Hemorrhagic Fever: Symptoms, Causes & Treatment

Hemorrhagic fever is a serious illness that can cause symptoms such as a sudden high fever, severe headache, purple or red spots on the skin, and bleeding from the eyes, mouth, nose, or ears. Blood may also appear in the urine, stool, or vomit.

Hemorrhagic fever can develop as a severe complication of infections such as dengue, yellow fever, leptospirosis, Ebola, or malaria. These infections can damage blood vessels, interfere with normal blood clotting, and cause severe bleeding.

Hemorrhagic fever requires emergency hospital care from a medical team that may include infectious disease, critical care, and hematology specialists. Treatment may involve intravenous fluids, medications, oxygen therapy, and other supportive care.

Main symptoms

The main symptoms of hemorrhagic fever include:

• A sudden high fever above 100.4°F (38°C)

• Purple or red spots on the skin

• Pain behind the eyes or joint pain

• Severe headache

• Extreme fatigue and muscle pain

• Blood in vomit

• Bleeding from the eyes, mouth, nose, or ears, or blood in the urine or stool

If it is not treated quickly, hemorrhagic fever can affect several organs, including the liver, spleen, lungs, kidneys, and brain. It may also cause seizures or coma.

Anyone with symptoms of hemorrhagic fever should go to an emergency room immediately. Prompt treatment can help prevent life-threatening complications.

What is dengue hemorrhagic fever?

Dengue hemorrhagic fever is a serious complication of dengue that may develop after the initial infection. It interferes with normal blood clotting, which increases the risk of bleeding.

Symptoms may include bleeding gums, blood in the vomit or stool, confusion, or difficulty breathing.

Confirming a diagnosis

Hemorrhagic fever is evaluated in an emergency or hospital setting based on the person's symptoms, medical history, possible exposures, and recent travel. The medical team may include emergency physicians, infectious disease specialists, and other specialists as needed.

The healthcare team will perform a physical examination and review recent travel to areas where viral hemorrhagic fevers are present, as well as any contact with infected people, animals, or bodily fluids.

Routine tests may include a complete blood count (CBC), coagulation panel, liver and kidney function tests, urinalysis, and blood cultures. These tests help assess the person's condition and rule out other possible infections.

Confirmatory testing depends on the suspected virus and may include RT-PCR or virus-specific IgM and IgG antibody tests. 

Possible causes

The main causes of hemorrhagic fever include:

• Dengue

• Yellow fever or typhoid fever

• Malaria

• Leptospirosis

• Ebola

The microorganisms responsible for these infections can trigger a severe inflammatory response, increase blood vessel permeability, and interfere with normal blood clotting. These changes can result in bleeding or severe hemorrhage.

Main viruses

The main viruses that cause hemorrhagic fever are:

1. Arenaviruses

Arenaviruses belong to the Arenaviridae family and are an important group of viruses associated with hemorrhagic fever.

These viruses may be transmitted through contact with the urine or feces of infected rodents. Some arenaviruses may also spread through respiratory droplets or direct contact with an infected person.

The incubation period is generally 10 to 14 days, and symptoms may begin suddenly.

2. Hantaviruses

Hantavirusees can cause hemorrhagic fever and are mainly transmitted by inhaling airborne particles contaminated with the urine, feces, or saliva of infected rodents.

Symptoms may develop between 3 and 60 days after infection. In North and South America, hantavirus infection can cause hantavirus cardiopulmonary syndrome (HCPS).

In other regions, including parts of Asia and Europe, hantaviruses may cause hemorrhagic fever with renal syndrome.

3. Enteroviruses

Enterovirus infections caused by viruses such as echoviruses, enteroviruses, and coxsackieviruses may cause illnesses with skin rashes. In some cases, these infections may become severe and cause bleeding-related complications.

Other bacterial infections may also cause a rash or red spots on the skin and, in severe cases, can lead to bleeding complications. Examples include typhoid fever, meningococcal disease, and spotted fever rickettsiosis, including Rocky Mountain spotted fever.

4. Dengue and Ebola viruses

Dengue and Ebola viruses can both cause severe illnesses involving bleeding.

Dengue is transmitted through the bite of an infected Aedes aegypti mosquito. Severe dengue can interfere with blood clotting and increase the risk of bleeding.

Ebola spreads through direct contact with the blood, vomit, urine, feces, saliva, semen, or other body fluids of an infected person. The infection is highly aggressive and can also affect the liver and kidneys.

Ebola is more common in certain regions of Africa.

5. Bunyaviruses

Viruses historically classified as bunyaviruses include Crimean-Congo hemorrhagic fever virus, which causes Crimean-Congo hemorrhagic fever.

This virus is transmitted through the bite of infected Hyalomma ticks. It can cause internal and external bleeding as well as kidney failure.

Brazilian hemorrhagic fever

Brazilian hemorrhagic fever is an extremely rare viral illness caused by Sabiá virus, an arenavirus first identified in Brazil. Only a small number of human cases have been reported.

Sabiá virus is believed to be associated with rodents, as are other South American arenaviruses. However, its natural reservoir, transmission routes, and incubation period are not fully understood.

The illness may begin with fever, headache, muscle pain, nausea, or vomiting and can rapidly progress to severe bleeding, shock, coma, or death.

Treatment options

Treatment for hemorrhagic fever generally requires hospitalization and care from a team that may include emergency physicians, infectious disease specialists, critical care physicians, hematologists, and other healthcare professionals.

The main treatments for hemorrhagic fever may include:

• Intravenous fluids to maintain hydration and blood pressure
• Medications to control fever, pain, nausea, or vomiting
• Antiviral treatment, such as ribavirin, for certain arenavirus infections
• Oxygen therapy or mechanical ventilation

According to the US Food and Drug Administration, the monoclonal antibody treatments Inmazeb, which contains atoltivimab, maftivimab, and odesivimab-ebgn, and Ebanga, which contains ansuvimab-zykl, are approved for treating infection caused by Zaire ebolavirus in adults and children.

People with suspected or confirmed viral hemorrhagic fever are placed in isolation in the hospital, and healthcare workers follow strict infection-control precautions to reduce the risk of transmission.

How to prevent

To reduce the risk of infection, keep the environment clean, eliminate standing water, and use insect repellent to prevent mosquito bites, particularly bites from Aedes aegypti mosquitoes.

It is also important to avoid contact with infected people or animals, wash food thoroughly, drink safe or filtered water, and avoid contact with floodwater.

According to the CDC, Dengvaxia is the only dengue vaccine approved for use in the United States and is recommended for children ages 9 through 16 who have laboratory-confirmed previous dengue infection and live in a dengue-endemic area.