1. VIRAL
HAEMORRHAGIC
FEVER
PROF FARHAT BASHIR
CGH & UMDC

2. • Zoonoses caused by different viruses
• Ebola, Marburg, Lassa, Dengue, CCHF

3. Clinical features
• Starts with non-specific fever, malaise, body
pains, sore throat, headache
• Conjunctivitis, throat congestion, rash,
hemorrhage, lymphadenopathy
• Capillary leak due to endothelial damage by virus.
• Bleeding due to endothelial and platelet
dysfunction
• ARDS, shock, organ failure
• Travel history, contact history

4. Investigations
• CBC- leucopenia, thrombocytopenia
• Urine DR- proteinuria
• LFT
• Blood, urine, throat swab, pleural fluid for
serology and PCR for viral nucleic acid

5. Management
• Specialized high security infectious disease
unit
• Supportive management
• Ribavirin

6. • Flavi virus
• Aedes aegypti—breeds in standing water
• Incubation period 2—7 days
DENGUE FEVER

7. • PRODROME
• ACUTE : fever continuous / saddle back, high
grade, 7-8 days
– Backache, arthralgias, headache, pain on eye
movement
– Anorexia, nausea, vomiting
– Prostration
– Rash macular, maculopapular, scarlet, centrifugal
spread
Clinical features

8. Rash maculopapular in dengue

11. • DENGUE HAEMORRHAGIC FEVER: petichiae,
ecchymosis, epistaxis, GI bleeding, DIC
• DENGUE SHOCK SYNDROME: After 3-4 days of
fever—hypotension, circulatory failure
• Hepatitis, myocarditis, encephalitis,
rhabdomyolysis, cranial nerve palsies
Complications

13. • Tourniquet test
• CBC
• LFT
• RFT
• SEROLOGY
– Dengue NS-1 antigen
– Dengue serology
• Imaging
Investigations

14. MANAGEMENT
• Symptomatic
• Treatment of complications

15. Crimean-Congo
hemorrhagic fever

16. Historical Background
CCHF like symptoms were described initially by
physicians in 12th century from the region
currently known as Tazhikistan.
In 1944-1945 when 200 Soviet military personnel
were infected during war in Crimea.
In 1967 peoples from Congo and Uganda were
infected by similar disease thus the name
Crimean Congo hemorrhagic fever.
In 1967, Chumakov in Moscow first used newborn
white mice for the isolation of CCHF virus. This resulted
in a Drosdov strain which became the prototype strain
for experimental work.
16

17. Problem statement
52 countries
More than
6,000
cases
Nearly
140
outbreaks
17

18. 3 March 2020 Dr. Sunil Panjwani, 9825331039 18

19. Geographical distribution
• Geographically this tick borne viral infection has
been reported from different countries in
Southeast Europe
Asia
Middle East
Africa
19

20. • Crimean-Congo haemorrhagic fever (CCHF) is a viral
haemorrhagic fever caused by Nairovirus.
• Primarily an animal disease, sporadic cases and
outbreaks of CCHF affecting humans do occur.
• CCHF outbreaks constitute a threat to public health
because of its
Epidemic potential.
High case fatality.
Potential for nosocomial outbreaks.
Difficulties in treatment and prevention.
20

21. Mode of transmission
• Bite of an infective adult tick, particularly
Hyalomma marginatum or Hyalomma
anatolicum.
• Skin lesions when crushing an infected tick.
• Nosocomial outbreaks due to exposure to
infected blood and secretions.
• Slaughtering of infected animals via small-particle
aerosol from infected rodent excreta.
• From contaminated needle sticks or infected
fomites.
3 March 2020 22Dr. Sunil Panjwani, 9825331039

22. 3 March 2020 23Dr. Sunil Panjwani, 9825331039

23. 3 March 2020 Dr. Sunil Panjwani, 9825331039 24

24. 3 March 2020 Dr. Sunil Panjwani, 9825331039 25

25. At-risk population
• Animal handlers, livestock workers, and slaughter
houses in endemic areas are at risk of CCHF.
• Healthcare workers in endemic areas are at risk of
infection through unprotected contact with infectious
blood and body fluids.
• Individuals and international travelers with contact to
livestock in endemic regions may also be exposed.
• Age – all ages.
• Sex – 3 times more in males than females.
• Immunity – Life time immunity for that genome.
26

26. Incubation period
• This depends on the route of exposure to
virulence and viral dose.
• The incubation period after tick bite is usually
1 to 3 days, with a maximum of 9 days.
• The incubation period following contact with
infected blood or tissues is usually 5 to 6 days,
with a documented maximum of 13 days.
3 March 2020 28

27. 3 March 2020 32

28. 3 March 2020 33

29. Clinical Features
• Course of this disease follows four distinct
phases in humans
–Incubation phase
–Pre-hemorrhagic phase- fever, body
ache
–Hemorrhagic phase-skin, mucous
membrane, organ failure, ARDS
–Convalescence phase
3 March 2020 34

30. Laboratory Findings
• CBC- anemia, leucopenia,
thrombocytopenia
• Urine DR- proteinuria, hematuria
• LFT
• RFT
• LDH
• PT, APTT, INR
• CPK
35

31. Diagnosis
• There are no rapid diagnostic tests.
• ELISA-for IgG and IgM from 6th day of illness.
IgM - upto four months
IgG - upto five years.
• The virus may be isolated from blood or tissue
specimens in the first five days of illness, and
grown in cell culture.
• PCR and RT PCR-for detecting the viral
genome
36

32. Differential Diagnosis
• There are a number of tropical infections which
presents similar clinical features and hence they should
be suspected and ruled out while making a diagnosis of
CCHF. The differentials include
– Dengue Hemorrhagic Fever
– Falciparum malaria
– Leptospirosis
– Typhoid Fever
– Septicemic Plague
– Rickettsial Infections
– Meningococcemia
– Viral Hepatitis
– Other viral hemorrhagic fevers.
37

33. Treatment
• The mainstay of treatment in CCHF is
supportive in nature
Maintenance of fluid and electrolyte balance.
Maintenance of circulatory volume, and blood
pressure.
Platelet transfusion, PCV transfusion.
Management of DIC, sepsis, shock and MOF
• Possible benefits with immunoglobulin .
38

34. • Antivirus drug Ribavirin, the dosage
recommended by the WHO within 24 hours of
hospital admission for better results are
2 gm loading dose
 4 gm/day in 4 divided doses for 4 days.
 2 gm/day in 4 divided doses for 6 days.
39

35. Prophylaxis Protocol
Indirect contact with case body fluids should be monitored for
14 days from the date of last contact with the patient or other
source of infection by taking the temperature twice daily.
OR
If the patient develops a temperature of 38.5° C or greater,
headache and muscle pains, he/she would be considered a
probable case and should be admitted to hospital and started
on ribavirin treatment.
40
Treatment Protocol for CCHF disease
High-dose oral Ribavirin therapy :
 2 gm loading dose
 4 gm/day in 4 divided doses (6 hourly) for 4 days.
 2 gm/day in 4 divided doses for 6 days.

36. LASSA FEVER
• Rodent associated.
• Arenavirus
• Virus is in rat excreta, spread by direct contact
or aerosolized particles.
• Clinical features---
• Diagnosis serological , PCR
• Treatment : ribavirin.
• Post exposure prophylaxis.

37. THANKYOU

38. CHIKUNGUNYA
• Alpha virus
• Fever, rash and arthropathy
• Aedes aegypti
• Incubation period 2-12 days
• Fever, followed by afebrile phase, recrudescence
of fever
• Children most commonly develop rash
• Adults develop arthritis with pain and swelling
• Joint pain becomes chronic in individuals positive
for HLA-B27

39. • DIAGNOSIS
• MANAGEMENT