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{{SK}} Lassa hemorrhagic fever; LHF
{{SK}} Lassa hemorrhagic fever; LHF
==Overview==
==Overview==
Lassa fever is commonly associated with [[fever]] on physical examination at admission. At advanced stages of the disease, physical examination findings are more pertinent and often include unstable vital signs, such as [[tachycardia]] or relative [[bradycardia]], [[hypotension]], and [[tachypnea]]. Physical examination may also be remarkable for [[abdominal tenderness]], abdominal distension and neurological impairment.
Persistent, high-grade fever is the most common sign on physical examination. Other common signs on physical examination include tachycardia, tachypnea, conjunctival injection, abdominal/chest tenderness, pharyngitis with tonsillar exudates, and hepatosplenomegaly.


==Physical Examination==
==Physical Examination==
===Appearance of the Patient===
===General Appearance===
The general appearance of the patient depends on the severity of the disease. Typically, patients demonstrate [[prostration]], may be [[nauseated]] and [[vomiting]], and less commonly very ill looking<ref name="pmid26022703">{{cite journal| author=Kyei NN, Abilba MM, Kwawu FK, Agbenohevi PG, Bonney JH, Agbemaple TK et al.| title=Imported Lassa fever: a report of 2 cases in Ghana. | journal=BMC Infect Dis | year= 2015 | volume= 15 | issue= 1 | pages= 217 | pmid=26022703 | doi=10.1186/s12879-015-0956-2 | pmc=PMC4448534 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26022703  }} </ref>.
*In distress
===Vitals===
*Ill-looking<ref name="pmid26022703">{{cite journal| author=Kyei NN, Abilba MM, Kwawu FK, Agbenohevi PG, Bonney JH, Agbemaple TK et al.| title=Imported Lassa fever: a report of 2 cases in Ghana. | journal=BMC Infect Dis | year= 2015 | volume= 15 | issue= 1 | pages= 217 | pmid=26022703 | doi=10.1186/s12879-015-0956-2 | pmc=PMC4448534 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26022703  }} </ref>.
====Temperature====
===Vital Signs===
* High-grade [[fever]] is often present in more than 80% of patients. Fever is the most common presenting sign.
* Persistent, high-grade [[fever]]
 
*[[Tachycardia]] or relative [[bradycardia]]
====Pulse====
[[Hypotension]]  
*[[Tachycardia]]
*Tachypnea
* Relative [[bradycardia]]
 
====Blood Pressure====
* [[Hypotension]] (SBP<90 mmHg and/or DBP<60 mmHg)
* [[Postural hypotension]] is common in dehydrated patients with inadequate volume repletion
 
====Respiratory Rate====
*[[Signs]] of [[shortness of breath|respiratory difficulty]] may be present, such as:
:* [[Intercostal]] retractions
:* Paradoxical [[breathing]]
:* [[Nasal]] flare
*[[Tachypnea]] often precedes death during final hours of infection.


===Skin===
===Skin===
* Uncontrolled [[bleeding]] from [[venipuncture]] can occur if there is [[platelet]] dysfunction.
*Uncontrolled [[bleeding]] from [[venipuncture]] sites
 
*Jaundice
===Eyes===
* [[Conjunctival hemorrhage]] is a the most common sign of abnormal clotting


===Nose===
===HEENT and Neck===
* [[Epistaxis]] may be present.
*[[Conjunctival injection]]
* [[Nasal discharge]] may be present.
[[Conjunctival hemorrhage]]
* Nasal flaring
* [[Epistaxis]]
* [[Nasal discharge]]  
* Hearing impairment (abnormal Renne and Weber tests)
* [[Mucosal]] [[hyperemia]] of the [[oral cavity]]
*Pharyngitis with exudation
*Cervical lymphadenopathy


===Throat===
===Thoracic===
* [[Mucosal]] [[hyperemia]] of the [[oral cavity]] is a common finding.
*Paradoxical breathing
*Chest tenderness


===Abdomen===
===Abdomen===
* [[Abdominal tenderness]] may suggest [[pancreatitis]], [[intestinal swelling]], or [[mesenteric lymphadenopathy]]
* [[Abdominal tenderness]]
* [[Abdominal distention]] may suggest [[paralytic ileus]]
* [[Abdominal distention]]
* Tender [[hepatomegaly]]
* Tender [[hepatomegaly]]
* [[Splenomegaly]]
* [[Splenomegaly]]
* [[Bowel sounds]] are usually present.
* Bowel sounds may be hyperactive (bleeding) or hypoactive (ileus)


===Extremities===
===Extremities===
* [[Edema]] may be present.
* Extremity [[edema]]


===Neurologic===
===Neurologic===
* [[Obtundation]] may be present.
* [[Obtundation]]
* [[Stupor]]
* [[Stupor]]
* [[Coma]]
* [[Coma]]
* [[Tremor]]
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 20:33, 9 June 2015

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

Synonyms and keywords: Lassa hemorrhagic fever; LHF

Overview

Persistent, high-grade fever is the most common sign on physical examination. Other common signs on physical examination include tachycardia, tachypnea, conjunctival injection, abdominal/chest tenderness, pharyngitis with tonsillar exudates, and hepatosplenomegaly.

Physical Examination

General Appearance

  • In distress
  • Ill-looking[1].

Vital Signs

Hypotension

  • Tachypnea

Skin

HEENT and Neck

Conjunctival hemorrhage

Thoracic

  • Paradoxical breathing
  • Chest tenderness

Abdomen

Extremities

Neurologic

References

  1. ↑ Kyei NN, Abilba MM, Kwawu FK, Agbenohevi PG, Bonney JH, Agbemaple TK; et al. (2015). "Imported Lassa fever: a report of 2 cases in Ghana". BMC Infect Dis. 15 (1): 217. doi:10.1186/s12879-015-0956-2. PMC 4448534. PMID 26022703.


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