Marburg hemorrhagic fever differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Marburg hemorrhagic fever}}
{{Marburg hemorrhagic fever}}
{{CMG}}{{AE}}
{{CMG}} ; {{AE}} {{ADG}}
 
==Overview==
==Overview==
Marburg hemorrhagic fever must be differentiated from other viral hemorrhagic fevers that may cause fever, abdominal pain,and bleeding such as [[Ebola]], [[Crimean-Congo hemorrhagic fever]] (CCHF), [[Hantavirus infection|Hantavirus Infection]], [[Rift valley fever|Rift Valley fever]], Lujo hemorrhagic fever and [[Lassa fever]]. SInce many of the signs and symptoms of marburg hemorrhagic fever are similar to those of other infectious diseases such as [[malaria]] or [[Typhoid fever|typhoid]] fever, [[leptospirosis]], marburg hemorrhagic fever must also be differentiated from those infections.
==Differentiating Marburg Hemorrhagic Fever from other Diseases==
==Differentiating Marburg Hemorrhagic Fever from other Diseases==
Marburg hemorrhagic fever must be differentiated from other diseases that may cause fever, abdominal pain, diarrhea, vomiting and bleeding such as:
Marburg hemorrhagic fever must be differentiated from other viral hemorrhagic fevers that may cause fever, abdominal pain,and bleeding such as [[Ebola]], [[Crimean-Congo hemorrhagic fever]] (CCHF), [[Hantavirus infection|Hantavirus Infection]], [[Rift valley fever|Rift Valley fever]], Lujo hemorrhagic fever and [[Lassa fever]]. SInce many of the signs and symptoms of marburg hemorrhagic fever are similar to those of other infectious diseases such as [[malaria]] or [[Typhoid fever|typhoid]] fever, [[leptospirosis]], marburg hemorrhagic fever must also be differentiated from those infections.<ref name="pmid11292640">{{cite journal |vauthors=Levett PN |title=Leptospirosis |journal=Clin. Microbiol. Rev. |volume=14 |issue=2 |pages=296–326 |year=2001 |pmid=11292640 |pmc=88975 |doi=10.1128/CMR.14.2.296-326.2001 |url=}}</ref><ref name="urlMarburg Hemorrhagic Fever (Marburg HF) | CDC">{{cite web |url=https://www.cdc.gov/vhf/marburg/index.html |title=Marburg Hemorrhagic Fever (Marburg HF) &#124; CDC |format= |work= |accessdate=}}</ref><ref name="urlChapare Hemorrhagic Fever (CHHF) | CDC">{{cite web |url=https://www.cdc.gov/vhf/chapare/index.html |title=Chapare Hemorrhagic Fever (CHHF) &#124; CDC |format= |work= |accessdate=}}</ref><ref name="urlLassa Fever | CDC">{{cite web |url=https://www.cdc.gov/vhf/lassa/index.html |title=Lassa Fever &#124; CDC |format= |work= |accessdate=}}</ref><ref name="urlLujo Hemorrhagic Fever (LUHF) | CDC">{{cite web |url=https://www.cdc.gov/vhf/lujo/index.html |title=Lujo Hemorrhagic Fever (LUHF) &#124; CDC |format= |work= |accessdate=}}</ref><ref name="urlLymphocytic Choriomeningitis (LCM) | CDC">{{cite web |url=https://www.cdc.gov/vhf/lcm/index.html |title=Lymphocytic Choriomeningitis (LCM) &#124; CDC |format= |work= |accessdate=}}</ref><ref name="urlCrimean-Congo Hemorrhagic Fever (CCHF) | CDC">{{cite web |url=https://www.cdc.gov/vhf/crimean-congo/index.html |title=Crimean-Congo Hemorrhagic Fever (CCHF) &#124; CDC |format= |work= |accessdate=}}</ref><ref name="urlCDC - Hantavirus Pulmonary Syndrome (HPS) - Hantavirus">{{cite web |url=https://www.cdc.gov/hantavirus/hps/index.html |title=CDC - Hantavirus Pulmonary Syndrome (HPS) - Hantavirus |format= |work= |accessdate=}}</ref><ref name="urlRift Valley Fever | CDC">{{cite web |url=https://www.cdc.gov/vhf/rvf/index.html |title=Rift Valley Fever &#124; CDC |format= |work= |accessdate=}}</ref><ref name="urlEbola Hemorrhagic Fever | CDC">{{cite web |url=https://www.cdc.gov/vhf/ebola/index.html |title=Ebola Hemorrhagic Fever &#124; CDC |format= |work= |accessdate=}}</ref><ref name="urlAlkhurma Hemorrhagic Fever (AHF) | CDC">{{cite web |url=https://www.cdc.gov/vhf/alkhurma/index.html |title=Alkhurma Hemorrhagic Fever (AHF) &#124; CDC |format= |work= |accessdate=}}</ref><ref name="urlKyasanur Forest Disease (KFD) | CDC">{{cite web |url=https://www.cdc.gov/vhf/kyasanur/index.html |title=Kyasanur Forest Disease (KFD) &#124; CDC |format= |work= |accessdate=}}</ref><ref name="urlOmsk Hemorrhagic Fever | CDC">{{cite web |url=https://www.cdc.gov/vhf/omsk/index.html |title=Omsk Hemorrhagic Fever &#124; CDC |format= |work= |accessdate=}}</ref><ref name="pmid28791003">{{cite journal |vauthors=Yap SSL, Nguyen-Khuong T, Rudd PM, Alonso S |title=Dengue Virus Glycosylation: What Do We Know? |journal=Front Microbiol |volume=8 |issue= |pages=1415 |year=2017 |pmid=28791003 |pmc=5524768 |doi=10.3389/fmicb.2017.01415 |url=}}</ref>
* [[Ebola hemorrhagic fever]]
{|
* [[Lassa hemorrhagic fever]]
! rowspan="3" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Virus}}
* [[Crimean-Congo hemorrhagic fever]]  
! rowspan="3" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Disease}}
 
! rowspan="3" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Incubation Period}}
* [[Malaria]]
! colspan="6" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Symptoms}}
* [[Typhoid fever]]
! rowspan="3" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Laboratory findings}}
* [[Shigellosis]]
* [[Cholera]]
* [[Leptospirosis]]
* [[Plague]],
* [[Rickettsiosis]]
* [[Relapsing fever]]
* [[Meningitis]]
* [[Hepatitis]]
* Other [[viral hemorrhagic fevers]]
{| class="wikitable"
! rowspan="2" |
! rowspan="2" |Incubation
period
! rowspan="2" |Vector
! colspan="4" |Symptoms
! rowspan="2" |Differentiating
Features
! colspan="2" |Diagnosis
|-
|-
!fever
! colspan="5" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Prodromal phase}}
!abdominal pain
! rowspan="2" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Illness phase}}
!diarrhea
!bleeding
!Differentiating
Laboratory findings
!exam findings
|-
|-
|Marburg Hemorrhagic Fever
! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Fever}}
| 2-21
! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Headache}}
|
! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Myalgia}}
|
! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Abdominal pain}}
|
! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Hemorrhage}}
|
|
|
|
|
|-
|-
|[[Ebola hemorrhagic fever]]
| rowspan="2" style="background: #DCDCDC; text-align: center;" |Filoviruses
|
| style="background: #DCDCDC; text-align: center;" |Marburg Hemorrhagic Fever
|
| style="background: #F5F5F5; text-align: center;" |5-10
|
| style="background: #F5F5F5; text-align: center;" | '''+'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| rowspan="2" style="background: #F5F5F5;" |
|
* '''Clinically indistinguishable'''
* [[Maculopapular rash]] on the trunk (chest, back, stomach)
* [[Multiorgan failure]]
| rowspan="2" style="background: #F5F5F5;" |
* [[Thrombocytopenia]]
* [[Leukopenia]]
* [[Lymphocytopenia|Lymphopenia]]
|-
|-
|[[Lassa hemorrhagic fever]]
| style="background: #DCDCDC; text-align: center;" |Ebola
|
| style="background: #F5F5F5; text-align: center;" |2-21
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''+'''
|
| style="background: #F5F5F5; text-align: center;" | '''+'''
|
|
|
|-
|-
|[[Crimean-Congo hemorrhagic fever]]
| rowspan="3" style="background: #DCDCDC; text-align: center;" |Bunyaviruses
|
| style="background: #DCDCDC; text-align: center;" |Crimean-Congo hemorrhagic fever (CCHF)
|
| style="background: #F5F5F5; text-align: center;" |13
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5;" |
|
* [[Red eyes]], a flushed face, a red throat, and petechiae (red spots) on the palate
* Changes in mood and sensory perception.
| style="background: #F5F5F5;" |
 
|-
|-
|[[Malaria]]
| style="background: #DCDCDC; text-align: center;" |Hantavirus Infection
|
| style="background: #F5F5F5; text-align: center;" | 9 -33
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5;" |
|
* [[Flushing]] of the face
|
* [[Conjunctival injection|Injection of the conjunctiva]]
* [[Prostration]]
| style="background: #F5F5F5;" |
* [[Thrombocytopenia]]
* [[Leukocytosis]]
* Raised [[PT]] and aPTT
 
* '''[[Hematocrit|Elevated hematocrit]]'''
 
|-
|-
|[[Typhoid fever]]
| style="background: #DCDCDC; text-align: center;" |Rift Valley fever
|
| style="background: #F5F5F5; text-align: center;" |2-6 
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|
| style="background: #F5F5F5;" |
|
* '''Most commonly mild disease''' with recovery in 2 weeks
|
* [[Encephalitis]]
* Hemorrhagic fever, which occurs in '''less than''' 1% of overall RVF
| style="background: #F5F5F5;" |
 
|-
|-
|[[Shigellosis]]
| rowspan="3" style="background: #DCDCDC; text-align: center;" |Arenaviruses
|
| style="background: #DCDCDC; text-align: center;" |Lassa fever
|
| style="background: #F5F5F5; text-align: center;" |7-21
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|
| style="background: #F5F5F5;" |
|
* '''[[Deafness]]'''
* '''[[Respiratory distress]]'''
* Repeated vomiting
* Facial swelling
* Pain in the chest, back, and abdomen, and shock.encephalitis
* [[Hemorrhage]] only 20% have severe disease
| style="background: #F5F5F5;" |
|-
|-
|[[Cholera]]
| style="background: #DCDCDC; text-align: center;" |Lujo hemorrhagic fever
|
| style="background: #F5F5F5; text-align: center;" | 7-13
|
| style="background: #F5F5F5; text-align: center;" |'''+'''
|
| style="background: #F5F5F5; text-align: center;" |'''+'''
|
| style="background: #F5F5F5; text-align: center;" |'''+'''
|
| style="background: #F5F5F5; text-align: center;" |'''+'''
|
| style="background: #F5F5F5; text-align: center;" |'''+'''
|
| style="background: #F5F5F5;" | 
|
* Morbilliform rash of the face and trunk
|
* '''Face and neck swelling'''
* '''[[Pharyngitis]]'''
* [[Diarrhea]]
| style="background: #F5F5F5;" |
 
|-
|-
|[[Leptospirosis]]
| style="background: #DCDCDC; text-align: center;" |Lymphocytic choriomeningitis (LCM)
|2-30
| style="background: #F5F5F5; text-align: center;" | 8-13
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|
| style="background: #F5F5F5;" |
|
* [[Meningitis]], [[encephalitis]], [[meningoencephalitis]]
|
* Acute [[hydrocephalus]]
|-
* '''[[Myocarditis]]'''
|[[Plague]]
| style="background: #F5F5F5;" |
|
* [[Thrombocytopenia]]
|
* [[Leukopenia]]
|
* Elevated liver enzymes
|
 
|
|
|
|
|
|-
|[[Rickettsiosis]]
|
|
|
|
|
|
|
|
|
|-
|-
|[[Relapsing fever]]
| rowspan="3" style="background: #DCDCDC; text-align: center;" |Flaviviruses
|
| style="background: #DCDCDC; text-align: center;" |Alkhurma hemorrhagic fever (AFD)
|
| style="background: #F5F5F5; text-align: center;" |2-4 
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|
| style="background: #F5F5F5;" |
|
* Neurologic symptoms
* '''Hemorrhagic symptoms only''' in severe form.
* [[Multiorgan failure|Multi-organ failure]] 
| style="background: #F5F5F5;" |
* [[Thrombocytopenia]]
* [[Leukopenia]]
* Elevated liver enzymes
|-
|-
|[[Meningitis]]
| style="background: #DCDCDC; text-align: center;" |Kyasanur Forest Disease (KFD)
|
| style="background: #F5F5F5; text-align: center;" |3-8 
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5;" |'''<u>Biphasic</u>'''
|
* Complete recovery by 2 week
|
* Wave of symptoms in 3 rd week with '''[[tremors]], and [[Blindness|vision deficits]].'''
| style="background: #F5F5F5;" |
* [[Pancytopenia]]
|-
|-
|[[Hepatitis]]
| style="background: #DCDCDC; text-align: center;" |Omsk hemorrhagic fever
|
| style="background: #F5F5F5; text-align: center;" | 3-8
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5;" |'''<u>Biphasic</u>'''
|
* Complete recovery by 2 week
|
* Wave of symptoms in 3 rd week with '''[[encephalitis]]'''
|-
| style="background: #F5F5F5;" |
|[[Dengue fever|Dengue]]
* [[Pancytopenia]]
|
|
|
|
|
|
|
|
|
|}
|}
Treatment should be based on the most likely etiology of fever according to local [[epidemiology]]. If the [[fever]] continues after 3 days of recommended treatment, and if the patient has [[signs]] such as [[bleeding]] or [[shock]], a viral hemorrhagic fever should be considered. It is important to review the patient’s history for any contact with someone who was ill with [[fever]] and [[bleeding]] or who died from an unexplained [[illness]] with [[fever]] and [[bleeding]].
 
<br>
<br>


'''''Shown below is a table summarizing the typical findings of the differential diagnoses of MHF.'''''
'''''Shown below is a table summarizing the typical findings of the differential diagnoses of MHF.'''''
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
<small><small>
|+
{|
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Incubation period
! colspan="7" style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical signs
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Lab findings
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Other findings
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Shigellosis]] & other bacterial enteric infections'''
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Fever
| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[diarrhea]], possibly [[Dysentery|bloody]], accompanied by [[fever]], [[nausea]], and sometimes [[toxemia]], [[vomiting]], [[cramps]], and [[tenesmus]]. [[Stool]]s contain [[blood]] and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and [[blood smear]]s, should be made. Presence of [[leucocytosis]] distinguishes bacterial infections.
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Cough
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Rash
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Joint pain
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Myalgia
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Diarrhea
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Common hemorrhagic symptoms
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Characterestic physical finding
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Icterus
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Plasma Creatine kinase
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Confirmatory test
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Typhoid fever]]'''
! style="background:#DCDCDC;" align="center" + |Marburg hemorrhagic fever
| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[fever]], [[headache]], [[rash]], gastrointestinal symptoms, with [[lymphadenopathy]], relative [[bradycardia]], [[cough]] and [[leucopenia]] and sometimes [[sore throat]]. [[Blood]] and [[stool culture]] can demonstrate causative bacteria.
| style="background:#F5F5F5;" + |
*5-10 days
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | [[Maculopapular rash]] on the trunk (chest, back, stomach)
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |
* [[Bloody diarrhea]] ([[Melena]])
* [[Hematemesis]]
* Exanthema
* [[Petechiae]]/[[ecchymoses]]
* [[Mucosal]] [[hemorrhage]]
* [[Visceral]] [[hemorrhage]]
| style="background:#F5F5F5;" align="center" + |[[Fever]] and upper [[respiratory]] symptoms
| style="background:#F5F5F5;" align="center" + | -
| style="background:#F5F5F5;" align="center" + |Normal
| style="background:#F5F5F5;" align="center" + |[[Viral culture]] or [[PCR]]
| style="background:#F5F5F5;" + |
*History of Travel
*Patients with co-morbid conditions
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Malaria]]'''
! style="background:#DCDCDC;" align="center" + |[[Leptospirosis]]
| style="padding: 5px 5px; background: #F5F5F5;" |Presents with acute [[fever]], [[headache]] and sometime [[diarrhea]] (children). [[Blood smear]]s must be examined for malaria parasites. Presence of [[parasites]] does not exclude concurrent viral infection. [[Antimalarial]] must be prescribed in an attempt at therapy.
| style="background:#F5F5F5;" + |
*2 to 30 days
| style="background:#F5F5F5;" align="center" + |[[Fever]] last for 4-7 days, remission for 1-2 days and then relapse
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |Present over legs<br>[[hemorrhagic]] [[rash]]
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +<br>(Severe [[myalgia]] is<br>characteristic of<br>leptospirosis typically<br>localized to the [[Calf muscle|calf]]<br>and [[lumbar]] areas)
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |[[Conjunctival hemorrhage]],
[[Hemoptysis]]
| style="background:#F5F5F5;" align="center" + |[[Conjunctival hemorrhage|Conjunctival suffusion]]
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |Elevated
| style="background:#F5F5F5;" align="center" + |[[Agglutination|Microscopic agglutination test]] of urine
| style="background:#F5F5F5;" + |
*History of exposure to soil or watercontaminated by [[infected]] rodents
*Recent history travel to tropical, sub tropical areas, or humid areas
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lassa fever]]'''
! style="background:#DCDCDC;" align="center" + |'''[[Dengue fever|Dengue]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Disease onset is usually gradual, with [[fever]], [[sore throat]], [[cough]], [[pharyngitis]], and [[facial edema]] in the later stages. Inflammation and exudation of the [[pharynx]] and [[conjunctiva]] are common.
| style="background:#F5F5F5;" + |
*4 to 10 days
| style="background:#F5F5F5;" align="center" + |[[Fever]] last for 1-2 days, remission for 1-2 days, and then relapse for 1-2 days
(Biphasic [[fever]] pattern)
| style="background:#F5F5F5;" align="center" + | -
| style="background:#F5F5F5;" align="center" + |Pruritic [[rash]] over<br>legs and [[trunk]]<br>(may be [[hemorrhagic]])
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | -
| style="background:#F5F5F5;" align="center" + |[[Upper gastrointestinal bleeding]]
| style="background:#F5F5F5;" align="center" + |[[Lymphadenopathy|Painful lymphadenopathy]]
| style="background:#F5F5F5;" align="center" + | -
| style="background:#F5F5F5;" align="center" + |Normal
| style="background:#F5F5F5;" align="center" + |Serology showing positive [[IgM]] or [[IgG]]
| style="background:#F5F5F5;" + |
*Recent travel to South America, Africa, or Southeast Asia
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Yellow fever]] and other [[Flaviviridae]] '''
! style="background:#DCDCDC;" align="center" + |'''[[Malaria]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Present with [[hemorraghe|hemorrhagic]] complications. Epidemiological investigation may reveal a pattern of disease transmission by an insect vector. Virus isolation and serological investigation serves to distinguish these [[virus]]. Confirmed history of previous [[yellow fever]] [[vaccination]] will rule out [[yellow fever]].
| style="background:#F5F5F5;" + |
* ''[[Plasmodium falciparum]]: 9-14 days''
* ''[[Plasmodium vivax]]: 12-18 days''
* ''[[Plasmodium ovale]]: 18-40 days''
| style="background:#F5F5F5;" align="center" + |[[Fever]] present daily or on alternate day or every 3 days depending on [[Plasmodium|Plasmodium sps]].
| style="background:#F5F5F5;" align="center" + | -
| style="background:#F5F5F5;" align="center" + |No rash
| style="background:#F5F5F5;" align="center" + | -
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | -
| style="background:#F5F5F5;" align="center" + |[[Hematuria|Bloody urine]]
| style="background:#F5F5F5;" align="center" + |[[Hepatosplenomegaly]]
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |Normal
| style="background:#F5F5F5;" align="center" + |[[Giemsa stain|Giemsa]] stained thick and thin [[blood]] smears
| style="background:#F5F5F5;" + |
*Recent travel to South America, Africa, or Southeast Asia
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''Others'''
! style="background:#DCDCDC;" align="center" + |'''[[Ebola]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |[[Viral hepatitis]], [[leptospirosis]], [[rheumatic fever]], [[typhus]], and [[mononucleosis]] produce signs and symptoms that may be confused with [[Ebola]] in the early stages of infection.
| style="background:#F5F5F5;" + |
*2 to 21 days.
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |[[Maculopapular]]<br>non-pruritic [[rash]]<br>with [[erythema]]<br>Centripetal distribution
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
May be bloody in the early phase
| style="background:#F5F5F5;" align="center" + |[[Epistaxis]]<br>[[Mucosal bleeding]]
| style="background:#F5F5F5;" align="center" + |Sudden onset of high [[fever]] with [[conjunctival injection]] and early [[gastrointestinal]] symptoms
| style="background:#F5F5F5;" align="center" + | -
| style="background:#F5F5F5;" align="center" + |Normal
| style="background:#F5F5F5;" align="center" + |[[RT-PCR]]
| style="background:#F5F5F5;" + |
*Recent visit to endemic area especially African countries
|-
|-
| colspan="2" style="padding: 5px 5px; background: #FFF;" | <SMALL>Table adapted from WHO Guidelines For Epidemic Preparedness And Response: Ebola Haemorrhagic Fever <ref name="WHO">{{cite web| title=WHO Guidelines For Epidemic Preparedness And Response: Ebola Haemorrhagic Fever |url= http://apps.who.int/iris/handle/10665/63806 }} </ref></SMALL>
! style="background:#DCDCDC;" align="center" + |'''[[Yellow fever]]'''
| style="background:#F5F5F5;" + |
*3 to 6 days
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | -
| style="background:#F5F5F5;" align="center" + | -
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | -
| style="background:#F5F5F5;" align="center" + |[[Conjunctival hemorrhage]],<br>[[Hemoptysis]]
| style="background:#F5F5F5;" align="center" + |Relative [[bradycardia]]<br>([[Faget's sign]])
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |Normal
| style="background:#F5F5F5;" align="center" + |[[RT-PCR]],<br>[[Nucleic acid amplification technique|Nucleic acid amplification test]],<br> [[Immunohistochemical staining|Immuno-histochemical staining]]
| style="background:#F5F5F5;" + |
*Recent travel to  Africa, South and Central America, and the Caribbean
*Tropical rain forests of south America
|-
|-
! style="background:#DCDCDC;" align="center" + |'''[[Typhoid fever]]'''
| style="background:#F5F5F5;" + |
*6 to 30 days
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | -
| style="background:#F5F5F5;" align="center" + |Blanching [[erythematous]]<br>[[maculopapular]][[lesions]]<br>on the lower chest<br>and abdomen
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + | +
| style="background:#F5F5F5;" align="center" + |[[Intestinal bleeding]]
| style="background:#F5F5F5;" align="center" + |[[Rose spots]]
| style="background:#F5F5F5;" align="center" + | -
| style="background:#F5F5F5;" align="center" + |Normal
| style="background:#F5F5F5;" align="center" + |[[Blood]] or [[stool]] [[Culture medium|culture]] showing ''[[Salmonella typhi|salmonella typhi sps]].''
| style="background:#F5F5F5;" + |
*Residence in [[endemic]] area
*Recent travel to [[endemic]] area
|}
|}
<\small>


==References==
==References==

Latest revision as of 13:45, 23 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Marburg hemorrhagic fever must be differentiated from other viral hemorrhagic fevers that may cause fever, abdominal pain,and bleeding such as Ebola, Crimean-Congo hemorrhagic fever (CCHF), Hantavirus Infection, Rift Valley fever, Lujo hemorrhagic fever and Lassa fever. SInce many of the signs and symptoms of marburg hemorrhagic fever are similar to those of other infectious diseases such as malaria or typhoid fever, leptospirosis, marburg hemorrhagic fever must also be differentiated from those infections.

Differentiating Marburg Hemorrhagic Fever from other Diseases

Marburg hemorrhagic fever must be differentiated from other viral hemorrhagic fevers that may cause fever, abdominal pain,and bleeding such as Ebola, Crimean-Congo hemorrhagic fever (CCHF), Hantavirus Infection, Rift Valley fever, Lujo hemorrhagic fever and Lassa fever. SInce many of the signs and symptoms of marburg hemorrhagic fever are similar to those of other infectious diseases such as malaria or typhoid fever, leptospirosis, marburg hemorrhagic fever must also be differentiated from those infections.[1][2][3][4][5][6][7][8][9][10][11][12][13][14]

Virus Disease Incubation Period Symptoms Laboratory findings
Prodromal phase Illness phase
Fever Headache Myalgia Abdominal pain Hemorrhage
Filoviruses Marburg Hemorrhagic Fever 5-10 + + + + +
Ebola 2-21 + + + + +
Bunyaviruses Crimean-Congo hemorrhagic fever (CCHF) 13 + + + + +
  • Red eyes, a flushed face, a red throat, and petechiae (red spots) on the palate
  • Changes in mood and sensory perception.
Hantavirus Infection  9 -33 + + + - +
Rift Valley fever 2-6  + - + - -
  • Most commonly mild disease with recovery in 2 weeks
  • Encephalitis
  • Hemorrhagic fever, which occurs in less than 1% of overall RVF
Arenaviruses Lassa fever 7-21 + + + - -
Lujo hemorrhagic fever  7-13 + + + + +  
Lymphocytic choriomeningitis (LCM)  8-13 + + + - -
Flaviviruses Alkhurma hemorrhagic fever (AFD) 2-4  + - + - -
Kyasanur Forest Disease (KFD) 3-8  + + + + + Biphasic
Omsk hemorrhagic fever  3-8 + + + + + Biphasic
  • Complete recovery by 2 week
  • Wave of symptoms in 3 rd week with encephalitis


Shown below is a table summarizing the typical findings of the differential diagnoses of MHF.

Disease Incubation period Symptoms Physical signs Lab findings Other findings
Fever Cough Rash Joint pain Myalgia Diarrhea Common hemorrhagic symptoms Characterestic physical finding Icterus Plasma Creatine kinase Confirmatory test
Marburg hemorrhagic fever
  • 5-10 days
 + + Maculopapular rash on the trunk (chest, back, stomach) + + + Fever and upper respiratory symptoms - Normal Viral culture or PCR
  • History of Travel
  • Patients with co-morbid conditions
Leptospirosis
  • 2 to 30 days
 Fever last for 4-7 days, remission for 1-2 days and then relapse + Present over legs
hemorrhagic rash 		+ +
(Severe myalgia is
characteristic of
leptospirosis typically
localized to the calf
and lumbar areas) 		+ Conjunctival hemorrhage,

Hemoptysis

Conjunctival suffusion + Elevated Microscopic agglutination test of urine
  • History of exposure to soil or watercontaminated by infected rodents
  • Recent history travel to tropical, sub tropical areas, or humid areas
Dengue
  • 4 to 10 days
 Fever last for 1-2 days, remission for 1-2 days, and then relapse for 1-2 days

(Biphasic fever pattern)

- Pruritic rash over
legs and trunk
(may be hemorrhagic) 		+ + - Upper gastrointestinal bleeding Painful lymphadenopathy - Normal Serology showing positive IgM or IgG
  • Recent travel to South America, Africa, or Southeast Asia
Malaria Fever present daily or on alternate day or every 3 days depending on Plasmodium sps. - No rash - + - Bloody urine Hepatosplenomegaly + Normal Giemsa stained thick and thin blood smears
  • Recent travel to South America, Africa, or Southeast Asia
Ebola
  • 2 to 21 days.
 + + Maculopapular
non-pruritic rash
with erythema
Centripetal distribution 		+ + +

May be bloody in the early phase

Epistaxis
Mucosal bleeding 		Sudden onset of high fever with conjunctival injection and early gastrointestinal symptoms - Normal RT-PCR
  • Recent visit to endemic area especially African countries
Yellow fever
  • 3 to 6 days
 + + - - + - Conjunctival hemorrhage,
Hemoptysis 		Relative bradycardia
(Faget's sign) 		+ Normal RT-PCR,
Nucleic acid amplification test,
Immuno-histochemical staining
  • Recent travel to  Africa, South and Central America, and the Caribbean
  • Tropical rain forests of south America
Typhoid fever
  • 6 to 30 days
 + - Blanching erythematous
maculopapularlesions
on the lower chest
and abdomen 		+ + + Intestinal bleeding Rose spots - Normal Blood or stool culture showing salmonella typhi sps.

<\small>

References

  1. ↑ Levett PN (2001). "Leptospirosis". Clin. Microbiol. Rev. 14 (2): 296–326. doi:10.1128/CMR.14.2.296-326.2001. PMC 88975. PMID 11292640.
  2. ↑ "Marburg Hemorrhagic Fever (Marburg HF) | CDC".
  3. ↑ "Chapare Hemorrhagic Fever (CHHF) | CDC".
  4. ↑ "Lassa Fever | CDC".
  5. ↑ "Lujo Hemorrhagic Fever (LUHF) | CDC".
  6. ↑ "Lymphocytic Choriomeningitis (LCM) | CDC".
  7. ↑ "Crimean-Congo Hemorrhagic Fever (CCHF) | CDC".
  8. ↑ "CDC - Hantavirus Pulmonary Syndrome (HPS) - Hantavirus".
  9. ↑ "Rift Valley Fever | CDC".
  10. ↑ "Ebola Hemorrhagic Fever | CDC".
  11. ↑ "Alkhurma Hemorrhagic Fever (AHF) | CDC".
  12. ↑ "Kyasanur Forest Disease (KFD) | CDC".
  13. ↑ "Omsk Hemorrhagic Fever | CDC".
  14. ↑ Yap S, Nguyen-Khuong T, Rudd PM, Alonso S (2017). "Dengue Virus Glycosylation: What Do We Know?". Front Microbiol. 8: 1415. doi:10.3389/fmicb.2017.01415. PMC 5524768. PMID 28791003. Vancouver style error: initials (help)
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