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Introduction

These tests are done to diagnose viral hemorrhagic fever (VHF). VHF is caused by RNA viruses and varies according to the family of virus involved. Hantavirus hemorrhagic fever with renal syndrome is caused by the Bunyaviridae virus and is an endemic threat in the United States. Yellow fever and dengue fever are caused by the Flaviviridae family of viruses and are associated with hepatitis and liver failure. The Filoviridae virus causes Ebola virus and Marburg virus.

Although different VHF’s affect the body in different ways, common signs and symptoms include fever, disseminated intravascular coagulation, shock, multisystem organ failure, and pulmonary edema. Jaundice occurs with yellow fever. Heavy rains are associated with an increase in number of rodents (which are the vectors of VHF) and mosquitoes with yellow fever and dengue fever. The hantavirus Sin Nombre is responsible for hantavirus pulmonary syndrome (HPS). The deer mouse is the major reservoir for the hantavirus Sin Nombre. The mortality rate associated with HPS can be as high as 5%–15%. Individuals handling infected green monkeys are at risk, as are people in close contact with infected individuals such as in a healthcare setting or family members.

Procedure

  1. Obtain specimen of blood (red-topped tube), sputum, tissue, and possibly urine following standard precautions.

  2. Label specimens with the patient’s name, date, and test(s) ordered and place specimens in biohazard bags. All specimens are considered infectious.

  3. Antigen-capture ELISA, IgM-capture ELISA, PCR, or virus isolation methods are used on specimens collected.

Procedural Alert

  1. Follow airborne precautions with negative-pressure rooms if available.

  2. Use PPE.

Clinical Implications

Growth of hantavirus (or any of the other 17 causative viruses) in culture or presence of hantavirus antigens is evidence of infection. Thrombocytopenia is present in blood samples.

Clinical Alert

Evidence of VHF is reported to local, state, and federal authorities.

Interventions

Pretest Patient Care

  1. Explain necessity, purpose, and procedure of testing. Assess for and document signs and symptoms of infection (headache, pneumonia, fever, vomiting, cough, muscular pain, jaundice, hemorrhage from nose or GI tract, facial swelling). HPS is characterized by a fever (temperature higher than 101 °F) with bilateral diffuse interstitial pulmonary edema. Questions regarding occupation, living accommodations, and circumstances (e.g., recent heavy rains, mosquitoes, tropical climate, port city) are important.

  2. In most cases, no person-to-person transmission has been described; however, close contact with infected individuals poses a higher risk.

  3. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed. Counsel, monitor, and treat the patient appropriately. Report signs and symptoms. Patients are usually very ill. If the VHF viruses are isolated or the hantavirus antigens (or other causative viruses) are identified, supportive therapy (e.g., supplemental oxygen, mechanical ventilation, maintaining blood pressure through volume control) and antibiotic drugs are used to treat secondary bacterial infections. Correct dehydration and electrolyte imbalance and treat acidosis and blood cell abnormalities.

  2. Immunity to yellow fever occurs after recovery.

  3. Recovery from Marburg virus HF can be prolonged. Some complications include testicular inflammation, recurrent hepatitis, inflammation of the parotid gland, or uveitis (intraocular inflammation).

  4. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Clinical Alert

  1. Monitor close and high-risk contact for 21 days.

  2. There is no known cure, vaccine, or treatment, other than supportive care, for HPS.

Reference Values

Normal

No evidence of hantavirus, Ebola virus, or 17 other viruses that may cause VHF

No evidence of yellow fever virus that may cause hepatitis

Negative for dengue virus antibodies

Negative for presence of antibodies to hantavirus

Negative antigen-detection ELISA for Marburg virus