Viral hemorrhagic fevers

Abstract

A 15-year-old European boy, who had been in Kenya for 1 month, was admitted to the hospital with a 3-day history of headache, malaise, anorexia, fever, and vomiting. Throughout the course of the illness, he developed copious bloody diarrhea, hypotension, leukocytosis, thrombocytopenia, and prolonged prothrombin and partial thromboplastin times consistent with disseminated intravascular coagulation (DIC). Despite intensive supportive therapy, which included antibiotics, steroids, heparin, fresh plasma, and blood transfusions, his condition steadily deteriorated, and he died on the 11th day of illness. Based on the characteristic clinical picture, provisional diagnoses were either viral hemorrhagic fever or, less likely, typhoid fever with “extreme toxicity.” An autopsy was performed soon after death. Postmortem examination showed extensive petechial and purpuric hemorrhage in the skin, conjunctiva, and gastrointestinal mucosa. Blood-tinged pleural, pericardial, and peritoneal effusions were copious, and retroperitoneal edema was striking. The lungs and tracheobronchial tree were hemorrhagic. Multiple petechial hemorrhages were observed on the epicardium, renal cortex and pelvis, and urinary bladder. Marburg virus was isolated from fluids and tissues and was identified in tissues by immunohistochemistry, electron microscopy, and immunoelectron microscopy (1).