ABSTRACT
One of the most difficult problems in dealing with patients with hemorrhagic fever is the early recognition of the cause of the disease. The first suspicion that a patient may have one of the virus hemorrhagic fevers is usually aroused on clinical grounds. The hemorrhagic state is characterized by bleeding from the mucous membranes, often first manifesting as epistaxis or bleeding from the nose, followed by hematemesis or vomiting blood, hemoptysis or coughing blood, and then melena or passing blood. Patients suffering from psittacosis, especially if complicated by chlamydial endocarditis, may manifest petechial hemorrhages. Patients suffering from rickettsial diseases, if at all severe, develop a characteristic rash. A hemorrhagic state may complicate a number of bacterial infections and, indeed, is an outstanding sign in some of them. Acute fungal infections, particularly in immunosuppressed patients, may be associated with a hemorrhagic state. Such complications have been noted in patients with acute candidiasis and acute histoplasmosis.
