever. Microbes Infect 2002;4:43–50.PubMedCrossRefGoogle Scholar
  23. 23.
    Maiztegui J, Feuillade M, Briggiler A. Progessive extension of the endemic area and changing incidence of Argentine hemorrhagic fever. Med Microbiol Immunol 1986;175:149–152.PubMedCrossRefGoogle Scholar
  24. 24.
    Johnson KM, Wiebenga NH, Mackenzie RB, et al. Virus isolations from human cases of hemorrhagic fever in Bolivia. Proc Soc Exp Biol Med 1965;118:113–118.PubMedGoogle Scholar
  25. 25.
    Salas R, de Manzione N, Tesh RB, et al. Venezuelan haemorrhagic fever. Lancet 1991;338:1033–1036.PubMedCrossRefGoogle Scholar
  26. 26.
    Lisieux T, Coimbra M, Nassar ES, et al. New arenavirus isolated in Brazil. Lancet 1994;343:391–392.PubMedCrossRefGoogle Scholar
  27. 27.
    Centers for Disease Control and Prevention. Fatal illness associated with a new world arenavirusCalifornia. MMWR 2000;49:709–711. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4931a1.htm (accessed 19 November 2002).Google Scholar
  28. 28.
    Easterday BC. Rift Valley fever. Adv Vet Sci 1965;10:65–127.PubMedGoogle Scholar
  29. 29.
    Daubney R, Hudson JR, Garnham PC. Enzootic hepatitis or Rift Valley fever. An undescribed virus disease of sheep, cattle and man from East Africa. J Pathol Bacteriol 1931;34:545–579.CrossRefGoogle Scholar
  30. 30.
    Shawky S. Rift Valley fever. Saudi Med J 2000;21:1109–1115.PubMedGoogle Scholar
  31. 31.
    van Eeden PJ, van Eeden, SF, Joubert JR, King JB, van de Wal BW, Michell WL. A nosocomial outbreak of Crimean-Congo haemorrhagic fever at Tygerberg Hospital, II: Management of patients. S Afr Med J 1985;68:718–721.PubMedGoogle Scholar
  32. 32.
    Nuzum EO, Rossi CA, Stephenson EH, LeDuc JW. Aerosol transmission of Hantaan and related viruses to laboratory rats. Am J Trop Med Hyg 1988;38:636.PubMedGoogle Scholar
  33. 33.
    Lee HW. Hemorrhagic fever with renal syndrome in Korea. Rev Infect Dis 1989;11(suppl 4):S864–5876.PubMedCrossRefGoogle Scholar
  34. 34.
    Butler CJ, Peters CJ. Hantaviruses and hantavirus pulmonary syndrome. Clin Infect Dis 1994;19:387–395.PubMedCrossRefGoogle Scholar
  35. 35.
    Peters CJ, Khan AS. Hantavirus pulmonary syndrome: the new American hemorrhagic fever. Clin Infect Dis 2002;34:1224–1231.PubMedCrossRefGoogle Scholar
  36. 36.
    Martini GA, Siegert R. Marburg Virus Disease. Springer-Verlag, Berlin, 1971.Google Scholar
  37. 37.
    Zeller H. Les leçons de l’ épidémie a virus Marburg a Durba, République Démocratique du Congo (1998–2000). (French) [Lessons from the Marburg virus epidemic in Durba, Democratic Republic of the Congo (1998–2000). Med Tron (Mars) 2000:60(suppll): 23–26Google Scholar
  38. 38.
    World Health Organization International Study Team. Ebola haemorrhagic fever in Zaire, 1976. Bull WHO 1978:56:271–293.Google Scholar
  39. 39.
    World Health Organization International Study Team. Ebola haemorrhagic fever in Sudan, 1976. Bull WHO 1978;56:247–270.Google Scholar
  40. 40.
    Khan AS, Tshioko FK, Heymann DL, et al. The reemergence of Ebola hemorrhagic fever, Democratic Republic of the Congo, 1995. J Infect Dis 1995;179(suppl 1):S76–S86.CrossRefGoogle Scholar
  41. 41.
    Georges-Courbot MC, Sanchez A, Lu CY, et al. Isolation and phylogenetic characterization of Ebola viruses causing different outbreaks in Gabon. Emerg Infect Dis 1997:3:59–62.PubMedCrossRefGoogle Scholar
  42. 42.
    Centers for Disease Control and Prevention. Outbreak of Ebola hemorrhagic fever Uganda, August 2000-January 2001. MMWR 2001;50:73–77. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5005al.htm (accessed on 19 November 2002).Google Scholar
  43. 43.
    Le Guenno B, Formenty P, Wyers M, Gounon P, Walker F, Boesch C. Isolation and partial characterization of a new strain of Ebola virus. Lancet 1995;345:1271–1274.PubMedCrossRefGoogle Scholar
  44. 44.
    Monath TP. Yellow fever: Victor Victoria? Conqueror, conquest? Epidemics and research in the last forty years and prospects for the future. Am J Trop Med Hyg 1991;45:1–43.PubMedGoogle Scholar
  45. 45.
    Pavri K. Clinical, clinicopathological, and hematologic features of Kyasanur Forest disease. Rev Infect Dis 1989;11(suppl 4):S854–S859.PubMedCrossRefGoogle Scholar
  46. 46.
    Chumakov MR Studies of virus hemorrhagic fevers. J Hyg Epidemiol Microbiol Immunol 1959; 7:125–135.Google Scholar
  47. 47.
    Halstead SB. Antibody, macrophages, dengue virus infection, shock, and hemorrhage: a pathogenetic cascade. Rev Infect Dis 1989;11(suppl 4):S830–S839.PubMedCrossRefGoogle Scholar
  48. 48.
    McKay DG, Margaretten W. Disseminated intravascular coagulation in virus diseases. Arch Intern Med 1967;120:129–152.PubMedCrossRefGoogle Scholar
  49. 49.
    WHO Collaborating Centre for Research and Training in Veterinary Epidemiology and Management. Report of the WHO/IZSTE Consultation on Recent Developments in Rift Valley Fever (RVF) (With the Participation of FAO and OIE). 1993;128:1–23. Civitella del Tronto, Italy, 14–15 September, 1993. WHO/CDS/VPH/93.123.Google Scholar
  50. 50.
    Rosen L. Disease exacerbation caused by sequential dengue infections: myth or reality? Rev Infect Dis 1989;11(suppl 4):S840–S842.PubMedCrossRefGoogle Scholar
  51. 51.
    Centers for Disease Control and Prevention, National Institutes of Health. Biosafety in Microbiology and Biomedical Laboratories. Government Printing Office, Washington, DC, 1993. HHS Publication (CDC) 93–8395. Also available at: http://www.orcbs.msu.edu/biological/BMBL/BMBL-1.htm. (accessed November 18,2002).Google Scholar
  52. 52.
    van der Groen G, Elliot LH. Use of betapropiolactone inactivated Ebola, Marburg and Lassa intracellular antigens in immunofluorescent antibody assay. Ann Soc Belg Med Trop 1982;62:49–54.PubMedGoogle Scholar
  53. 53.
    Trappier SG, Contay AL, Farrar BB, Auperin DD, McCormick JB, Fisher-Hoch SP. Evaluation for the polymerase chain reaction for diagnosis of Lassa virus infection. Am J Trop Med Hyg 1993;49:214–221.PubMedGoogle Scholar
  54. 54.
    Ksiazek TG, Rollin PE, Jahrling PB, Dalgard DW, Peters CJ. Enzyme immunosorbent assay for Ebola virus antigens in tissues of infected primates. J Clin Microbiol 1992:30:947–950.PubMedGoogle Scholar
  55. 55.
    Leroy EM, Baize S, Lu CY, et al. Diagnosis of Ebola hemorrhagic fever by RT-PCR in an epidemic setting. J Med Virol 2000;60:463–467.PubMedCrossRefGoogle Scholar
  56. 56.
    Drosten C, Gottig S, Schilling S, et al. Rapid detection and quantification of RNA of Ebola and Marburg viruses, Lassa virus, Crimean-Congo hemorrhagic fever virus, Rift Valley fever virus, dengue virus, and yellow fever virus by real-time reverse transcription-PCR. J Clin Microbiol 2002;40:2323–2330. Available to members at: http://jcm.asm.org/cgi/content/ful1/40/7/2323?view=full&pmid=12089242 (accessed 19 November, 2002).PubMedCrossRefGoogle Scholar
  57. 57.
    Geisbert TW, Rhoderick JB, Jahrling PB. Rapid identification of Ebola and related filoviruses in fluid specimens by indirect immunoelectron microscopy. J Clin Pathol 1991;44:521–522.PubMedCrossRefGoogle Scholar
  58. 58.
    Geisbert TW, Jahrling PB. Differentiation of filoviruses by electron microscopy. Virus Res 1995; 39:129–150.PubMedCrossRefGoogle Scholar
  59. 59.
    Fisher-Hoch SP. Arenavirus pathophysiology. In Salvato MS, ed. The Arenaviridae. Plenum Press, New York, 1993, pp. 299–323.CrossRefGoogle Scholar
  60. 60.
    Centers for Disease Control. Management of patients with suspected viral hemorrhagic fever. MMWR 1988;37(suppl 3):1–16. Available at http://www.cdc.gov/mmwr/preview/mmwrhtm1/00037085.htm (accessed November 19,2002), and Update available at: http://www.bt.cdc.gov/agent/vhf/index.asp (accessed November 18,2002).Google Scholar
  61. 61.
    Canonico PG, Kende M, Luscri BJ, Huggins JW. In-vivo activity of antivirals against exotic RNA viral infections. J Antimicrob Chemother 1984;14(suppl A):27–41.PubMedGoogle Scholar
  62. 62.
    McCormick JB, King IJ, Webb PA, et al. Lassa fever. Effective therapy with ribavirin. N Engl J Med 1986;314:20–26.PubMedCrossRefGoogle Scholar
  63. 63.
    Rebetol product information. Available at: http://www.rebetol.com/index.html (and http://www.spfiles.com/pirebetol.pdf) (accessed November 19,2002).
  64. 64.
    Huggins JW. Prospects for treatment of viral hemorrhagic fevers with ribavirin, a broad-spectrum antiviral drug. Rev Infect Dis 1989;11(suppl 4):S750–S761.PubMedCrossRefGoogle Scholar
  65. 65.
    Kilgore PE, Ksiazek TG, Rollin PE, et al. Treatment of Bolivian hemorrhagic fever with intravenous ribavirin. Clin Infect Dis 1997;24:718–722.PubMedCrossRefGoogle Scholar
  66. 66.
    Morrill JC, Jennings GB, Cosgriff TM, Gibbs PH, Peters CJ. Prevention of Rift Valley fever in rhesus monkeys with interferon-a. Rev Infect Dis 1989;11(suppl 4):S815–S825.PubMedCrossRefGoogle Scholar
  67. 67.
    Emond RT, Evans B, Bowen ET, Lloyd G. A case of Ebola virus infection. BMJ 1977;2:541–544.PubMedCrossRefGoogle Scholar
  68. 68.
    Enria DA, Fernandez NJ, Briggiler AM, Lewis SC, Maiztegui JI. Importance of neutralizing antibodies in treatment of Argentine hemorrhagic fever with immune plasma. Lancet 1984;4:255–256.CrossRefGoogle Scholar
  69. 69.
    Peters CJ, Jones D, Trotter R, et al. Experimental Rift Valley fever in rhesus macaques. Arch Virol 1988;99:31–44.PubMedCrossRefGoogle Scholar
  70. 70.
    Monath TP, Maher M, Casals J, Kissling RE, Cacciapuoti A. Lassa fever in the Eastern Province of Sierra Leone, 1970–1972, II: Clinical observations and virological studies on selected hospital cases. Am J Trop Med Hyg 1974;23:1140–1149.PubMedGoogle Scholar
  71. 71.
    Mupapa K, Massamba M, Kibadi K, et al. Treatment of Ebola hemorrhagic fever with blood transfusions from convalescent patients. J Infect Dis 1999;179(suppl 1):S18-S23.PubMedCrossRefGoogle Scholar
  72. 72.
    Stille W, Bohle E, Helm E, van Rey W, Siede W. Uber eine durch Cercopithecus aethiops ubertragene Infektionskrankheit. (“Grune-Meerkatzen-Krankheit”, “Green Monkey Disease”) (German) [On an infectious disease transmitted by Cercopithecus aethiops (“Green monkey disease”)]. Dtsch Med Wochenschr 1968;93:572–582.PubMedCrossRefGoogle Scholar
  73. 73.
    Leifer E, Gocke DJ, Bourne H. Lassa fever, a new virus disease in man from West Africa, II: report of a laboratory-acquired infection treated with plasma from a person recently recovered from the disease. Am J Trop Med Hyg 1970;19:677–679.PubMedGoogle Scholar
  74. 74.
    Frame JD, Verbrugge GP, Gill RG, Pinneo L. The use of Lassa fever convalescent plasma in Nigeria. Trans R Soc Trop Med Hyg 1984;78:319–324.PubMedCrossRefGoogle Scholar
  75. 75.
    Maiztegui JI, Fernandez NJ, de Damilano AJ. Efficacy of immune plasma in treatment of Argentine haemorrhagic fever and association between treatment and a late neurological syndrome. Lancet 1979;2:1216–1217.PubMedCrossRefGoogle Scholar
  76. 76.
    White HA. Lassa fever: a study of 23 hospital cases. Trans R Soc Trop Med Hyg 1972;66:390–401.PubMedCrossRefGoogle Scholar
  77. 77.
    Clayton AJ. Lassa immune serum. Bull WHO 1977;55:435–439.PubMedGoogle Scholar
  78. 78.
    Halstead SB. In vivo enhancement of dengue virus infection in rhesus monkeys by passively transferred antibody. J Infect Dis 1979;140:527–533.PubMedCrossRefGoogle Scholar
  79. 79.
    Jahrling PB, Frame JD, Rhoderick JB, Monson MH. Endemic Lassa fever in Liberia, IV: selection of optimally effective plasma for treatment by passive immunization. Trans R Soc Trop Med Hyg 1985;79:380–384.PubMedCrossRefGoogle Scholar
  80. 80.
    Shepherd AJ, Swanepoel R, Leman PA. Antibody response in Crimean-Congo hemorrhagic fever. Rev Infect Dis 1989:11(suppl 4):S801-S806.PubMedCrossRefGoogle Scholar
  81. 81.
    Parren PW, Geisbert TW, Maruyama T, Jahrling PB, Burton DR. Pre- and post-exposure prophylaxis of Ebola virus infection in an animal model by passive transfer of a neutralizing human antibody. J Virol 2002;76:6408–6412. Available to members at http://jvi.asm.org/cgi/content/ful1/76/12/6408? view=full&pmid=12021376 (accessed November 19,2002).PubMedCrossRefGoogle Scholar
  82. 82.
    Monath TP. Yellow fever: an update. Lancet Infect Dis 2001;1:11–20.PubMedCrossRefGoogle Scholar
  83. 83.
    McKee KT, Oro JG, Kuehne AI, Spisso JA, Mahlandt BG. Candid No. 1 Argentine hemorrhagic fever vaccine protects against lethal Junin virus challenge in rhesus macaques. Intervirology 1992;34:154–163.PubMedCrossRefGoogle Scholar
  84. 84.
    Maiztegui JI, McKee KT, Barrera Oro JG, et al. Protective efficacy of a live attenuated vaccine against Argentine hemorrhagic fever. J Infect Dis 1998;177:277–283.PubMedCrossRefGoogle Scholar
  85. 85.
    Pittman PR, Liu CT, Cannon TL, et al. Immunogenicity of an inactivated Rift Valley fever vaccine in humans. Vaccine 1999;18:181–189.PubMedCrossRefGoogle Scholar
  86. 86.
    Dandawate CN, Desai GB, Achar TR, Banerjee K. Field evaluation of formalin inactivated Kyasanur Forest disease virus tissue culture vaccine in 3 districts of Karnataka state. Indian J Med Res 1994;99: 152–158.PubMedGoogle Scholar
  87. 87.
    Sullivan NJ, Sanchez A, Rollin PE, Yang ZY, Nabel GJ. Development of a preventative vaccine for Ebola virus infection in primates. Nature 2000;408:605–609. Available at http://www.nature.com/cgitaf/DynaPage.taf?file=/nature/iournal/v408/n6812/fu11/408605a0fs.html (accessed November 19.2002).PubMedCrossRefGoogle Scholar
  88. 88.
    Fisher-Hoch SP, Hutwagner L, Brown B, McCormick JB. Effective vaccine for Lassa fever. J Virol 2000;74:6777–6783.PubMedCrossRefGoogle Scholar

Copyright information

© Humana Press Inc., Totowa, NJ 2004

Authors and Affiliations

  • Thomas W. Geisbert
  • Aileen M. Marty
  • Peter B. Jahrling

There are no affiliations available

Personalised recommendations