3 - Viral Hemorrhagic Flashcards
Dengue Fever
Very high fever RETRO-ORBITAL PAIN HA N/V (Hematemesis / melena) ABD pain Truncal scarlatinaform rash Severe muscle aches Small bleeding from gums or nose Petechiae / purprua - non-blanching Conjunctival injection Pharyngeal injection Lymphadenopathy Hepatomegaly
“Saddleback”
Bleeding at venipuncture
TOURNIQUET TEST - 20 per sq. inch
High crit = plasma seeping
Low crit = real bleeding
Leukopenia
Hyponatremia
Txt - APAP, IVF, fresh whole blood
Prevent with DEET
Yellow fever
1937 - Vaccine
Virus gets into vascular endothelial cells and reticuloendothelial system - immune system overwhelmed
Black water vomit (bleeding)
Mucosal bleeding
Acute - fever, HA, N/V, conjunctival injection
Then remission
THEN
Toxic phase - jaundice, hepatomegaly, petechiae, blood from both ends, AMS, relative bradycardia, anasarca
Txt - supportive, central line, FFP, no effective antivirals - so get the fucking vaccine
Ebola and marburg
Bats
Filovirus - threadlike
Uganda - Marburg AND Ebola
DRC - Ebola (contaminated meat? Recurrent outbreaks in DRC)
Severe HA Fever Anorexia Rash Conjunctival injection Arthralgias / Myalgias ABD pain N/V/D Odynophagia / dysphagia
Later - ghostlike face, bleeding from everywhere, tachypnea, toxic - they gon’ die - normothermic by this point
Supportive - no real therapy - Ig from someone who survived it
Vaccine in use, pending FDA approval
High fatality rate
Survivors are fucked up
Lassa
West Africa
Rodents
Nosocomial outbreaks
Bad in 3rd trimester preggos
Bleeding = rare
Most are subclinical
Insidious onset Fever Weakness Cough HA Prostration Face/neck edema
MC sequelae = deafness
Major cause of peds hospitalization
Swollen baby syndrome
Txt - ribavirin works, best if started within 6 days (but it’s usually intercepted by warlords)
Bad for preggos and fetus
Hantavirus
NOT the same as the US one (the pulmonary one)
This is Hemorrhagic Fever with Renal Failure Syndrome (HFRS)
Far East
Rodent reservoir
Triad - fever, hemorrhage, renal insufficiency
If under 15yrs, mild dz
Phases - febrile, HOTN, oliguric, diuretic, convalescent
Txt - supportive, ribavirin
Crimean-Congo Hemorrhagic Fever
Africa / Western Asia / Middle East / Eastern Europe
Ticks -> livestock
Flu-like initially After 5 days hemorrhage begins Massive ecchymosis (DIFFERENT THAN ALL THE OTHERS WITH PETECHIAE) Epistaxis Hepatomegaly Erythema
Txt - supportive, ribavirin
