The agents of viral hemorrhagic fevers (VHF) are members of four distinct families of ribonucleic acid viruses that cause clinical syndromes with overlapping features: fever, malaise, headache, myalgias, prostration, mucosal hemorrhage, and other signs of increased vascular permeability and circulatory dysregulation, leading to shock and multiorgan system failure in advanced cases (Borio et al.,
2002). Specific agents of VHF may also be associated with specific target organ effects. These pathogens include the agents of Ebola, Marburg, Lassa fever, Rift Valley fever, and Congo-Crimean hemorrhagic fever.
Hemorrhagic fever viruses have been viewed as emerging infections in nature due to their sporadic occurrence in focal outbreaks throughout the world; they are thought to be the results of human intrusion into a viral ecologic niche. They are, however, potential weapons of bioterrorism because they are highly infectious in aerosol form, are transmissible in health-care settings, cause high morbidity and mortality, and are purported to have been successfully weaponized (Alibek, 1999). Additionally, VHF frequently produce dramatic clinical pictures that have received worldwide attention, thus fulfilling another terrorist goal - to induce maximum fear and panic in the civilian population.
Blood and other body fluids from infected patients are extremely infectious, and person-to-person air-borne transmission may occur; therefore, strict contact and air-borne precautions should be instituted in these cases (Borio et al., 2002). Treatment is largely supportive, and includes the early use of vasopressors as needed. Ribavirin is effective against some forms of VHF, but not those caused by Ebola and Marburg viruses. Nonetheless, this drug should be initiated empirically in patients presenting with a syndrome consistent with VHF until the etiology is confirmed.
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