Brazilian hemorrhagic fever, caused by Sabiá virus, has been documented in three cases. It is characterized by a gradual and progressive illness consisting of constitutional symptoms, hemorrhage, neurologic manifestations, etc. Complications include shock, coma, and death.
Brazilian hemorrhagic fever is caused by the Sabiá virus, which is the most recently discovered of the five arenaviruses from South America . The reservoir and mode of transmission of Sabiá virus are not fully understood although wild rodents are known as the source of the other arenaviruses . There have been only three reported cases of this disease. The first documented case occurred in 1990 in São Paulo, Brazil, when the virus was isolated from an agricultural engineer . The other two cases resulted from laboratory accidents.
Although there are only a few cases of Brazilian hemorrhagic fever, it is clear that it shares similar presentations to other South American hemorrhagic fever illnesses, in which the onset is insidious and evolves gradually  following a two week incubation period .
The first patient, who had an unremarkable history, presented with a 12-day duration of fever, myalgia, weakness, headache, nausea, and emesis . The diseases progressed over the next several days as she developed conjunctival petechia, hematemesis, and vaginal bleeding as well as seizures, tremors, difficulty walking which was followed by coma, shock, and death.
The second patient was a laboratory technician in Brazil who probably acquired the virus through aerosol . He manifested with a fever, malaise, nausea, emesis, headache, myalgia, sore throat, and gingival bleeding . The patient recovered after therapy.
The final case occurred at Yale University in 1994 through aerosol after accidental exposure . This patient reported a fever, headache, myalgia and a nuchal stiffness . Like the second patient, this individual recovered following appropriate treatment .
South American hemorrhagic fevers typically have multi-organ involvement . Patients are likely to develop hepatitis , pleural effusion, and neurologic sequelae such as seizures and encephalopathy . Hemorrhage is followed by dehydration, hypotension, shock, coma and possibly death  .
Patients are likely to have orthostatic hypotension and other abnormal vital signs. Overall, they appear ill and exhibit an altered mental status and signs of dehydration . Generally, individuals with South American hemorrhagic fever will have flushing, lymphadenopathy, conjunctival injection, petechia, and palatal enanthem of a vesicular appearance. Facial and neck swelling are also common .
Patients presenting with the above symptoms should be evaluated with a full personal and travel history, physical exam, and the appropriate studies. Urgent assessment and prompt initiation of therapy can prevent complications and death.
A complete blood count (CBC) and complete metabolic panel (CMP) including liver function tests (LFTs) are essential studies. Likely findings include leukopenia, thrombocytopenia, and possibly LFT abnormalities  .
Viral detection techniques include reverse transcription-polymerase chain reaction (RT-PCR), virus isolation from blood or tissue samples, and antigen-capture enzyme-linked immunoabsorbent assay (ELISA) . The latter may be the earliest diagnostic method.
Additionally, serological tests can be performed as well. For example, antibodies to arenaviruses may be measured through IgG-ELISA and IgM-ELISA. Other techniques include indirect immunofluorescence assay (IFA) or virus neutralization assay . Of note, antibodies in patients with South American hemorrhagic fevers appear during the third week of the disease.