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Symptoms
By Mayo Clinic staffThe VHF designation includes a broad range of diseases. Signs and symptoms can vary widely, even among members of the same viral family. But VHFs do have some common characteristics, especially in their effects on your vascular system — the network of arteries, veins and capillaries that circulates blood throughout your body.
Hemorrhagic fevers make blood vessels more permeable — that is, more likely to leak — causing bleeding that can range from relatively minor to massive. Bleeding may occur under your skin, in internal organs, and from your mouth, eyes, ears and rectum. People with severe bleeding may experience potentially lethal signs and symptoms such as shock and coma, but rarely die of blood loss.
In general, signs and symptoms of most VHFs begin two days to two weeks after you've been exposed to the virus. Typically, VHFs begin with fever and muscle aches; many cause vomiting and diarrhea; and all create problems in a number of organ systems, especially your liver, lymphatic system, lungs and sometimes your kidneys.
Problems more specific to diseases within each of the four families of viruses that cause viral hemorrhagic fevers are listed below.
Arenaviruses
This viral family includes Lassa fever, Argentine hemorrhagic fever, Bolivian hemorrhagic fever, Brazilian hemorrhagic fever and Venezuelan hemorrhagic fever. If you've been exposed to one of these illnesses, you're likely to experience some of the following signs and symptoms:
- Fever, which may be constant or intermittent
- Pain behind your chest wall and in your back
- A sore and inflamed throat with white patches on your tonsils
- Cough
- Abdominal pain
- Vomiting
- Diarrhea
- Conjunctivitis, an inflammation of the transparent membrane (conjunctiva) that covers your eyelids and part of your eyeballs
- Bleeding from your gums or in your stomach, small intestine and other internal organs
- Facial swelling
- Temporary or permanent hearing loss
- Fluid around your lungs (pleural effusion)
- Encephalitis, a life-threatening inflammation of the brain
Bunyaviruses
Included in this group of VHFs are Rift Valley fever, Crimean-Congo hemorrhagic fever, hemorrhagic fever with renal syndrome, and hantavirus pulmonary syndrome. Depending on the type of virus involved, signs and symptoms of bunyaviruses may include:
- Fever
- Severe muscle aches
- Sore throat
- Headache
- Cough
- Diarrhea
- Encephalitis
- In the case of Crimean-Congo hemorrhagic fever, sore eyes and sensitivity to light (photophobia); mood swings and agitation; bleeding into the skin and from the gums, rectum and kidneys; and eventual pulmonary failure
- In the case of hantavirus pulmonary syndrome, shortness of breath and difficulty breathing, possibly leading to respiratory failure
Filoviruses
This viral family consists of the Ebola virus and Marburg viruses, which are among the most virulent of all known diseases.
Signs and symptoms appear within two days to two weeks of infection and initially include those common to other VHFs: fever, intense weakness, muscle pain, vomiting and diarrhea. As the disease progresses, some people also develop:
- A distinctive, hemorrhagic rash, often appearing around the fifth day
- Bleeding from the nose, mouth, eyes, ears and rectum
- Seizures
- Coma
- Delirium
Depending on the strain, Ebola and Marburg viruses are fatal in 50 to 90 percent of infected people and are almost always fatal in pregnant women.
Flaviviruses
This group includes yellow fever, dengue fever, dengue hemorrhagic fever, Kyasanur Forest disease and Omsk hemorrhagic fever. Yellow fever and dengue fever are probably the most well known VHFs. Dengue is a major public health concern, with 50 million cases a year occurring worldwide, including major epidemics at popular tourist destinations.
Yellow fever. Yellowing of the skin and eyes (jaundice) is the hallmark sign of yellow fever. Other common signs and symptoms include fever, headache, muscle aches, facial flushing and sensitivity to light.
Dengue fever. Signs and symptoms of dengue fever vary with age. Infants and young children usually develop a rash and severe, flu-like symptoms, whereas older children and adults may experience a high fever, severe headache, eye pain, muscle aches and rash. In the hemorrhagic form, an extremely high fever may be accompanied by bleeding, convulsions and circulatory failure.
Kyasanur Forest disease and Omsk hemorrhagic fever. Both conditions are biphasic diseases, meaning that the initial signs and symptoms are followed by a brief period of recovery before they reappear. No matter when they occur, signs and symptoms of these two diseases generally include:
- Fever, which may be constant or intermittent
- Headache
- Pain behind your eyes
- Pain in your arms and legs
- A rash on the soft palate of your mouth
- Swollen glands in your neck
- Diarrhea
- Vomiting
- Bleeding in your eyes
- Nosebleeds
- Bleeding in your gastrointestinal tract
When to see a doctor
The best time to see a doctor is before you travel to a developing country to ensure you've received any available vaccinations and pre-travel advice for staying healthy.
If you suspect you've been exposed to a VHF virus in your travels, see a doctor immediately. If you become ill while traveling in a foreign country, call the U.S. Consulate for a list of doctors. Better yet, find out in advance about medical care in the areas you'll visit, and carry a list of the names, addresses and phone numbers of recommended English-speaking doctors. Your doctor, local or state medical society, the International Association for Medical Assistance to Travellers or the Department of State's Office of Overseas Citizens Services can help provide the information you need. In addition, some experts strongly advise purchasing medical evacuation insurance before you travel.
If you develop signs and symptoms once you return home, consider consulting a doctor who focuses on international medicine or infectious diseases. A specialist may be able to recognize and treat your illness faster. Be sure to let your doctor know what areas you've visited.
