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Brazilian Hemorrhagic Fever

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.


Presentation

Brazilian hemorrhagic fever is caused by the Sabiá virus, which is the most recently discovered of the five arenaviruses from South America [1]. 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 [2]. 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 [3]. 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 [4] following a two week incubation period [5].

The first patient, who had an unremarkable history, presented with a 12-day duration of fever, myalgia, weakness, headache, nausea, and emesis [3]. 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 [6]. He manifested with a fever, malaise, nausea, emesis, headache, myalgia, sore throat, and gingival bleeding [3]. The patient recovered after therapy.

The final case occurred at Yale University in 1994 through aerosol after accidental exposure [7]. This patient reported a fever, headache, myalgia and a nuchal stiffness [2]. Like the second patient, this individual recovered following appropriate treatment [2].

Complications

South American hemorrhagic fevers typically have multi-organ involvement [8]. Patients are likely to develop hepatitis [3], pleural effusion, and neurologic sequelae such as seizures and encephalopathy [9]. Hemorrhage is followed by dehydration, hypotension, shock, coma and possibly death [8] [9].

Physical exam

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 [3]. 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 [9].

Fever
  • This patient reported a fever, headache, myalgia and a nuchal stiffness. Like the second patient, this individual recovered following appropriate treatment. Complications South American hemorrhagic fevers typically have multi-organ involvement.[symptoma.com]
  • Infections and conditions requiring containment care during transport Arenavirus infection Argentine hemorrhagic fever (Junin virus) Bolivian hemorrhagic fever (Machupo virus) Brazilian hemorrhagic fever (Sabia virus) Lassa fever Venezuelan hemorrhagic[medical-dictionary.thefreedictionary.com]
  • MalaCards based summary : Brazilian Hemorrhagic Fever, is also known as sabia hemorrhagic fever. Affiliated tissues include skin and eye.[malacards.org]
  • Entry H01544 Disease Name Brazilian hemorrhagic fever Supergrp South American hemorrhagic fever [DS: H00385 ] Arenaviral hemorrhagic fever [DS: H02173 ] Description Brazilian hemorrhagic fever is an infectious disease caused by Sabia virus (SABV), a New[genome.jp]
  • Inhalt Monkeypox 329 Plague 330 Poliomyelitis Polio 337 Rabies 348 Relapsing Fever 357 Respiratory Tract Infections 358 Rickettsial Infections 363 Rift Valley Fever 365 General Strategies in EnvironmentRelated Special Risks 94 Essentials of Aviation Medicine[books.google.de]
High Fever
  • Signs and symptoms of CCHF Initial signs include headache, high fever, back pain, joint pain, stomach pain, and vomiting. Red eyes, a flushed face, a red throat, and red spots on the roof of the mouth are also common.[express.co.uk]
  • Symptoms of dengue fever include high fever, severe headache, backache, joint pains and eye pain, nausea, vomiting and a rash, according to the CDC. There is no vaccine to prevent dengue fever or dengue hemorrhagic fever, the CDC said.[cnn.com]
  • While most victims recover at this point, approximately 15% to 20% advance to a second stage where symptoms intensify into high fever, hemorrhagic tissue damage, and liver failure.[invisiverse.wonderhowto.com]
Constitutional Symptom
  • It is characterized by a gradual and progressive illness consisting of constitutional symptoms, hemorrhage, neurologic manifestations, etc. Complications include shock, coma, and death.[symptoma.com]
Difficulty Walking
  • 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.[symptoma.com]
Constitutional Symptom
  • It is characterized by a gradual and progressive illness consisting of constitutional symptoms, hemorrhage, neurologic manifestations, etc. Complications include shock, coma, and death.[symptoma.com]
Sputum
  • Brazilian hemorrhagic fever (Sabia virus) Lassa fever Venezuelan hemorrhagic fever (Guanarito virus) Bunyavirus infection Congo-Crimean hemorrhagic fever Filovirus infection Ebola Marburg Orthopoxvirus infection Monkeypox Variola Pneumonic plague until sputum[medical-dictionary.thefreedictionary.com]
Severe Clinical Course
  • Compared to the patients who did not receive ribavirin, the patient who was treated with it had a shorter and less severe clinical course.[en.wikipedia.org]
Severe Clinical Course
  • Compared to the patients who did not receive ribavirin, the patient who was treated with it had a shorter and less severe clinical course.[en.wikipedia.org]
Nausea
  • The first patient, who had an unremarkable history, presented with a 12-day duration of fever, myalgia, weakness, headache, nausea, and emesis.[symptoma.com]
  • Fever, headache, myalgia, nausea, vomiting, weakness, and pronounced sore throat were symptoms exhibited in all cases of Sabia infection. Additional symptoms include conjunctivitis, diarrhea, epigastric pain, and bleeding gums.[stanford.edu]
  • Within 3 to 6 days of being bitten by an infected mosquito, symptoms such as fever, headache, muscle aches, nausea, and vomiting can present and last for as long as 3 to 4 days.[contagionlive.com]
  • Symptoms of dengue fever include high fever, severe headache, backache, joint pains and eye pain, nausea, vomiting and a rash, according to the CDC. There is no vaccine to prevent dengue fever or dengue hemorrhagic fever, the CDC said.[cnn.com]
Vomiting
  • Fever, headache, myalgia, nausea, vomiting, weakness, and pronounced sore throat were symptoms exhibited in all cases of Sabia infection. Additional symptoms include conjunctivitis, diarrhea, epigastric pain, and bleeding gums.[stanford.edu]
  • Signs and symptoms of CCHF Initial signs include headache, high fever, back pain, joint pain, stomach pain, and vomiting. Red eyes, a flushed face, a red throat, and red spots on the roof of the mouth are also common.[express.co.uk]
  • Within 3 to 6 days of being bitten by an infected mosquito, symptoms such as fever, headache, muscle aches, nausea, and vomiting can present and last for as long as 3 to 4 days.[contagionlive.com]
  • Symptoms of dengue fever include high fever, severe headache, backache, joint pains and eye pain, nausea, vomiting and a rash, according to the CDC. There is no vaccine to prevent dengue fever or dengue hemorrhagic fever, the CDC said.[cnn.com]
Bleeding Gums
  • Additional symptoms include conjunctivitis, diarrhea, epigastric pain, and bleeding gums. In both cases that occurred in 1990, symptoms lasted approximately 15 days.[stanford.edu]
Hypotension
  • Hemorrhage is followed by dehydration, hypotension, shock, coma and possibly death. Physical exam Patients are likely to have orthostatic hypotension and other abnormal vital signs.[symptoma.com]
  • These highly infectious viruses lead to a potentially lethal disease syndrome characterized by fever, malaise, vomiting, mucosal and gastrointestinal (GI) bleeding, edema, and hypotension.[emedicine.medscape.com]
Orthostatic Hypotension
  • Physical exam 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.[symptoma.com]
Red Eye
  • Red eyes, a flushed face, a red throat, and red spots on the roof of the mouth are also common. Symptoms may also include jaundice, and in severe cases, changes in mood and sensory perception.[express.co.uk]
Conjunctival Petechiae
  • 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.[symptoma.com]
Conjunctival Petechiae
  • 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.[symptoma.com]
Flushing
  • 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.[symptoma.com]
  • Red eyes, a flushed face, a red throat, and red spots on the roof of the mouth are also common. Symptoms may also include jaundice, and in severe cases, changes in mood and sensory perception.[express.co.uk]
Petechiae
  • 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.[symptoma.com]
  • The image below depicts palatal petechiae and hemorrhage in a patient with Ebola virus disease (EVD). Filovirus disease - Ebola fever. Patient with Ebola hemorrhagic fever during 1976 outbreak in Zaire demonstrating palatal petechiae and hemorrhage.[emedicine.medscape.com]
Myalgia
  • The first patient, who had an unremarkable history, presented with a 12-day duration of fever, myalgia, weakness, headache, nausea, and emesis.[symptoma.com]
  • Fever, headache, myalgia, nausea, vomiting, weakness, and pronounced sore throat were symptoms exhibited in all cases of Sabia infection. Additional symptoms include conjunctivitis, diarrhea, epigastric pain, and bleeding gums.[stanford.edu]
  • Case Presentation and Clinical Course On August 16, 1994, the virologist noted myalgias, a mild headache, a stiff neck, and fever while driving home to New Haven, Connecticut, after a weekend visit to Boston.[doi.org]
Epistaxis
  • Ecchymoses often are accompanied by hemorrhage in other locations: epistaxis, puncture sites, hematemesis, melena, and hematuria. Image provided by Robert Swaneopoel, PhD, DTVM, MRCVS, National Institute of Virology, Sandringham, South Africa.[emedicine.medscape.com]
Neck Swelling
  • 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.[symptoma.com]
Vaginal Bleeding
  • 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.[symptoma.com]
Headache
  • The first patient, who had an unremarkable history, presented with a 12-day duration of fever, myalgia, weakness, headache, nausea, and emesis.[symptoma.com]
  • Fever, headache, myalgia, nausea, vomiting, weakness, and pronounced sore throat were symptoms exhibited in all cases of Sabia infection. Additional symptoms include conjunctivitis, diarrhea, epigastric pain, and bleeding gums.[stanford.edu]
  • I was exhausted and had an annoying headache. But no sore throat, no cough and no viscous substances running through my nose. So I reached Dr.[nytimes.com]
  • He also reported a severe headache. The patient was sent home with a white-cell count of 3800 per cubic millimeter on August 29 after 10 days of intravenous ribavirin.[doi.org]
  • Signs and symptoms of CCHF Initial signs include headache, high fever, back pain, joint pain, stomach pain, and vomiting. Red eyes, a flushed face, a red throat, and red spots on the roof of the mouth are also common.[express.co.uk]
Seizure
  • 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.[symptoma.com]
  • Human-to-human transmission through contact with bodily fluids Symptoms: Fever Eye redness Fatigue Dizziness Muscle aches Weakness Severe Symptoms Bleeding under the skin, internal organs, or from body orifices Shock Nervous system malfunction Coma Delirium Seizures[sites.google.com]
  • Severely ill patients show shock, nervous system malfunction, coma, delirium, and seizures. [1] The Sabiá virus can be acquired through inhalation, ingestion, the eyes, and contact with urine, saliva, blood, or feces of rodents. [1] The Sabiá virus is[wikidoc.org]
Tremor
  • 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.[symptoma.com]
Tremor
  • 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.[symptoma.com]
Altered Mental Status
  • Overall, they appear ill and exhibit an altered mental status and signs of dehydration.[symptoma.com]

Workup

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.

Laboratory tests

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 [3] [10].

Diagnostic studies

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) [11]. 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 [11]. Of note, antibodies in patients with South American hemorrhagic fevers appear during the third week of the disease.

Treatment

  • Seek medical attention immediately Supportive Treatment Quarantine Incubation Period: 7 - 16 days' Useful Links:[sites.google.com]
  • […] of Malaria, and Diagnosis and Treatment of Sexually Transmitted Diseases.[books.google.de]
  • Like the second patient, this individual recovered following appropriate treatment. Complications South American hemorrhagic fevers typically have multi-organ involvement.[symptoma.com]
  • Brazilian hemorrhagic fever Pathogen Sabia mammarenavirus [GN: T40008 ] Other DBs ICD-11: 1D61.Y ICD-10: A96.8 Reference PMID: 7596373 Authors Barry M, Russi M, Armstrong L, Geller D, Tesh R, Dembry L, Gonzalez JP, Khan AS, Peters CJ Title Brief report: treatment[genome.jp]
  • Treatment: Like other arenaviruses, Sabia virus proved to be responsive to treatment with ribavirin. In confirmed cases of Sabia infection, ribavirin is unquestionably the most appropriate treatment.[stanford.edu]

Epidemiology

  • Emergence of new viruses and syndromes, changes in epidemiological patterns, absence of vaccines for orphan viruses, increasing antiviral resistance and threats of bioterrorism are factors that constitute the scenario for the emergence and re-emergence[paho.org]
  • Epidemiology and History: Only one known case of naturally contracted Sabia virus infection has been documented, yet the virus remains important due to at least two laboratory infections that have occurred.[stanford.edu]
  • A new epidemiological update released by PAHO on July 10, 2017, details the yellow fever situation in Brazil, Colombia, Ecuador, Peru, and the Plurinational State of Bolivia from epidemiological week 1 to 26 of 2017.[contagionlive.com]
  • The plans included restricting the number of health care workers who came in contact with people who might have been secondarily infected; immediately notifying the clinical laboratories, the hospital epidemiology department, the state health department[doi.org]
  • Gas Referendum, 2004 Bolivia, Referendum, Natural gas, President of Bolivia, Carlos Mesa, Bolivian gas conflict, Gonzalo Sánchez de Lozada Modern age until 1918 Flu Press (2011-11-01) - ISBN-13: 978-613-8-16039-7 45.00 Dengue Fever in Pakistan Clinico-epidemiological[morebooks.de]
Sex distribution
Age distribution

Prevention

  • […] transmission through contact with bodily fluids Symptoms: Fever Eye redness Fatigue Dizziness Muscle aches Weakness Severe Symptoms Bleeding under the skin, internal organs, or from body orifices Shock Nervous system malfunction Coma Delirium Seizures Prevention[sites.google.com]
  • Urgent assessment and prompt initiation of therapy can prevent complications and death. Laboratory tests A complete blood count (CBC) and complete metabolic panel (CMP) including liver function tests (LFTs) are essential studies.[symptoma.com]
  • The manual focuses on preventive measures to be considered for travelers.[books.google.de]
  • There is no vaccine to prevent dengue fever or dengue hemorrhagic fever, the CDC said. E-mail to a friend All About Brazil • Rio de Janeiro • Centers for Disease Control and Prevention[cnn.com]
  • The patient was immediately hospitalized and treated with intravenous ribavirin at a dosage used by the Centers for Disease Control and Prevention (CDC) for other arenavirus infections (a loading dose of 30 mg per kilogram of body weight, followed by[doi.org]

References

Article

  1. Gonzalez JP, Bowen MD, Nichol ST, Rico-Hesse R. Genetic characterization and phylogeny of Sabiá virus, an emergent pathogen in Brazil. Virology. 1996;221(2):318-24.
  2. Barry M, Russi M, Armstrong L, et al. Treatment of a Laboratory-Acquired Sabiá Virus Infection. N Engl J Med. 1995;333(5):294-6.
  3. Lisieux T, Coimbra TL, Nassar ES, et al. New arenavirus isolated in Brazil. Lancet. 1994;343(8894):391-392.
  4. Vainrub B, Salas R. Latin American hemorrhagic fever. Infect Dis Clin North Am. 1994; 8(1):47-59.
  5. McCormick JB. Lassa, Junin, Machupo and guanarito viruses. In: Webster RG, Granoff A, eds. Encyclopedia of virology. San Diego, CA: Academic Press; 1994: 776-837.
  6. Vasconcelos PFC, Travassos da Rosa APA, Rodrigues SG, et al. Infeccao humana pelo virus SP H 114202 (Arenavirus: familia Arenaviridae): aspectos clinicos e laboratoriais de uma nova doenca. Rev Inst Med Trop São Paulo. 1993; 35(6):521-525.
  7. Gandsman EJ, Aaslestad HG, Ouimet TC, Rupp WD. Sabia virus incident at Yale University. Am Ind Hyg Assoc J. 1997;58(1):51-3.
  8. Peters CJ, Zaki SR. Role of the endothelium in viral hemorrhagic fevers. Crit Care Med. 2002; 30 (5 Suppl): S268-73.
  9. Lupi O, Tyring SK. Tropical dermatology: Viral tropical diseases. J Am Acad Dermatol. 2003; 49(6):979-1000.
  10. Doyle TJ, Bryan RT, Peters CJ. Viral hemorrhagic fevers and hantavirus infections in the Americas. Infect Dis Clin North Am. 1998;12(1):95-110.
  11. Fukushi S, Tani H, Yoshikawa T, Saijo M, Morikawa S. Serological Assays Based on Recombinant Viral Proteins for the Diagnosis of Arenavirus Hemorrhagic Fevers. Viruses. 2012;4(10):2097-2114.

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Last updated: 2019-07-11 20:22