A history of travel or work in endemic regions in South America, contact with rodents or their excreta, and development of haemorrhagic symptoms are key to diagnosis of South American haemorrhagic fevers.
Often presents with non-specific influenza-like or dengue-like symptoms in the first week of illness; around 20% to 30% go on to develop haemorrhagic or neurological symptoms in the second week, which often results in multi-organ failure and death.
Healthcare workers should use full personal protective equipment and ensure laboratory samples are appropriately labelled and transported.
Diagnosis is confirmed by reverse transcription-polymerase chain reaction (RT-PCR).
Mainstay of treatment for all symptomatic patients is supportive care.
South American haemorrhagic fevers (SAHFs) are viral infections that may result in haemorrhage and organ malfunction, which often leads to death. The viral infections are caused by clade B New World arenaviruses (family Arenaviridae; genus Mammarenavirus) that naturally infect rodents, but can be passed to humans mainly through aerosolisation of and mucous membrane contact with infected rodent secretions and excreta. While uncommon, these viruses can be transmitted between humans through contact with infected bodily fluids (e.g., saliva, urine, faeces, blood). Nosocomial and laboratory spread have also been described.
SAHFs occur in Bolivia, Argentina, Venezuela, and Brazil. Different viruses are responsible for causing disease in these countries; for example, Chapare and Machupo viruses in Bolivia, Guanarito virus in Venezuela, Junin virus in Argentina, and Sabia virus in Brazil. This is due to the presence of different rodent vectors in each country.
Other New World arenaviruses that have been reported to cause clinical disease in humans include Flexal virus (Brazil) and Tacaribe virus (Trinidad); however, they are not regarded as viral haemorrhagic fever viruses. Furthermore, very few cases have been reported, and all have resulted from laboratory exposure.
History and exam
Key diagnostic factors
- presence of risk factors
- fever ≥37.5°C
- bleeding (gums, epistaxis, gastrointestinal, metrorrhagia)
Other diagnostic factors
- abdominal pain
- neurological symptoms (e.g., confusion, ataxia, seizures)
- sore throat
- occupational exposure
- exposure to relevant rodent species
- adult males
- contact with infected person
- dwelling in endemic area
1st investigations to order
- reverse transcription-polymerase chain reaction (RT-PCR)
- enzyme-linked immunosorbent assay (ELISA)
Investigations to consider
- malaria screen
- blood culture
- electrolytes and renal function
- liver function
- coagulation screen
- lactate dehydrogenase
- creatine phosphokinase
- arterial blood gas
Nathalie MacDermott, MBBCh
Wellcome Clinical Research Training Fellow
Imperial College London
NMD declares that she has no competing interests.
Thomas G. Ksiazek, DVM, PhD
University of Texas Medical Branch (UTMB) at Galveston
TGK has grants and contracts from NIH but is not involved in drug or vaccine research relating to South American haemorrhagic fevers. He has patents in regard to Ebola, Rift Valley fever, and hantaviruses. TGK is an author of a reference cited in this topic.
Stalin Vilcarromero, MD
US Naval Medical Research Unit 6 (NAMRU-6)
SV declares that he has no competing interests.
Vanessa Raabe, MD, MSc
Adult and Pediatric Infectious Disease Fellow
VR declares that she has no competing interests.
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