Table 12.

Clinical presentations of VHF

VHF	Symptoms	Physical Findings
Dengue	Headache Retro-orbital pain Myalgia and arthralgia (breakbone fever) Nausea/vomiting/diarrhea Abdominal pain Anorexia Cough Sore throat Nasal congestion	Fever (saddle-back patter) Rash Petechiae Evidence of bleeding (epistaxis, ecchymosis, melena, menorrhagia, hematuria, oozing from IV sites, and so forth) Hypotension/shock
Crimean-Congo hemorrhagic fever	Headache Back pain Myalgia/arthralgia Abdominal pain Nausea and vomiting Altered mood and sensory perception	High fever Conjunctival injection Facial flushing Pharyngitis Petechiae (commonly seen on oral palate) Jaundice Evidence of bleeding (epistaxis, ecchymosis, melena, menorrhagia, oozing from IV sites, and so forth)
Ebola and Marburg hemorrhagic fevera	Chills Malaise/weakness Severe headache Myalgia Nausea/vomiting/diarrhea Abdominal pain Cough Hiccups	Fever ± relative bradycardia Rash Pharyngitis Prostration/stupor Hypotension (shock) Hemorrhage (epistaxis, ecchymosis, melena, menorrhagia, hematuria, oozing from IV sites, and so forth)
Hantavirus pulmonary syndrome	Fatigue Myalgia Headache Dizziness Chills Nausea/vomiting/diarrhea Abdominal pain Dyspnea ± chest tightness Cough	Fever Conjunctivitis Facial flushing Petechiae rash on the trunk, axillary folds, soft palate, or neck Crackles on auscultation
Hemorrhagic fever with renal syndromeb	Headache Back pain Abdominal pain Chills Nausea Blurred vision	Fever Conjunctivitis Rash Facial flushing Hypotension/shock Oliguria/anuria
Lassa fever	Retrosternal pain Sore throat Back pain Cough Abdominal pain Nausea/vomiting/diarrhea Frothy urine (proteinuria) Hearing loss	Fever Pharyngitis Conjunctivitis Facial edema Frothy urine (proteinuria) Mucosal hemorrhage Tremors Encephalitis
Rift Valley fever	Headache Malaise Back pain Dizziness Anorexia	Fever Weight loss ± jaundice ± mucosal hemorrhage ± hypotension/shock Encephalitis

Abbreviations: ±, may or may not be seen; IV, intravenous.

^aNote: most recent strain of Ebola lacks many of the typical hemorrhagic features typically seen.

^bSignificant variation in presentation depending on the strain of virus.

Data from Centers for Disease Control and Prevention. Special pathogens branch disease information. Available at: http://www.cdc.gov/ncidod/dvrd/spb/mnpages/disinfo.htm. Accessed February 2, 2013.