Marburg hemorrhagic fever differential diagnosis: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
(15 intermediate revisions by 3 users not shown)
Line 1: Line 1:
__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="3" |
! rowspan="3" |
! rowspan="3" |Incubation
 
Period
! colspan="6" |Symptoms
! rowspan="3" |Laboratory  
findings
|-
|-
! colspan="5" |Prodromal phase
! colspan="5" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Prodromal phase}}
! rowspan="2" |Illness phase
! rowspan="2" style="background: #4479BA; text-align: center;" |{{fontcolor|#FFF|Illness phase}}
|-
|-
!Fever
! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Fever}}
!Headache
! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Headache}}
!Myalgia
! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Myalgia}}
!Abdominal pain
! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Abdominal pain}}
!Hemorrhage
! style="background: #7d7d7d; text-align: center;" |{{fontcolor|#FFF|Hemorrhage}}
|-
|-
| rowspan="2" |Filoviruses
| rowspan="2" style="background: #DCDCDC; text-align: center;" |Filoviruses
|Marburg Hemorrhagic Fever
| style="background: #DCDCDC; text-align: center;" |Marburg Hemorrhagic Fever
|5-10  
| style="background: #F5F5F5; text-align: center;" |5-10  
| +
| style="background: #F5F5F5; text-align: center;" | '''+'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
| rowspan="2" |
| rowspan="2" style="background: #F5F5F5;" |
* '''Clinically indistinguishable'''
* '''Clinically indistinguishable'''
* Maculopapular rash on the trunk (chest, back, stomach)
* [[Maculopapular rash]] on the trunk (chest, back, stomach)
* Multiorgan failure
* [[Multiorgan failure]]
| rowspan="2" |
| rowspan="2" style="background: #F5F5F5;" |
* [[Thrombocytopenia]]
* [[Leukopenia]]
* [[Lymphocytopenia|Lymphopenia]]
|-
|-
|Ebola
| style="background: #DCDCDC; text-align: center;" |Ebola
|2-21
| style="background: #F5F5F5; text-align: center;" |2-21
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''+'''
| +
| style="background: #F5F5F5; text-align: center;" | '''+'''
|-
|-
| rowspan="3" |Bunyaviruses
| rowspan="3" style="background: #DCDCDC; text-align: center;" |Bunyaviruses
|Crimean-Congo hemorrhagic fever (CCHF)
| style="background: #DCDCDC; text-align: center;" |Crimean-Congo hemorrhagic fever (CCHF)
|13
| style="background: #F5F5F5; text-align: center;" |13
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<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
* [[Red eyes]], a flushed face, a red throat, and petechiae (red spots) on the palate
* changes in mood and sensory perception.
* Changes in mood and sensory perception.
|
| style="background: #F5F5F5;" |


|-
|-
|Hantavirus Infection
| style="background: #DCDCDC; text-align: center;" |Hantavirus Infection
| 9 -33
| style="background: #F5F5F5; text-align: center;" | 9 -33
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>-</nowiki>
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|
| style="background: #F5F5F5;" |
* [[Flushing]] of the face
* [[Flushing]] of the face
* [[Conjunctival injection|Injection of the conjunctiva]]
* [[Conjunctival injection|Injection of the conjunctiva]]
* [[Prostration]]
* [[Prostration]]
|
| style="background: #F5F5F5;" |
* [[Thrombocytopenia]]
* [[Leukocytosis]]
* Raised [[PT]] and aPTT
 
* '''[[Hematocrit|Elevated hematocrit]]'''


|-
|-
|Rift Valley fever
| style="background: #DCDCDC; text-align: center;" |Rift Valley fever
|2-6 
| style="background: #F5F5F5; text-align: center;" |2-6 
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>-</nowiki>
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>-</nowiki>
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|
| style="background: #F5F5F5;" |
* '''Most commonly mild disease''' with recovery in 2 weeks
* '''Most commonly mild disease''' with recovery in 2 weeks
* Encephalitis, or inflammation of the brain
* [[Encephalitis]]
* Hemorrhagic fever, which occurs in '''less than''' 1% of overall RVF
* Hemorrhagic fever, which occurs in '''less than''' 1% of overall RVF
|
| style="background: #F5F5F5;" |


|-
|-
| rowspan="3" |Arenaviruses
| rowspan="3" style="background: #DCDCDC; text-align: center;" |Arenaviruses
|Lassa fever
| style="background: #DCDCDC; text-align: center;" |Lassa fever
|7-21
| style="background: #F5F5F5; text-align: center;" |7-21
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>-</nowiki>
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|
| style="background: #F5F5F5;" |
* '''Deafness'''
* '''[[Deafness]]'''
* '''Respiratory distress'''  
* '''[[Respiratory distress]]'''  
* Repeated vomiting  
* Repeated vomiting  
* Facial swelling
* Facial swelling
* Pain in the chest, back, and abdomen, and shock.encephalitis
* Pain in the chest, back, and abdomen, and shock.encephalitis
* Hemorrhage only 20% have severe disease
* [[Hemorrhage]] only 20% have severe disease
|
| style="background: #F5F5F5;" |
 
|-
|-
|Lujo hemorrhagic fever
| style="background: #DCDCDC; text-align: center;" |Lujo hemorrhagic fever
| 7-13
| 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
* Morbilliform rash of the face and trunk
* '''Face and neck swelling'''
* '''Face and neck swelling'''
* '''Pharyngitis'''  
* '''[[Pharyngitis]]'''  
* Diarrhea
* [[Diarrhea]]
|
| style="background: #F5F5F5;" |


|-
|-
|Lymphocytic choriomeningitis (LCM)
| style="background: #DCDCDC; text-align: center;" |Lymphocytic choriomeningitis (LCM)
| 8-13
| style="background: #F5F5F5; text-align: center;" | 8-13
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>-</nowiki>
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|
| style="background: #F5F5F5;" |
* Meningitis, encephalitis, meningoencephalitis
* [[Meningitis]], [[encephalitis]], [[meningoencephalitis]]
 
* Acute [[hydrocephalus]]
* Acute hydrocephalus
* '''[[Myocarditis]]'''
 
| style="background: #F5F5F5;" |
* '''Myocarditis'''
* [[Thrombocytopenia]]
|
* [[Leukopenia]]
* Elevated liver enzymes


|-
|-
| rowspan="3" |Flaviviruses
| rowspan="3" style="background: #DCDCDC; text-align: center;" |Flaviviruses
|Alkhurma hemorrhagic fever (AFD)
| style="background: #DCDCDC; text-align: center;" |Alkhurma hemorrhagic fever (AFD)
|2-4 
| style="background: #F5F5F5; text-align: center;" |2-4 
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>-</nowiki>
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>-</nowiki>
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| style="background: #F5F5F5; text-align: center;" |<nowiki>-</nowiki>
|
| style="background: #F5F5F5;" |
* Neurologic symptoms
* Neurologic symptoms
* '''Hemorrhagic symptoms only''' in severe form.
* '''Hemorrhagic symptoms only''' in severe form.
* Multi-organ failure 
* [[Multiorgan failure|Multi-organ failure]] 
|
| style="background: #F5F5F5;" |
* Thrombocytopenia,
* [[Thrombocytopenia]]
* Leukopenia
* [[Leukopenia]]
* Elevated liver enzymes
* Elevated liver enzymes
|-
|-
|Kyasanur Forest Disease (KFD)
| style="background: #DCDCDC; text-align: center;" |Kyasanur Forest Disease (KFD)
|3-8 
| style="background: #F5F5F5; text-align: center;" |3-8 
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|'''<u>Biphasic</u>'''
| style="background: #F5F5F5;" |'''<u>Biphasic</u>'''
* Complete recovery by 2 week
* Complete recovery by 2 week
* Wave of symptoms in 3 rd week with '''tremors, and vision deficits.'''
* Wave of symptoms in 3 rd week with '''[[tremors]], and [[Blindness|vision deficits]].'''
|
| style="background: #F5F5F5;" |
* Pancytopenia
* [[Pancytopenia]]
|-
|-
|Omsk hemorrhagic fever
| style="background: #DCDCDC; text-align: center;" |Omsk hemorrhagic fever
| 3-8
| style="background: #F5F5F5; text-align: center;" | 3-8
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|<nowiki>+</nowiki>
| style="background: #F5F5F5; text-align: center;" |'''<nowiki>+</nowiki>'''
|'''<u>Biphasic</u>'''
| style="background: #F5F5F5;" |'''<u>Biphasic</u>'''
* Complete recovery by 2 week
* Complete recovery by 2 week
* Wave of symptoms in 3 rd week with '''encephalitis'''
* Wave of symptoms in 3 rd week with '''[[encephalitis]]'''
|
| style="background: #F5F5F5;" |
* Pancytopenia
* [[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
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Shigellosis]] & other bacterial enteric infections'''
! colspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Physical signs
| 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.
! 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;" | '''[[Typhoid 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="padding: 5px 5px; background: #DCDCDC;" |'''[[Malaria]]'''
| 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="padding: 5px 5px; background: #DCDCDC;" | '''[[Lassa fever]]'''
! style="background:#7d7d7d; color: #FFFFFF;" align="center" + |Fever
| 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:#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;" | '''[[Yellow fever]] and other [[Flaviviridae]] '''
! style="background:#DCDCDC;" align="center" + |Marburg hemorrhagic fever
| 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;" + |
*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;" | '''Others'''
! style="background:#DCDCDC;" align="center" + |[[Leptospirosis]]
| 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 30 days
| 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:#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]]
<small><small>
| style="background:#F5F5F5;" align="center" + | +
{| class="wikitable"
| 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)
! rowspan="2" |Disease
| style="background:#F5F5F5;" align="center" + | +
! rowspan="2" |Incubation period
| style="background:#F5F5F5;" align="center" + |[[Conjunctival hemorrhage]],
! rowspan="2" |Vector
! colspan="7" |Symptoms
! colspan="2" |Physical signs
! colspan="2" |Lab findings
! rowspan="2" |Other findings
! rowspan="2" |Treatment
|-
!Fever
!Cough
!Rash
!Joint pain
!Myalgia
!Diarrhea
!Common hemorrhagic symptoms
!Characterestic physical finding
!Icterus
!Plasma Creatine kinase
!Confirmatory test
|-
![[Leptospirosis]]
| align="center" |2 to 30 days
| align="center" |Rodents
 
Domestic animals
| align="center" |[[Fever]] last for 4-7 days, remission for 1-2 days and then relapse  
| align="center" | +
| align="center" |Present over legs [[Hemorrhagic]] [[rash]]
| align="center" | +
| align="center" | +
(Severe [[myalgia]] is characteristic of leptospirosis typically localized to the [[Calf muscle|calf]] and [[lumbar]] areas)
| align="center" | +
| align="center" |[[Conjunctival hemorrhage]],
[[Hemoptysis]]
[[Hemoptysis]]
| align="center" |[[Conjunctival hemorrhage|Conjunctival suffusion]]
| style="background:#F5F5F5;" align="center" + |[[Conjunctival hemorrhage|Conjunctival suffusion]]
| align="center" | +
| style="background:#F5F5F5;" align="center" + | +
| align="center" |Elevated
| style="background:#F5F5F5;" align="center" + |Elevated
| align="center" |[[Agglutination|Microscopic agglutination test]] of urine
| style="background:#F5F5F5;" align="center" + |[[Agglutination|Microscopic agglutination test]] of urine
| align="center" |History of exposure to soil or water
| style="background:#F5F5F5;" + |
contaminated by [[infected]] rodents
*History of exposure to soil or watercontaminated by [[infected]] rodents
 
*Recent history travel to tropical, sub tropical areas, or humid areas
Recent history travel to tropical,  
sub tropical areas or humid areas
| align="center" |[[NSAIDs]]
|-
|-
!'''[[Dengue fever|Dengue]]'''
! style="background:#DCDCDC;" align="center" + |'''[[Dengue fever|Dengue]]'''
| align="center" |4 to 10 days
| style="background:#F5F5F5;" + |
| align="center" |''[[Aedes]]'' [[Aedes|mosquito]]
*4 to 10 days
| align="center" |[[Fever]] last for 1-2 days,  
| style="background:#F5F5F5;" align="center" + |[[Fever]] last for 1-2 days, remission for 1-2 days, and then relapse for 1-2 days
remission for 1-2 days and then relapse for 1-2 days
(Biphasic [[fever]] pattern)
(Biphasic [[fever]] pattern)
| align="center" | -
| style="background:#F5F5F5;" align="center" + | -
| align="center" |Over legs and [[trunk]]
| style="background:#F5F5F5;" align="center" + |Pruritic [[rash]] over<br>legs and [[trunk]]<br>(may be [[hemorrhagic]])
 
| style="background:#F5F5F5;" align="center" + | +
pruritic [[rash]] May be [[hemorrhagic]]  
| style="background:#F5F5F5;" align="center" + | +
| align="center" | +
| style="background:#F5F5F5;" align="center" + | -
| align="center" | +
| style="background:#F5F5F5;" align="center" + |[[Upper gastrointestinal bleeding]]
| align="center" | -
| style="background:#F5F5F5;" align="center" + |[[Lymphadenopathy|Painful lymphadenopathy]]
| align="center" |[[Upper gastrointestinal bleeding]]
| style="background:#F5F5F5;" align="center" + | -
| align="center" |[[Lymphadenopathy|Painful lymphadenopathy]]
| style="background:#F5F5F5;" align="center" + |Normal
| align="center" | -
| style="background:#F5F5F5;" align="center" + |Serology showing positive [[IgM]] or [[IgG]]
| align="center" |Normal
| style="background:#F5F5F5;" + |
| align="center" |Serology showing positive [[IgM]] or [[IgG]]
*Recent travel to South America, Africa, or Southeast Asia
| align="center" |Recent travel to South America, Africa, Southeast Asia
| align="center" |Supportive care
Avoid aspirin and other [[NSAIDs]]
|-
|-
!'''[[Malaria]]'''
! style="background:#DCDCDC;" align="center" + |'''[[Malaria]]'''
| align="center" |
| style="background:#F5F5F5;" + |
* ''[[Plasmodium falciparum]]: 9-14 days''
* ''[[Plasmodium falciparum]]: 9-14 days''
* ''[[Plasmodium vivax]]: 12-18 days''
* ''[[Plasmodium vivax]]: 12-18 days''
* ''[[Plasmodium ovale]]: 18-40 days''
* ''[[Plasmodium ovale]]: 18-40 days''
| align="center" |[[Anopheles|Female Anopheles]]
| style="background:#F5F5F5;" align="center" + |[[Fever]] present daily or on alternate day or every 3 days depending on [[Plasmodium|Plasmodium sps]].
| align="center" |[[Fever]] present daily or on alternate day or every 3 days depending on [[Plasmodium|Plasmodium sps]].
| style="background:#F5F5F5;" align="center" + | -
| align="center" | -
| style="background:#F5F5F5;" align="center" + |No rash
| align="center" |No rash
| style="background:#F5F5F5;" align="center" + | -
| align="center" | -
| style="background:#F5F5F5;" align="center" + | +
| align="center" | +
| style="background:#F5F5F5;" align="center" + | -
| align="center" | -
| style="background:#F5F5F5;" align="center" + |[[Hematuria|Bloody urine]]
| align="center" |[[Hematuria|Bloody urine]]
| style="background:#F5F5F5;" align="center" + |[[Hepatosplenomegaly]]
| align="center" |[[Hepatosplenomegaly]]
| style="background:#F5F5F5;" align="center" + | +
| align="center" | +
| style="background:#F5F5F5;" align="center" + |Normal
| align="center" |Normal
| style="background:#F5F5F5;" align="center" + |[[Giemsa stain|Giemsa]] stained thick and thin [[blood]] smears  
| align="center" |[[Giemsa stain|Giemsa]] stained thick and thin [[blood]] smears  
| style="background:#F5F5F5;" + |
| align="center" |Recent travel to South America, Africa, Southeast Asia
*Recent travel to South America, Africa, or Southeast Asia
| align="center" |[[Antimalarial medication|Anti malarial regimen]]
|-
|-
!'''[[Ebola]]'''
! style="background:#DCDCDC;" align="center" + |'''[[Ebola]]'''
| align="center" |2 to 21 days.
| style="background:#F5F5F5;" + |
| align="center" |No vector
*2 to 21 days.
 
| style="background:#F5F5F5;" align="center" + | +
Human to human transmission
| style="background:#F5F5F5;" align="center" + | +
 
| style="background:#F5F5F5;" align="center" + |[[Maculopapular]]<br>non-pruritic [[rash]]<br>with [[erythema]]<br>Centripetal distribution
[[Airborne transmission|Air born disease]]
| style="background:#F5F5F5;" align="center" + | +
| align="center" | +
| style="background:#F5F5F5;" align="center" + | +
| align="center" | +
| style="background:#F5F5F5;" align="center" + | +
| align="center" |[[Maculopapular]]  
non-pruritic [[rash]] with [[erythema]]
 
Centripetal distribution
| align="center" | +
| align="center" | +
| align="center" | +
 
May be bloody in the early phase
May be bloody in the early phase
| align="center" |[[Epistaxis]]
| 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
[[Mucosal bleeding]]
| style="background:#F5F5F5;" align="center" + | -
| align="center" |Sudden onset of high [[fever]] with [[conjunctival injection]] and early [[gastrointestinal]] symptoms
| style="background:#F5F5F5;" align="center" + |Normal
| align="center" | -
| style="background:#F5F5F5;" align="center" + |[[RT-PCR]]
| align="center" |Normal
| style="background:#F5F5F5;" + |
| align="center" |[[RT-PCR]]
*Recent visit to endemic area especially African countries
| align="center" |Recent visit to endemic area especially African countries
| align="center" |Isolation of the patient,
 
supportive therapy
|-
|-
!'''[[Influenza]]'''
! style="background:#DCDCDC;" align="center" + |'''[[Yellow fever]]'''
| align="center" |1-4 days
| style="background:#F5F5F5;" + |
| align="center" |No vector
*3 to 6 days
 
| style="background:#F5F5F5;" align="center" + | +
[[Airborne transmission|Air born disease]]
| style="background:#F5F5F5;" align="center" + | +
| align="center" | +
| style="background:#F5F5F5;" align="center" + | -
| align="center" | +
| style="background:#F5F5F5;" align="center" + | -
| align="center" | +/-
| style="background:#F5F5F5;" align="center" + | +
| align="center" | +
| style="background:#F5F5F5;" align="center" + | -
| align="center" | +
| style="background:#F5F5F5;" align="center" + |[[Conjunctival hemorrhage]],<br>[[Hemoptysis]]
| align="center" | +
| style="background:#F5F5F5;" align="center" + |Relative [[bradycardia]]<br>([[Faget's sign]])
| align="center" | -
| style="background:#F5F5F5;" align="center" + | +
| align="center" |[[Fever]] and upper [[respiratory]] symptoms
| style="background:#F5F5F5;" align="center" + |Normal
| align="center" | -
| style="background:#F5F5F5;" align="center" + |[[RT-PCR]],<br>[[Nucleic acid amplification technique|Nucleic acid amplification test]],<br> [[Immunohistochemical staining|Immuno-histochemical staining]]
| align="center" |Normal
| style="background:#F5F5F5;" + |
| align="center" |[[Viral culture]] or [[PCR]]
*Recent travel to  Africa, South and Central America, and the Caribbean
| align="center" |Health care workers
*Tropical rain forests of south America
Patients with co-morbid conditions
| align="center" |Symptomatic treatment
 
[[Oseltamivir]] or [[zanamivir]]
|-
|-
!'''[[Yellow fever]]'''
! style="background:#DCDCDC;" align="center" + |'''[[Typhoid fever]]'''
| align="center" |3 to 6 days
| style="background:#F5F5F5;" + |
| align="center" |[[Aedes]] or [[Aedes|Haemagogus]] species mosquitoes
*6 to 30 days
| align="center" | +
| style="background:#F5F5F5;" align="center" + | +
| align="center" | +
| style="background:#F5F5F5;" align="center" + | -
| align="center" | -
| style="background:#F5F5F5;" align="center" + |Blanching [[erythematous]]<br>[[maculopapular]][[lesions]]<br>on the lower chest<br>and abdomen
| align="center" | -
| style="background:#F5F5F5;" align="center" + | +
| align="center" | +
| style="background:#F5F5F5;" align="center" + | +
| align="center" | -
| style="background:#F5F5F5;" align="center" + | +
| align="center" |[[Conjunctival hemorrhage]],
| style="background:#F5F5F5;" align="center" + |[[Intestinal bleeding]]
 
| style="background:#F5F5F5;" align="center" + |[[Rose spots]]
[[Hemoptysis]]
| style="background:#F5F5F5;" align="center" + | -
| align="center" |Relative [[bradycardia]]
| style="background:#F5F5F5;" align="center" + |Normal
([[Faget's sign]])
| style="background:#F5F5F5;" align="center" + |[[Blood]] or [[stool]] [[Culture medium|culture]] showing ''[[Salmonella typhi|salmonella typhi sps]].''
| align="center" | +
| style="background:#F5F5F5;" + |
| align="center" |Normal
*Residence in [[endemic]] area
| align="center" |[[RT-PCR]],
*Recent travel to [[endemic]] area
 
[[Nucleic acid amplification technique|Nucleic acid amplification test]],
 
[[Immunohistochemical staining|Immuno-histochemical staining]]
| align="center" |Recent travel to  Africa, South and Central America, and the Caribbean.
 
Tropical rain forests of south America
| align="center" |Symptomatic treatment,
 
[[Anti inflammatory medications|Anti-inflammatory drugs]]
|-
!'''[[Typhoid fever]]'''
| align="center" |6 to 30 days
| align="center" |No vector
 
[[Airborne transmission|Air born disease]]
| align="center" | +
| align="center" | -
| align="center" |Blanching [[erythematous]] 
[[maculopapular]][[lesions]] on the
lower chest and abdomen
| align="center" | +
| align="center" | +
| align="center" | +
| align="center" |[[Intestinal bleeding]]
| align="center" |[[Rose spots]]
| align="center" | -
| align="center" |Normal
| align="center" |[[Blood]] or [[stool]] [[Culture medium|culture]] showing ''[[Salmonella typhi|salmonella typhi sps]].''
| align="center" |Residence in [[endemic]] area
 
Recent travel to [[endemic]] area
| align="center" |[[Fluoroquinolones]],
 
[[Cephalosporin|Third generation cephalosporins]],
 
[[Azithromycin]]
|}
|}
<\small>


==References==
==References==

Latest revision as of 13:45, 23 October 2017

Marburg hemorrhagic fever Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Marburg hemorrhagic fever from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography and Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Future or Investigational Therapies

Case Studies

Case #1

Marburg hemorrhagic fever differential diagnosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Marburg hemorrhagic fever differential diagnosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Marburg hemorrhagic fever differential diagnosis

CDC on Marburg hemorrhagic fever differential diagnosis

Marburg hemorrhagic fever differential diagnosis in the news

Blogs on Marburg hemorrhagic fever differential diagnosis

Directions to Hospitals Treating Marburg hemorrhagic fever

Risk calculators and risk factors for Marburg hemorrhagic fever differential diagnosis

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)
Retrieved from "https://www.wikidoc.org/index.php?title=Marburg_hemorrhagic_fever_differential_diagnosis&oldid=1378231"