Viral Haemorrhagic Fever

Question 1

Explain VHF.

Answer 1

A term used for severe multi-organ dsiease in which the endothelium is damaged and homeostasis becomes impaired.

This can be a life-threatening condition.

Question 2

What types of VHFs are there?

Answer 2

Most importantly Ebola, Dengue and Yellow fever

Question 3

What is Ebola?

Answer 3

A filovirus that is endemic to sub-saharan africa and sometimes causes outbreaks resulting in epidemics.

There is cytokine activation leading to endothelial damage, oedema, coagulopathy, tissue necrosis and multi-organ failure.

The transmission occurs via mucous membranes or contact with bodily fluids including burial contact.

Question 4

Clinical presentation of Ebola.

Answer 4

Undifferentiated - ( 0 - 3d ) with a fever, myalgia, weakness, anorexia, headache and sore throat.

GI - ( 4 - 10d) with epigastric and abdominal pain, liver tenderness, N+V, hiccups, diarrhoea and hypovolaemia.

Late organ stage - ( > 10d ) with haemorrhagic petechiae, ecchymoses, mucosal haemorrhage, GI bleed and haemoptysis.
Neurological symptoms such as extreme weakness, confusion, agitation, bradypsychia and coma.
There may lso be hypoglycaemia, electrolyte abnormalities, secondary infection, shock, DIC, multiorgan failure and ultimately death.

Question 5

Complications post infection.

Answer 5

Arthralgia

Hepatitis

Orchitis

Transverse myelitis

Meningitis

uveitis

Vision and hearing impairment

Social isolation

Question 6

Diagnosis of Ebola.

Answer 6

Low WCC

Low plt

High AST>ALT

IgM after 3 days

IgG after 7 days

Reverse transcriptase PCR on blood, urine, saliva and throat swab.

Question 7

Treatment of ebola.

Answer 7

Supportive with fluid resus, correct electrolytes, coagulation and glucose.

Treat any secondary infection and maintain nutrition.

Trace contacts and support family.