Febrele hemoragice

Clasificarea febrelor hemoragice

Transmise de căpuşe De contact

 FH Crimea-Congo  FH cu sindrom renal
 FH de Omsc  Febra Lassa
 FH de Kiasanur  Febra Marburg
 Febra Ebola
Transmise de ţânţari  Febra de Argentina
 Febra galbenă  Febra de Bolivia
 Febra Denghe  Febra de Brazilia
 Febra Cicungunia  Febra de Venesuela
 Febra văii Rift
 Four distinct viral families:
Filoviridae
• Ebola
• Marburg
Arenaviridae
• Lassa fever
• New world hemorrhagic fever
• Bolivian hemorrhagic fever (Machupo)
• Argentine hemorrhagic fever (Junin virus)
• Venezuelan hemorrhagic fever (Guanarito
virus)
• Brazilian hemorrhagic fever (Sabia virus)
Bunyaviridae
• Crimean-Congo hemorrhagic fever
• Rift Valley fever
• Hantavirus
Flaviviridae
• Dengue
• Yellow fever
• Omsk hemorrhagic fever
• Kyasanur Forest disease
Căpuşele – vectori de transmitere a
febrelor hemoragice
 Animals:
 Numerous wild and domestic animals, such as cattle,
goats, sheep, and hares, serve as amplifying hosts
Filoviridae:
 Same clinical course as that of humans
 High primate mortality rate: ~ 82%
Bunyaviridae:
 CCHF- unapparent infection in livestock
 RVF- 100% abortion rate and mortality rate of > 90% in
young animals and 5-60% in older animals
 Hantavirus – unapparent infection in rodents
Flaviviridae:
 Non-human primates – varying clinical signs (Yellow
fever); no clinical signs (Dengue)
 Livestock – no symptoms (Kyasanur Forest Disease)
 Rodents – no symptoms
 Humans:
 Clinical signs and symptoms vary by the type of VHF
 Patients usually present with the following clinical signs and
symptoms:
Fever ³ 38.3°C of < 3 week duration
Fatigue
Dizziness
Muscle aches
Loss of strength
Exhaustion
At least two of the following:
Hemorrhagic or purple rash
Epistaxis
Hemoptysis
Blood in stools
Petechiae in nondependent areas
 No predisposing factors for hemorrhage and no established
alternative diagnosis
 Filoviridae:

 Most severe hemorrhagic fevers with abrupt onset and death around
day 7 to 11; painful recovery
 Incubation: 4 to 10 days
 Case fatality: 23-33% (Marburg) and 53-88% (Ebola)

Arenaviridae:
 Incubation: 10 to 14 days
 Case fatality: 5-35%
Bunyaviridae:

 Incubation: 3 to 7 days (CCHF); 2 to 5 days (RVF); 7 to 21 days

(Hantavirus)
 Case fatality: 30% (CCHF); 1% (RVF); 1-50% (Hantavirus)

Flaviviridae
 Incubation: 2 to 6 days
 Case fatality: 1-10% (Dengue); 3-5% (Kyasanur Forest virus); 0.5-
3% (Omsk hemorrhagic fever); varies (Yellow fever)
Febra hemoragică Crimea-Congo
Febra hemoragică Crimea-Congo
Febra hemoragică cu sindrom renal
Virusul Ebola Virusul Marburg
Familia Filivirusuri
Febra hemoragică Ebola şi Marburg
Manifestări clinice în FH Ebola şi Marburg

Debut brusc cu frison

Febră înaltă
Cefalee intensă
Mialgii
Dureri în abdomen
Diaree
Voma
Tusă şi dureri în torace
Sindrom hemoragic exprimat
Erupţii hemoragice la 4-5 zi
Hepatomegalie
Afectarea renală
Letalitatea – până la 80%
 Febra de Argentina şi de Bolivia

 Debut lent cu temperaturaă

subfebrilă
 Cefalee, mialgii
 Enantemă hemoragică la 2-3 zi
 Semne catarale
 Hiperemia feţii, conjunctivei
 Perioada de stare cu sindrom
hemoragic exprimat
 afectarea renală cu oligurie
 encefalită
Letalitatea 10-20%

Massive cutaneous ecchymosis

 Febra Lassa
Debut brusc
Sindrom de intoxicaţie exprimat
Sindrom dispeptic cu greaţă,
vomă, diaree
Limfadenopatie cervicală
Sindrom hemoragic exprimat
Focare de necroză în orofaringe
Ulceraţii cu depuneri fibrinoase
Şoc toxico-infecţios
Insuficienţă pulmonară
Insuficienţă renală
Sfârşit letal la 15-20%
Hantavirus sindrom febril
Măsurile antiepidemice în focare