What infectious diseases are associated with severe bleeding?

Infectious diseases that cause severe bleeding

Yellow fever, dengue (severe dengue), Ebola/Marburg (filoviruses), and Crimean–Congo hemorrhagic fever are the canonical infectious causes of severe bleeding and hemorrhagic shock, with high risks to morbidity, mortality, and quality of life. 1, 2, 3, 4

• Viral hemorrhagic fevers (VHFs)

  • Ebola and Marburg: abrupt fever → multisystem involvement with petechiae, ecchymoses, mucosal/GI bleeding; high case-fatality and nosocomial risk 2.
  • Crimean–Congo hemorrhagic fever: hemorrhagic manifestations, human-to-human transmission potential; HCID category 4.
  • Yellow fever: severe phase with jaundice, renal failure, shock, and bleeding (hematemesis, melena, hematuria, mucosal oozing); case fatality 20–50% in severe disease; avoid aspirin/NSAIDs; care is supportive 1.
  • Dengue (severe/with hemorrhage): thrombocytopenia, plasma leakage, serious bleeding and shock; recognized hemorrhagic entity with major adverse outcomes 3.

• Other notable infectious causes with hemorrhage

  • Leptospirosis (Weil’s disease): can cause pulmonary hemorrhage and mucosal/GI bleeding (support from broader evidence, fits differential listed alongside VHFs in YF guideline) 1.
  • Rickettsioses (e.g., RMSF/ehrlichiosis): petechial rash; severe disease can include coagulopathy and occasional hemorrhage 5.
  • Severe sepsis/meningococcemia: DIC with purpura fulminans, mucosal/GI bleeding; high mortality (supported by thrombocytopenia-infection literature) 6, 7.
  • Plague septicemia: hemoptysis in pneumonic plague; can bleed in severe sepsis 2.

Algorithmic pointers to protect morbidity, mortality, and QoL:

• Immediately suspect VHF or severe dengue/yellow fever with: high fever + bleeding (mucosal/GI/hematuria), shock, jaundice, or travel/residence in endemic area; institute isolation and supportive resuscitation; avoid aspirin/NSAIDs in suspected arboviral hemorrhagic disease 1, 2, 3.
• For yellow fever/dengue:
  • Strict supportive care; monitor/co-manage coagulopathy and organ failure; avoid aspirin; manage shock early 1, 3.
• Pitfalls to avoid:
  • Missing epidemiologic exposure (travel, vectors, contacts) when triaging hemorrhagic fever risk 1.
  • Using aspirin/NSAIDs in suspected yellow fever/dengue due to hemorrhage risk 1.
  • Delayed infection control measures in suspected HCID (Ebola/Marburg/CCHF) increasing nosocomial mortality 2, 4.