Dengue Hemorrhagic Fever

ID/CC A 58-year-old man who was hitchhiking through central and southern Africa was admitted to a hospital in Zaire in a state of shock following massive hemorrhage from the GI tract (hematcmesis and melena); he died within six hours of admission. Ten days later, a male doctor who had attended this patient and had attempted resuscitation became ill with a similar disease syndrome.

HPI At admission, he gave an eight-day history of progressive fever, myalgias, and watery diarrhea. He also reported an erythematous, measles-like skin rash that had begun to desquamate.

Labs CBC: leukopenia; Pelger-Huet anomaly of neutrophils with atypical mononuclear cells; thrombocytopenia with abnormal platelet aggregation. Markedly elevated AST and ALT; blood was inoculated intraperitoneally into young guinea pigs and into various tissue culture cell lines, and Ebola virus was detected by indirect immunofluorescent staining techniques.

At autopsy, lymph nodes, liver, and spleen found to be most conspicuously involved; stomach and intestines filled with blood; petechiae seen over bowel mucosa.

Severe congestion and stasis of spleen; widespread necrosis of liver cells; electron microscopy of liver revealed pleomorphic virus particles appearing in contrast preparations as long, filamentous forms, U-shaped forms, and some circular forms resembling a doughnut.

Treatment Outbreak was brought under control by isolating patients, instituting strict barrier nursing, and treatment of patient's excreta with disinfectants such as formaldehyde and hypochlorite.

Discussion A hemorrhagic, febrile infection of humans due to infection with the Ebola and Marburg viruses, both of which are flloviruses that are structurally indistinguishable but antigenically distinct. There is strong suspicion that this disease is a zoonosis, with monkeys initially being implicated. lp.198

FIRST AID

Imaging Gross Pathology

Micro Pathology

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