A98.0-4/A98.8/A99
* Notifiable medical condition.
Severe bacterial infections can mimic the features of haemorrhagic fever syndrome, and broad spectrum antibiotics, e.g. ceftriaxone, IV, 2 g daily, are indicated in every case until the diagnosis is confirmed.
DESCRIPTION
High fever, together with disseminated intravascular coagulation (DIC) and bleeding tendency. Other symptoms and organ involvement vary according to the causative virus.
Some important causes other than viral haemorrhagic fevers (VHF) are:
- severe bacterial infections, particularly N. meningitidis,
- severe tick bite fever,
- severe falciparum malaria,
- fulminant hepatitis,
- leptospirosis, and
- other causes for DIC or bleeding tendency.
Endemic causes of VHF in South Africa are Crimean-Congo fever and Rift Valley Fever, both of which may be transmitted between humans by means of blood and body fluids.
REFERRAL
All suspected VHF cases need to be discussed and managed in consultation with the Regional Virologist or Infectious Diseases Consultant at the referral centre.
Cases may also be discussed with the Special Pathogens Unit of the National Institute for Communicable Diseases (NICD):
Tel: 011 386 6000, Outbreak hotline: 082 883 9920
Transfer of patients will only occur once all relevant arrangements have been made to limit further exposure to a potentially contagious and life threatening virus.
MANAGEMENT
A detailed travel and clinical history is crucial. If VHF is still considered, isolate patient in a single room and take proper precautions to limit further exposure. These include:
- long sleeved disposable gown,
- vinyl or rubber apron if the patient is bleeding,
- two pairs of latex gloves, one below the gown and one over the gown,
- disposable face mask preferably with a visor,
- goggles if a mask without the visor is used, and
- waterproof boots or 2 pairs of overshoes, one over the other.
Exclude alternate diseases by means of appropriate laboratory testing.
Support patients with packed red cells and fresh frozen plasma, as required.
Testing for VHF may be required, both to confirm or exclude the possibility of VHF - this must be arranged with the NICD (see above), before sending the specimens, as specific precautions apply.
Record and follow up all patient contacts.