Central Nervous System Disease Associated with Major Viral Haemorrhagic Fever Viruses of Public Health Importance: Challenges in Patient Diagnosis, Evaluation, and Management in Resource-Limited Settings

Viral haemorrhagic fever (VHF) viruses cause infectious diseases that are of public health importance. Billions of people from all over the world are at risk of exposure to infection from these viruses with epidemics or outbreaks occurring in both endemic and non-endemic areas. The VHF viruses are largely neglected but are re-emerging as real threats to global health. While the more dramatic clinical presentations (such as bleeding and vascular collapse) are well known, the contribution of features that involve the central nervous system (CNS) to mortality and morbidity are not fully recognised. The diagnosis of VHF in febrile patients with CNS-related features, but who do not present with characteristic bleeding, may be missed or delayed because of a low index of suspicion. The proper evaluation of such patients with CNS disease is hampered by the dearth of neurologists and investigational tools, and weak health systems in resource-limited settings where most of the VHF viruses are endemic. Addressing these constraints would require investment in capacity building and infrastructural development in the affected countries.