Viral Hemorrhagic Fever: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate viral hemorrhagic fever (VHF):

Chikungunya fever

Chikungunya fever (incubation period* 3-12 days; manifestation rate: 72-95%) [second most common imported disease].

  • Acute rapid rise in fever
  • Cephalgia (headache)
  • Conjunctivitis (conjunctivitis)
  • Myalgia (muscle pain
  • Arthralgia (joint pain; polyarthralgia/pain in multiple joints; )
  • Synovitis (synovial inflammation) with joint swelling (25-40% of infected individuals).
  • Maculopapular (patchy, accompanied by papule formation) exanthema/generalized erythema (areal redness of the skin) (about 50% of infected persons).
  • Petechiae – punctate skin bleeding.

* Time period between the entry of a pathogen into the body and the appearance of the first symptoms. Further notes

Dengue fever

The spectrum of symptoms of dengue fever ranges from mild flu-like symptoms to serious complications such as hemorrhages (bleeding) or severe shock syndrome. Symptoms of classic dengue fever (DF) (incubation period: 4-7 (max. 14) days) [most common imported disease].

  • High fever (up to 40 °C, 48-96 hours) with brief drop in fever on day 3-4 (often but not always biphasic/”proceeding in two phases”).
  • Erythema (extensive reddening of the skin), especially on the face and chest, which can be pushed away; often with white dermographism (skin reaction visible a few seconds to minutes after moderately strong mechanical irritation (e.g., by a wooden spatula))
  • Exanthema (skin rash), maculopapular (patchy and with papules, i.e., vesicles):
    • Beginning on the dorsum of the hands and feet and then spreading to the proximal extremities and trunk (truncal), sparing the face [50% of patients have this after transient defever].
    • Nappes-claires-like recesses of unaffected skin (“islands of white in a sea of red”) are characteristic.
  • Mild bleeding signs (petechiae/punctate skin hemorrhages, bleeding from puncture sites).
  • Chills
  • Headache (frontal and retroorbital (“behind the eye socket”) headache/retrobulbar pain).
  • Conjunctivitis (conjunctivitis)
  • Photophobia (photophobia)
  • Back pain
  • Myalgia (muscle pain) and arthralgia (joint pain; “bone-crushing aspect”; “breakbone fever”/bone-crushing fever)
  • Generalized lymphadenopathy (lymph node enlargement) (esp. nuchal/in the neck region).
  • Splenomegaly (splenomegaly).
  • Conjunctivitis (conjunctivitis)
  • Bradycardia – too slow heartbeat: < 60 beats per minute.
  • Hypotension – low blood pressure
  • Transaminase increase – increase in liver enzymes [moderately increased].
  • Thrombocytopenia – decrease in platelets (thrombocytes) in the blood.
  • Lymphopenia – decrease in lymphocytes (white blood cells, which are divided into T and B lymphocytes) in the blood.

The convalescence is usually several weeks. Symptoms of mild atypical dengue fever.

  • Similar to classic dengue fever, but milder and short duration of three (to five) days maximum.

In rare cases, hemorrhages (bleeding) and shock can occur as complications already in a first infection – or in a second infection (there are 4 dengue serotypes). Symptoms of dengue hemorrhagic fever (DHS).

  • Rapid rise in fever
  • Headache
  • Nausea / vomiting
  • Dyspnea (shortness of breath)
  • Petechiae – punctate bleeding of the skin.
  • Purpura – small-spot capillary bleeding in the skin, subcutis or mucous membranes (skin hemorrhage).
  • Epistaxis (nosebleed)
  • Gastrointestinal bleeding (gastrointestinal bleeding).
  • Cerebral hemorrhages
  • Pneumonia (inflammation of the lungs)
  • Thrombocytopenia (decrease in platelets; platelet drop to < 100,000/µl → inpatient admission required).

Symptoms of severe dengue fever.

  • Dengue fever +
    • Capillary leak syndrome (synonym: Clarkson’s syndrome) – severe disease with generalized edema due to increased permeability of capillary vessels; subsequently, occurrence of severe hypovolemic shock (volume deficiency shock) associated with arterial hypotension (high blood pressure) with hemoconcentration (thickening of blood)
    • Dengue shock syndrome (DSS; see below).
    • Adult (Acute) Respiratory Distress Syndrome (ARDS) – acute respiratory failure in a previously lung-healthy individual.
    • Effusions
    • Or severe bleeding
    • Or organ dysfunction (e.g., transaminases > 1,000 IU/l; heart failure; impaired consciousness).

Symptoms of dengue shock syndrome (DSS; synonym: dengue vascular permeability syndrome (DVPS)) [2nd phase]

  • All DHS criteria (see above) + signs of shock:
    • Rapid, weak pulse with small pulse amplitude (< 20 mmHg).
    • Or hypotension (low blood pressure)
    • Cold sweats
    • Restlessness
  • Bleeding
  • Cardiovascular failure
  • Laboratory: increase in hematocrit (proportion of red blood cells (RBCs) in the volume of blood), thrombocytopenia (decreased number (<150,000/µl) of platelets (thrombocytes) in the blood), and hypoproteinemia (decreased concentration of total protein in blood plasma (<60 g/L)).

The lethality (mortality relative to the total number of people suffering from the disease) is up to 44%. Symptoms of convalescence [3rd phase].

Ebola/Marburg hemorrhagic fever

Ebola/Marburg hemorrhagic fever (incubation period: Ebola: 2-21 (4-10) days; Marburg hemorrhagic fever: (3) 5-7 (10) days).

  • Acute (sudden) onset fever (89%).
  • Cephalgia (headache) (80%)
  • Weakness (66%)
  • Dizziness (60%)
  • Myalgia (muscle pain)
  • Conjunctivitis (conjunctivitis)
  • Pharyngitis (pharyngitis)
  • Nausea (nausea)
  • Exanthema (skin rash), unspecified
  • Mucosal bleeding from day 5-7.
  • Ecchymoses (small-area skin bleeding).
  • Gastrointestinal symptoms nausea/nausea, vomiting (34%), abdominal pain/abdominal pain (40%), diarrhea/diarrhea (51%).
  • Oliguria (decreased urine output: 100-500 ml/d).
  • Anuria (urinary output: < 100 ml/d).
  • Encephalitis (inflammation of the brain)
  • Thrombocytpenia (too few platelets (thrombocytes) in the blood).
  • Lymphopenia (lack of lymphocytes (defense cells) in the blood).
  • Transaminases (“liver blood levels”) ↑
  • Profuse bleeding (0.9%)

Relative frequencies in round brackets

Yellow fever

Yellow fever (incubation period is usually 3-6 days).

1st phase

  • Acute onset of illness with high fever, chills.
  • Bradycardia – pulse at < 60 beats/min.
  • Cephalgia (headache)
  • Myalgia (muscle pain)
  • Epistaxis (nosebleed)
  • Nausea (nausea)/vomiting

These symptoms usually persist for a few days. Most patients are recovered thereafter. In up to 15% of infected people, it then comes to a 2nd phase of the disease. 2nd phase (toxic phase)

  • Bradycardia – pulse with < 60 beats/min.
  • Diarrhea (diarrhea), bloody
  • High fever
  • Icterus (jaundice)
  • Hematemesis (vomiting blood; coffee grounds vomiting).
  • Neurological disorders, which may be manifested by speech disorders, movement disorders, or convulsions, among other symptoms
  • Renal dysfunction, which can lead to anuria (less than 100 ml of urine in 24 hours).

In addition, there may be bleeding in the organs and skin

Especially in children usually occur very mild courses. The disease can also be asymptomatic, that is, there are no symptoms.

Crimean-Congo hemorrhagic fever (CCHF)

Crimean-Congo hemorrhagic fever (CCHF) (incubation period: 2-13 days).

  • Acute-onset fever
  • Chills
  • Strong feeling of illness
  • Cephalgia (headache)
  • Eye pain
  • Conjunctivitis (inflammation of the conjunctiva)
  • Meningismus (neck stiffness) and photophobia (photophobia) are signs of the acute onset of the disease.
  • After 2-4 days, the patient becomes increasingly sleepy
  • Myalgia (muscle pain)
  • Arthralgia (joint pain)
  • Relative bradycardia – the increase in heart rate that normally occurs with fever is absent
  • Mental abnormalities such as confusion, aggressiveness, mood swings.
  • Petechiae (pinpoint skin bleeding), especially on the chest and abdomen (in 20% of cases, on the 3-5th day of illness).
  • Ecchymoses – small-area skin bleeding.
  • Nausea (nausea)
  • Diarrhea (diarrhea)
  • Abdominal pain (abdominal pain)
  • Generalized swelling of the lymph nodes
  • Hepatomegaly (enlargement of the liver)
  • Bleeding (up to 20% of those affected).

The clinical picture ranges from inapparent (inconspicuous) or flu-like courses to the picture of hemorrhagic fever with high lethality (mortality). Lassa fever

Lassa fever (incubation period: (3) 7-10 (21) days).

  • High fever (up to 41 °C possible).
  • Cephalgia (headache)
  • Sore throat
  • Gastrointestinal discomfort (gastrointestinal discomfort).
  • Myalgia (muscle pain), pronounced.
  • Cough
  • Nausea (nausea)/vomiting
  • Abdominal pain (abdominal pain)
  • Swelling of the eyelids / face
  • Conjunctivitis (inflammation of the conjunctiva)
  • Proteinuria – increased excretion of protein in the urine.
  • Hypotension – too low blood pressure
  • Pharyngitis (pharyngitis), possibly with glottic edema (swelling of the laryngeal mucosa).

Often clinically mild courses!

Rift Valley fever

Rift Valley fever (incubation period 2-6 days).

  • Nonspecific symptoms
  • Cephalgia (headache)
  • Myalgia (muscle pain
  • After 3-4 days fulminant hemorrhagic fever
  • Hepatitis (inflammation of the liver)
  • Encephalitis (inflammation of the brain)

West Nile fever

West Nile fever (incubation period 3-6 days).

Main symptoms

  • Fever, abrupt onset (biphasic course/twophasic).
  • Chills
  • Fatigue
  • Emesis (vomiting)
  • Exanthema (rash), pale and maculopapular (blotchy and with papules, ie with vesicles), from the trunk to the head and limbs.
  • Headache and pain in the limbs
  • Lymphadenopathy (lymph node enlargement) (sometimes).
  • Myalgia (muscle pain)
  • Back pain (deep seated)
  • Neuroinvasive symptoms (approximately 1% of sufferers):
    • Meningitis (meningitis).
    • Encephalitis (inflammation of the brain)
    • Optic neuritis (inflammation of the optic nerve)
    • Polyradiculitis (inflammation of multiple nerve roots).
    • Ataxia (gait disorder)
    • Epileptic seizures (convulsive seizures)
    • Paresis (paralysis)

Other notes