Febrele Febrele hemoragicehemoragice

Clasificarea febrelor hemoragiceClasificarea febrelor hemoragice

Transmise de căpuşeTransmise de căpuşe FH Crimea-CongoFH Crimea-Congo FH de OmscFH de Omsc FH de KiasanurFH de Kiasanur

Transmise de ţânţariTransmise de ţânţari Febra galbenăFebra galbenă Febra DengheFebra Denghe Febra CicunguniaFebra Cicungunia Febra văii RiftFebra văii Rift

De contactDe contact FH cu sindrom renalFH cu sindrom renal Febra LassaFebra Lassa Febra MarburgFebra Marburg Febra EbolaFebra Ebola Febra de ArgentinaFebra de Argentina Febra de BoliviaFebra de Bolivia Febra de BraziliaFebra de Brazilia Febra de VenesuelaFebra de Venesuela

Four distinct viral families: Filoviridae • Ebola• MarburgArenaviridae • 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• HantavirusFlaviviridae • Dengue• Yellow fever• Omsk hemorrhagic fever• Kyasanur Forest disease

Căpuşele – vectori de transmitere a febrelor Căpuşele – vectori de transmitere a febrelor hemoragicehemoragice

Animals:Animals: Numerous wild and domestic animals, such as cattle, Numerous wild and domestic animals, such as cattle,

goats, sheep, and hares, serve as amplifying hostsgoats, sheep, and hares, serve as amplifying hostsFiloviridae: Filoviridae:

Same clinical course as that of humansSame clinical course as that of humans High primate mortality rate: ~ 82%High primate mortality rate: ~ 82%

Bunyaviridae: Bunyaviridae: CCHF- unapparent infection in livestockCCHF- unapparent infection in livestock RVF- 100% abortion rate and mortality rate of > 90% in RVF- 100% abortion rate and mortality rate of > 90% in

young animals and 5-60% in older animalsyoung animals and 5-60% in older animals Hantavirus – unapparent infection in rodentsHantavirus – unapparent infection in rodents

Flaviviridae: Flaviviridae: Non-human primates – varying clinical signs (Yellow Non-human primates – varying clinical signs (Yellow

fever); no clinical signs (Dengue)fever); no clinical signs (Dengue) Livestock – no symptoms (Kyasanur Forest Disease)Livestock – no symptoms (Kyasanur Forest Disease) Rodents – no symptomsRodents – no symptoms

Humans:Humans: Clinical signs and symptoms vary by the type of VHFClinical signs and symptoms vary by the type of VHF Patients usually present with the following clinical signs and Patients usually present with the following clinical signs and

symptoms: symptoms: Fever ³ 38.3°C of < 3 week durationFever ³ 38.3°C of < 3 week durationFatigueFatigueDizzinessDizzinessMuscle achesMuscle achesLoss of strengthLoss of strengthExhaustionExhaustionAt least two of the following: At least two of the following:

Hemorrhagic or purple rashHemorrhagic or purple rashEpistaxisEpistaxisHemoptysisHemoptysisBlood in stoolsBlood in stoolsPetechiae in nondependent areasPetechiae in nondependent areas

No predisposing factors for hemorrhage and no established No predisposing factors for hemorrhage and no established alternative diagnosisalternative diagnosis

Filoviridae: Filoviridae:

Most severe hemorrhagic fevers with abrupt onset and death Most severe hemorrhagic fevers with abrupt onset and death around day 7 to 11; painful recoveryaround day 7 to 11; painful recovery

Incubation: 4 to 10 daysIncubation: 4 to 10 days Case fatality: 23-33% (Marburg) and 53-88% (Ebola)Case fatality: 23-33% (Marburg) and 53-88% (Ebola)

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

Bunyaviridae: Bunyaviridae:

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

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

Flaviviridae Flaviviridae Incubation: 2 to 6 daysIncubation: 2 to 6 days Case fatality: 1-10% (Dengue); 3-5% (Kyasanur Forest virus); 0.5-Case fatality: 1-10% (Dengue); 3-5% (Kyasanur Forest virus); 0.5-

3% (Omsk hemorrhagic fever); varies (Yellow fever)3% (Omsk hemorrhagic fever); varies (Yellow fever)

Febra hemoragică Crimea-CongoFebra hemoragică Crimea-Congo

Febra hemoragică Crimea-CongoFebra hemoragică Crimea-Congo

Febra hemoragică cu sindrom renalFebra hemoragică cu sindrom renal

Virusul Ebola Virusul MarburgVirusul Ebola Virusul MarburgFamilia FilivirusuriFamilia Filivirusuri

Febra hemoragică Ebola şi MarburgFebra hemoragică Ebola şi Marburg

Manifestări clinice în FH Ebola şi MarburgManifestări clinice în FH Ebola şi Marburg

Debut brusc cu frisonDebut brusc cu frison

Febră înaltăFebră înaltă

Cefalee intensăCefalee intensă

MialgiiMialgii

Dureri în abdomenDureri în abdomen

DiareeDiaree

VomaVoma

Tusă şi dureri în toraceTusă şi dureri în torace

Sindrom hemoragic exprimatSindrom hemoragic exprimat

Erupţii hemoragice la 4-5 ziErupţii hemoragice la 4-5 zi

HepatomegalieHepatomegalie

Afectarea renalăAfectarea renală

Letalitatea – până la 80%Letalitatea – până la 80%

Febra de Argentina şi de BoliviaFebra de Argentina şi de Bolivia

Debut lent cu temperaturaă Debut lent cu temperaturaă subfebrilăsubfebrilă Cefalee, mialgiiCefalee, mialgii Enantemă hemoragică la 2-3 ziEnantemă hemoragică la 2-3 zi Semne cataraleSemne catarale Hiperemia feţii, conjunctiveiHiperemia feţii, conjunctivei Perioada de stare cu sindrom Perioada de stare cu sindrom hemoragic exprimathemoragic exprimat afectarea renală cu oligurieafectarea renală cu oligurie encefalită encefalită Letalitatea 10-20%Letalitatea 10-20%

Massive cutaneous ecchymosis

Febra LassaFebra Lassa

Debut bruscSindrom de intoxicaţie exprimatSindrom dispeptic cu greaţă, vomă, diareeLimfadenopatie cervicalăSindrom hemoragic exprimatFocare de necroză în orofaringeUlceraţii cu depuneri fibrinoaseŞoc toxico-infecţiosInsuficienţă pulmonarăInsuficienţă renalăSfârşit letal la 15-20%

Hantavirus sindrom febrilHantavirus sindrom febril

Diagnosticul de laboratorDiagnosticul de laborator

Măsurile antiepidemice în focareMăsurile antiepidemice în focare