What precautions should be taken for hemorrhagic fever?

Patients diagnosed with hemorrhagic fever—particularly those caused by hantaviruses (e.g., Hantaan, Seoul, or Dobrava viruses)—require careful clinical monitoring and supportive management. Key considerations include strict infection control measures, as transmission occurs primarily through inhalation of aerosolized rodent excreta; therefore, healthcare workers must use contact and airborne precautions during high-risk procedures. Early recognition of the disease’s biphasic course is critical: the febrile phase (days 1–4) features abrupt onset of fever, myalgia, headache, abdominal pain, and flushing, often accompanied by thrombocytopenia and leukocytosis; this may progress to the hypotensive/shock phase (days 4–8), characterized by increased vascular permeability, hemoconcentration, acute kidney injury, and potential disseminated intravascular coagulation (DIC). Renal involvement—manifesting as oliguria, rising serum creatinine, and proteinuria—is a hallmark and necessitates close fluid balance assessment to avoid both under-resuscitation and pulmonary edema. Platelet transfusions are reserved for active bleeding or severe thrombocytopenia (<20 × 10⁹/L) with procedural risk; routine prophylactic transfusion is not recommended. Antiviral therapy (e.g., ribavirin) has shown limited efficacy in some hantavirus infections but is not standard of care outside specific endemic contexts and remains unproven for most strains. Patients should be managed in settings capable of intensive monitoring, including serial electrolyte panels, coagulation studies, urinalysis, and renal replacement therapy if indicated. Recovery typically begins in the diuretic phase (days 9–14), but prolonged convalescence with fatigue and mild renal dysfunction may occur. Long-term follow-up is advised to assess for residual renal impairment or hypertension.