Bolivian hemorrhagic fever is a severe viral illness that happens in parts of Bolivia. The virus that causes it is called Machupo virus. This virus belongs to the arenavirus family, the same broad group as Lassa and Junín viruses. People usually get infected after breathing in dust or tiny droplets from the urine, feces, or saliva of infected wild mice. The illness can start like the flu, then turn into bleeding problems, low blood pressure, and organ stress. Without quick supportive care, it can be fatal. PMC+2CFSPH+2
Bolivian hemorrhagic fever is a severe viral illness found mainly in Bolivia. It is caused by arenaviruses—most often Machupo virus—that live in local rodents. People usually get infected by breathing in or touching dust, food, or items contaminated with rodent urine or droppings. Illness starts like the flu with fever, tiredness, body aches, and headache. In some people it becomes dangerous, with bleeding, low blood pressure, confusion, and organ failure. Quick isolation, careful nursing, fluids, and treating complications save lives. CDC+2CDC+2
The main mouse that carries the virus is the large vesper mouse (Calomys callosus). These mice do not look sick, but they can shed the virus for a long time and spread it in their environment. Humans can also become infected in hospitals or homes after close contact with blood or body fluids from a sick person, though this is less common. CDC+1
BHF was first recognized in 1959 around San Joaquín in the Beni region. Outbreaks have appeared off and on, including clusters in the 1990s and 2000s. The disease is rare but dangerous, and it requires strong infection control in clinics. CDC+2CDC+2
Other names
BHF is also called “black typhus” in some reports. You may also see it written simply as Machupo virus disease or as one of the South American hemorrhagic fevers. (Note: some sources also discuss Chapare virus in Bolivia; that is a different arenavirus that can cause a similar hemorrhagic fever.) CFSPH
Types
Doctors do not split BHF into strict “types” the way we do for some other diseases. Instead, they describe it by phase and severity:
Mild/Uncomplicated disease: fever, headache, muscle aches, and fatigue without bleeding. Many signs look like flu or dengue. PMC
Moderate disease: persistent high fever with low platelets, mild bleeding (nose, gums, spots under the skin), low blood pressure, or signs of organ strain. PMC
Severe/complicated disease (hemorrhagic phase): obvious bleeding, shock, confusion or tremors, lung fluid, or multi-organ failure. This group has the highest risk of death without intensive care. PMC
Phases over time: a prodromal phase (1–5 days), a hemorrhagic phase (2–10 days) in some patients, and a convalescent phase (weeks to months) for survivors. Wikipedia
Causes
For BHF there is one true cause—Machupo virus. The list below explains 20 exposures and conditions that raise the chance of infection or disease spread.
Breathing in contaminated dust in homes, grain stores, or barns where infected mice live. Tiny virus-containing particles can become airborne. CDC
Food contamination by rodent urine or droppings (for example, uncovered grains). CFSPH
Direct contact with rodent excreta/secreta while cleaning or handling supplies. CDC
Sleeping on floors or staying in rodent-infested housing. CFSPH
Agricultural work (harvesting, threshing, grain storage) in endemic zones. CFSPH
Poor rodent control in villages and food warehouses. CDC
Environmental changes that boost rodent numbers (e.g., loss of predators, crop changes). CDC
Dry, dusty seasons that make aerosols more likely indoors. CFSPH
Handling sick or dead rodents without protection. CFSPH
Nosocomial exposure (health-care settings) to blood/body fluids during care of an infected patient. ScienceDirect
Household caregiver exposure to a severely ill family member’s secretions. ScienceDirect
Inadequate disinfection of medical equipment used for bleeding or IV lines. CFSPH
Laboratory exposure (needlestick, spills) when handling arenaviruses; Machupo requires BSL-4. gideononline.com
Broken skin contact with contaminated materials (cuts, abrasions). CFSPH
Mucous membrane splash to eyes, nose, or mouth during patient care. CFSPH
Shared living with high rodent density (crowding, shared grain storage). CDC
Travel or field work in known BHF foci without precautions. PMC
Cleaning long-closed rooms or barns that stir up contaminated dust. CFSPH
Improper waste handling that attracts rodents. CFSPH
Co-circulation of similar viruses (e.g., Chapare) can confuse control efforts, increasing exposure if messages are mixed; the prevention steps are similar. CFSPH
Common symptoms
Fever: often high and abrupt; a core sign of viral infection. PMC
Severe headache: due to widespread inflammation. PMC
Muscle and joint pains: typical of arenaviral fevers. PMC
Extreme tiredness (malaise): body uses energy to fight the virus. PMC
Loss of appetite and nausea: common early features. PMC
Vomiting and diarrhea: appear in some patients as illness worsens. Wikipedia
Abdominal pain: from inflamed tissues or bleeding. PMC
Sore throat and cough: non-specific but reported in early disease. PMC
Bleeding from gums or nose: due to low platelets and clotting problems. PMC
Red spots or bruises on skin (petechiae/ecchymoses): tiny bleeds under the skin. PMC
Low blood pressure, fainting, or shock: due to fluid loss and leaky vessels. PMC
Shortness of breath or lung fluid: can occur in severe cases. PMC
Tremors or confusion: nervous system involvement in severe disease. PMC
Slow heart rate (bradycardia): described during the hemorrhagic phase. Wikipedia
Prolonged weakness during recovery: convalescence can take weeks to months. Wikipedia
Diagnostic tests
(Grouped as Physical Exam, Manual/bedside tests, Lab & Pathology, Electro-diagnostic & Monitoring, Imaging)
A) Physical exam
Vital signs check (fever, blood pressure, pulse): confirms fever and looks for low blood pressure or slow heart rate, which signal severe disease. PMC
Skin and mucosa inspection: searches for petechiae, bruises, gum bleeding, or nosebleeds—clues to hemorrhage. PMC
Lung exam: crackles may suggest fluid in the lungs; oxygen levels may be low. PMC
Neurologic check: tremor, confusion, or agitation may appear in severe BHF. PMC
Abdominal exam: tenderness or liver enlargement can point to organ stress. PMC
B) Manual / bedside tests
Capillary refill/skin perfusion test: quick screen for shock and poor circulation. PMC
Orthostatic blood pressure test: drop in pressure when standing can show dehydration or early shock. PMC
Bedside bleeding time (where available): crude clue of platelet function; modern labs are preferred, but bedside checks can alert clinicians in resource-limited settings. CFSPH
C) Laboratory & pathology
Complete blood count (CBC): often shows low platelets (thrombocytopenia) and low white counts; hemoglobin may fall with bleeding. PMC
Coagulation panel (PT/INR, aPTT, fibrinogen, D-dimer): detects clotting pathway problems linked to bleeding risk. PMC
Liver and kidney tests (AST, ALT, bilirubin, creatinine): assess organ injury from severe infection. PMC
Serology (ELISA IgM/IgG for Machupo): detects antibodies; IgM suggests recent infection; IgG helps with later/confirmatory testing. Testing should occur in qualified labs. PMC
RT-PCR for Machupo virus RNA: confirms infection early by finding viral genetic material; must be handled in high-containment or specialized reference labs. PMC
Virus isolation/culture: rarely done outside BSL-4 facilities; used for research/outbreak investigation. gideononline.com
Urinalysis: may show blood or protein from kidney involvement or bleeding. PMC
Cross-checks for similar diseases (malaria tests, dengue/other arenavirus panels): helps avoid misdiagnosis in endemic regions. CFSPH
D) Electro-diagnostic & monitoring
Electrocardiogram (ECG): can show slow heart rate or rhythm problems during severe illness; also watches for electrolyte-related changes. Wikipedia
Continuous pulse oximetry/monitoring: tracks oxygen saturation and heartbeat to detect deterioration early. PMC
E) Imaging
Chest X-ray: looks for lung fluid (pulmonary edema) or pneumonia-like changes in severe cases. PMC
Head CT (when indicated): assesses for brain bleeding in patients with severe headache, confusion, or sudden neurologic decline. PMC
Non-pharmacological treatments (therapies & others)
Notes: These are core supportive and public-health actions. They do not “cure” the virus but reduce complications and prevent spread.
Strict isolation & PPE — Put the patient in a single room, limit visitors, and use mask, gown, gloves, and eye protection. This blocks contact with blood and body fluids and stops onward transmission to staff or family. CDC+1
Hand hygiene & surface disinfection — Frequent handwashing and cleaning of high-touch surfaces with appropriate disinfectants lower contact transmission risk in clinics and homes. CDC
Careful IV/needle safety — Use safety-engineered sharps, closed systems, and proper disposal boxes to prevent healthcare-associated exposures. CDC
Aggressive fluid resuscitation — Guided IV fluids (e.g., normal saline/Ringer’s lactate) correct dehydration and shock while watching for fluid overload. This supports circulation and organs. World Health Organization+1
Oral rehydration (ORS) — Where IV access is delayed, ORS quickly replaces water and electrolytes and can be life-saving in early illness. World Health Organization
Electrolyte correction — Check and fix potassium, sodium, and acid-base problems to prevent arrhythmias, weakness, and seizures. NCBI
Temperature control (non-drug methods) — Tepid sponging and cooling blankets provide comfort and reduce metabolic stress alongside medicines when needed. World Health Organization
Bleeding precautions — Gentle oral care, soft toothbrushes, pressure after phlebotomy, and avoiding invasive procedures help reduce bleeding risk. World Health Organization
Transfusion support (as indicated) — Packed RBCs, platelets, or plasma are used for major bleeding or severe anemia/thrombocytopenia following local protocols. CDC
Oxygen therapy — Nasal cannula or mask oxygen treats hypoxemia from lung involvement or shock, buying time for definitive care. CDC
Airway protection & ventilation — If consciousness drops or breathing fails, intubation and ventilatory support are indicated with full PPE. CDC
Renal replacement (dialysis) when needed — Acute kidney injury in severe VHF may need dialysis to remove toxins and control fluids/electrolytes. CDC
Nutrition support — Early light feeding or enteral nutrition maintains strength and gut integrity while recovery proceeds. World Health Organization
Delirium/seizure precautions — Quiet room, reorientation, and safety measures reduce agitation and injury risk; escalate to medications if seizures occur. CDC
Rodent control (community level) — Trapping, sealing houses, and sanitation cut exposure to Calomys reservoirs; this historically reduced BHF cases. Iris+1
Safe burial practices — Trained teams, PPE, and body-handling protocols prevent exposures during funerals. CDC
Contact tracing & monitoring — Identify exposed people, monitor for fever, and isolate promptly if symptoms start to break chains of transmission. Pennsylvania Government
Health education — Teach families to store food safely, keep rodents out of homes, and seek prompt care for fever and bleeding. CDC
Transport precautions — Move patients with closed routes, minimal staff, and spill kits; clean vehicles after transfer. CDC
Multidisciplinary critical-care protocols — Checklists for shock, bleeding, organ support, and communication improve outcomes and safety in PPE-limited settings. World Health Organization
Drug treatments
Reality check: There is no FDA-approved antiviral specifically for BHF/Machupo. Limited, mixed evidence exists for ribavirin or convalescent plasma from related arenaviruses; use is investigational/off-label and should be done with expert/authority input. Most medicines below treat symptoms or complications (fever, nausea, seizures, shock, infections). FDA labels are cited for the drugs’ approved uses/dosing, not as BHF-specific approvals. ScienceDirect+1
Acetaminophen (paracetamol) — For fever/aches (avoid NSAIDs due to bleeding risk). Typical adult IV dosing per label; total daily limits to avoid liver injury. Class: Analgesic/antipyretic. Timing: q4–6h as needed. Mechanism: Central COX inhibition lowers fever set-point. Side effects: Liver toxicity if overdosed. FDA Access Data+1
Ondansetron — Controls vomiting to protect hydration and oral meds. Class: 5-HT3 antagonist. Dosage/Timing: Per label IV/IM dosing. Mechanism: Blocks serotonin receptors in gut/brain. Side effects: Headache, constipation, QT prolongation (rare). FDA Access Data
Pantoprazole (IV) — Stress-ulcer prophylaxis if critically ill or bleeding risk. Class: Proton-pump inhibitor. Dosage: 40 mg IV daily (per label for GERD; ICU use per protocol). Mechanism: Suppresses gastric acid. Side effects: Headache, low magnesium (long use). FDA Access Data
Norepinephrine (IV vasopressor) — Treats septic-shock-like hypotension after fluids. Class: Catecholamine vasopressor. Dosage: Titrate IV infusion to MAP targets. Mechanism: α-1 mediated vasoconstriction; some β-1. Side effects: Arrhythmias, limb ischemia with extravasation. FDA Access Data
Ceftriaxone (empiric bacterial coverage if secondary infection suspected) — Class: Third-gen cephalosporin. Dosage: Per label/indication. Mechanism: Inhibits cell-wall synthesis. Side effects: Allergy, biliary sludge; use only with evidence of bacterial infection. FDA Access Data
Levetiracetam (IV) — For seizures/status epilepticus. Class: Antiepileptic. Dosage: Per label (IV alternative to oral). Mechanism: SV2A modulation. Side effects: Somnolence, mood change. FDA Access Data
Electrolyte solutions (IV crystalloids) — Normal saline/LR are the first-line for dehydration and shock; though not “drugs” in the FDA sense, they are core therapy and dosed like medications. Mechanism: Restore intravascular volume. Risks: Fluid overload if not monitored. e-lactancia.org
Antipyretic sponges + acetaminophen combo — Using non-drug cooling with labeled acetaminophen reduces physiologic stress; avoid ibuprofen/ASA for bleeding. FDA Access Data
Remdesivir (context only) — A nucleotide analog approved for COVID-19, not BHF; no clinical evidence for Machupo. Listed here to prevent confusion. Mechanism: Viral RNA polymerase inhibitor. Use in BHF: Not established. Side effects: Transaminase elevations. FDA Access Data
Ribavirin (context only, off-label/investigational) — Evidence in New World arenaviruses is mixed; not FDA-approved for BHF; label is for hepatitis C (historic). Risks: Hemolytic anemia, teratogenic. Only under expert guidance. ScienceDirect+1
Antiemetics (alternative classes, e.g., metoclopramide per local protocols) — To maintain hydration. Mechanisms vary (dopamine/serotonin). Side effects and dosing per label/local guidance. FDA Access Data
Prophylactic anticoagulation — Generally avoided in active hemorrhagic diathesis; decision individualized by specialists. Included to stress avoidance unless clear benefit. CDC
Antipruritics/antihistamines (if needed) — Comfort care for rash/itch; dosing per labels; sedation as a side effect. World Health Organization
Prokinetics/PPIs combination — For persistent vomiting/bleeding-risk gastritis in ICU; dosing per labels. FDA Access Data
Broad-spectrum antibiotics (only if bacterial pneumonia/UTI, etc.) — Stewardship essential to avoid resistance; choose per cultures. FDA Access Data
Anticonvulsant alternatives (e.g., benzodiazepines acutely) — For status epilepticus per ACLS/ICU protocols. CDC
Antipyretic oral acetaminophen — Reinforcing fever control when IV not needed; respect daily maximum dose. FDA Access Data
Antitussives (if severe cough interfering with rest) — Symptomatic only; use cautiously to avoid sedation/aspiration. World Health Organization
Prophylaxis against stress gastritis in ventilated patients (PPI per label) — Reduces GI bleeding risk in ICU. FDA Access Data
Electrolyte supplements (K/Mg as ordered) — Corrects arrhythmia risk and muscle weakness; dosing and monitoring per ICU protocols. World Health Organization
Dietary molecular supplements
There is no supplement that treats BHF. If your clinician approves, these may support general immunity/nutrition during recovery; stay within safe limits.
Vitamin C — Antioxidant supporting immune cell function and collagen; helps iron absorption. Typical diet meets needs; high doses can cause GI upset/kidney stones. Office of Dietary Supplements
Zinc — Cofactor in hundreds of enzymes; vital for immune cell signaling and wound healing; excess >40 mg/day risks copper deficiency. Office of Dietary Supplements
Vitamin D — Supports bone and immune health; avoid exceeding the adult upper limit of 4,000 IU/day without medical advice. Office of Dietary Supplements
Balanced electrolytes (ORS) — Glucose-electrolyte solution optimizes water absorption in the gut; use WHO-style formulas. World Health Organization
Protein-dense foods/supplements — Maintain muscle and immune proteins; prioritize food first; shakes only if advised. World Health Organization
Thiamine (B1) — Supports energy metabolism; deficiency can worsen weakness and confusion. World Health Organization
Folate/B12 — Support red-blood-cell production during recovery from anemia; supplement only if deficient. World Health Organization
Multivitamin (standard dose) — Backstop for poor intake; avoid megadoses. Office of Dietary Supplements
Iron (only if iron-deficient) — Corrects true iron-deficiency anemia; avoid empiric iron during acute infection without testing. Office of Dietary Supplements
Probiotics (case-by-case) — May support gut tolerance during recovery; evidence not specific to BHF. Discuss with clinician. Office of Dietary Supplements
Immunity-booster / regenerative / stem-cell” drugs
There are no FDA-approved “immune-booster,” regenerative, or stem-cell drugs for BHF. Some biologics used for other diseases (e.g., tocilizumab) are immunosuppressive and not used to treat BHF. Any use of convalescent plasma or experimental antivirals is investigational and should occur only under expert/authority guidance. PMC+1
Convalescent plasma (investigational) — Historically beneficial in Argentine HF when given early; evidence for BHF is insufficient. Risks include transfusion reactions. PMC
Ribavirin (investigational) — Mixed arenavirus data; not FDA-approved for BHF; significant toxicity. ScienceDirect+1
Favipiravir/other nucleosides (investigational) — Laboratory/animal data for arenaviruses; no BHF approvals. PMC
Monoclonal antibodies to arenaviruses (research) — In development; not available for Machupo clinical use. PMC
Growth factors/stem-cell products — No role in acute BHF; not approved. World Health Organization
Remdesivir — FDA-approved for COVID-19 only; no established role in BHF. FDA Access Data
Surgeries
Surgery is not a treatment for the virus, but urgent operations should proceed if clinically needed (e.g., obstetric emergencies), with full PPE and meticulous hemostasis because bleeding risk is high. CDC
Emergency cesarean section — For standard obstetric indications to save mother/baby; full airborne/Contact/Droplet PPE and blood bank readiness. CDC
Exploratory laparotomy for uncontrolled intra-abdominal bleeding — When imaging/clinical signs demand operative control. CDC
Operative wound/soft-tissue hemostasis — For traumatic bleeding not controlled conservatively. CDC
Surgical airway (tracheostomy) or advanced airway procedures — Only if standard indications; maximize staff protection. CDC
Dialysis access placement — If renal failure requires hemodialysis; use full precautions. CDC
Preventions
Keep rodents out of homes (seal cracks, store food off the floor, secure grain). CDC
Trap and reduce rodent populations in affected areas. Iris
Clean up safely after rodent activity (wear gloves, wet disinfection—not dry sweeping). CDC
Protect food and water from contamination by rodents. CDC
Use PPE when caring for sick persons with suspected BHF. CDC
Prompt isolation and testing of suspected cases. CDC
Contact tracing and monitoring after exposures. Pennsylvania Government
Travel advice during outbreaks; avoid high-risk settings. Pennsylvania Government
Health education in communities about rodent risks and early care-seeking. CDC
Public-health surveillance to detect clusters quickly. Pan American Health Organization
When to see doctors (or call emergency services)
Seek urgent care for fever with bleeding, black stools, vomiting blood, fainting, confusion, severe weakness, fast breathing, severe dehydration, or worsening after 24–48 hours. In affected regions or after possible rodent exposure, any high fever should prompt medical evaluation and isolation precautions. Missouri Department of Health+1
What to eat (and what to avoid) during recovery (doctor-approved)
Eat: small, frequent meals; ORS or broths; bananas, rice, applesauce, toast; lean proteins (eggs, fish, lentils); fruits/vegetables as tolerated; and normal iodized-salt use to replace electrolytes—under clinical guidance. World Health Organization
Avoid: alcohol; NSAIDs (e.g., ibuprofen, aspirin) unless a doctor says otherwise; very spicy/greasy foods if nausea; raw/unsafe foods; and megadose supplements beyond safe limits (e.g., Vitamin D >4,000 IU/day; excess zinc >40 mg/day). Use acetaminophen instead for fever within labeled limits. FDA Access Data+2Office of Dietary Supplements+2
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The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: October 29, 2025.
