The Viral Hemorrhagic Fevers

摘要: A 34-year-old male presents to the emergency room with a 4-day history of fever, headache, myalgia, nausea, and general malaise. Physical exam reveals hyperthermia, tachycardia, diaphoresis. Laboratory tests show mild leucopenia thrombocytopenia elevated BUN creatinine. rapid test for influenza is negative. The patient clerk in municipal county building. He has no significant past medical history, not recently traveled outside United States, reports exposure exotic pets or foods. Acetaminophen oral rehydration solution are prescribed discharged diagnosis ‘‘viral syndrome.’’ next morning, 43-year-old woman similar clinical picture, but fine morbilliform rash over her face chest. As doctor working shift same from day before, coincidence that also works at building goes unnoticed. She similarly Later afternoon, an ambulance arrives returning man seen previous day, whose condition deteriorated include severe abdominal pain hematemesis. now shows hypothermia, hypotension, oozing blood nose gums. admitted critical care unit. Two days later joint morning report held physicians all hospitals area, one residents case 28-year-old fever bleeding. When it reported secretary building, doctors begin suspect common source. They contact city public health officials who, through further inquiry rooms throughout city, identify five more workers themunicipal recent febrile syndromes week,