Bolivian hemorrhagic fever: A narrative review

Bolivian hemorrhagic fever (BHF) is a sporadic high-mortality febrile illness. Two etiological agents are currently recognized: Machupo virus and Chapare virus. Infection in humans occurs by exposure to excreta and secretions of wild native rodents in Bolivia. BHF is considered a severe disease that has three clinical phases: prodromal, hemorrhagic, and convalescent. Unspecific symptoms occur during the first phase, severe hemorrhagic manifestations occur during the second phase, and finally patients who survive experience a slow convalescent phase. The incubation period is variable and depends on host factors, viral pathogenicity, and severity of the disease. The diagnosis is primarily clinical and epidemiological, and though diagnosis should be confirmed by laboratory tests, viral agents of BHF are considered very pathogenic and need to be handled in reference laboratories that are not available in endemic areas. The most recent outbreak was in 2019, in which health-care professionals were infected and is recognized as the first outbreak in La Paz department, Bolivia, a place where no prior cases had been reported. In addition, as tourism and travelling increase in Bolivia, along with ecological practices that could represent a risk for acquiring BHF, travelers could be infected, develop the disease, and be a diagnostic challenge in non endemic countries. No vaccines or antiviral therapies are available and approved for human use. Control measures are focused on peridomicile rodent population eradication which demonstrated efficacy in reducing cases during the first outbreaks.