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clinical manifestations and severity. Among the VHFs are Ebola and Marburg, certain Hantavirus infections,
Argentinian and Bolivian hemorrhagic fevers, Lassa fever, Crimean-Congo hemorrhagic fever, and yellow
fever. Incubation periods vary from several days to as long as several weeks.
Subjective: Symptoms
Fever, malaise, myalgias, headache, photophobia, vomiting, diarrhea, abdominal pain, cough and dizziness.
Objective: Signs
Using Basic Tools: Commonly seen: fever, GI bleeding, pulmonary hemorrhage, facial flushing, conjunctival
injection, petechiae, purpura, bleeding from the mucous membranes, and skin ecchymoses. Other symptoms:
hematuria, hypotension, shock, edema, hepatic tenderness (hepatic failure), pharyngitis, hyperesthesias.
Using Advanced Tools: Lab: Blood culture to rule out meningococcemia and typhoid fever.
Assessment:
Differential diagnosis - any cause of a bleeding, diathesis or disseminated intravascular coagulation (both
conventional causes as well as plague): dengue (which can cause hemorrhagic fever but is not transmissible
by aerosol), malaria, typhoid fever, meningococcemia, rickettsial diseases, leptospirosis, shigellosis, fulminant
hepatitis, leukemia, lupus, hemolytic-uremic syndrome, and thrombocytopenic purpuras. Most of these
conditions are discussed in this book and can be differentiated based on differences in presentation and
laboratory findings.
Plan:
Treatment
Primary: Supportive (oxygen, intravenous fluids, and antipyretics). Avoid aspirin and IM injections to avoid
additional bleeding.
Patient Education
General: Many VHFs are contagious; caregivers should employ contact precautions when dealing with
patients. At a minimum, this entails wearing gloves when touching the patient and disinfecting medical
equipment (such as stethoscopes) between patient encounters.
Prevention: A licensed vaccine is available for yellow fever. In the presence of endemic yellow fever
personnel should be immunized.
Follow-up Actions
Evacuation/Consultant Criteria: Consult early with preventive medicine experts. Isolate and do not evacuate
patient. Quarantine contacts for 21 days (incubation period) to ensure they will not be secondary cases.
Shorten the quarantine period to reflect the appropriate incubation period when a definitive diagnosis is
available.
NOTES: Advanced treatments and diagnostic tests will not be available in a field setting. Intravenous
ribavirin may be beneficial in certain VHFs (Argentinian & Bolivian hemorrhagic fevers, Lassa fever,
Hantavirus infection). The platelet count, PT, PTT, and serum protein levels are likely to be abnormal in VHF
patients, but such findings are not diagnostic. Lumbar punctures may be necessary to rule out meningitis in
patients with meningeal signs and/or altered mental status.
Chapter 27: CBR: Radiation Injury
Lt Col Aimee Hawley, USAF, MCIntroduction: Acute radiation injury results from high doses of radiation associated with a nuclear explosion,