Hemorrhagic Fever Caused by Chapare Virus

Hemorrhagic fever caused by Chapare virus is a rare but very serious viral illness. It is caused by a virus called Chapare virus, which belongs to a group of viruses known as arenaviruses. The virus damages many organs in the body and can make blood vessels weak and “leaky.” This can lead to bleeding under the skin, from the gums, nose, stomach, and other body parts. The disease has been reported only in Bolivia so far and has a high risk of death. PMC+3CDC+3Wikipedia+3

Hemorrhagic fever caused by Chapare virus is a very rare but very serious infection. It is called Chapare hemorrhagic fever (CHHF). The illness is caused by Chapare virus, a New World arenavirus (Mammarenavirus chapareense) first recognized in Bolivia. The virus likely lives in certain wild rodents, and people get infected when they touch or breathe in dust contaminated with rodent urine, droppings, or saliva, or when they have close contact with the body fluids of an infected person.CDC+1

After an incubation period of about 9–19 days, people often develop high fever, headache, muscle pain, back pain, nausea, vomiting and diarrhea. The disease can then progress to bleeding from gums and nose, bruises, low blood pressure, shock, confusion, seizures and multi-organ failure. The death rate is high.Wikipedia+1

Chapare hemorrhagic fever usually starts after a delay called the incubation period. This is the time between catching the virus and feeling sick. For Chapare virus, this period is usually around 9–19 days, and possibly up to about three weeks. After this time, the patient suddenly develops fever, headache, muscle and joint pain, nausea, vomiting, and diarrhea. Later, bleeding and problems with the brain, such as confusion or seizures, can appear in severe cases. PMC+3World Health Organization+3Wikipedia+3

Because there have been only a small number of known cases, doctors are still learning about this disease. But we know that the virus can spread from rodents to people, and also from sick people to other people in some situations, especially in hospitals. It is considered a type of viral hemorrhagic fever similar to other arenavirus diseases like Machupo and Lassa fever. ScienceDirect+3Wikipedia+3Pan American Health Organization+3

Other names and simple types

Hemorrhagic fever caused by Chapare virus can be called by several names in medical articles:

• Chapare hemorrhagic fever (CHHF)

• Chapare virus disease

• Hemorrhagic fever caused by Chapare virus

• An arenaviral hemorrhagic fever caused by Chapare virus

• A form of Bolivian hemorrhagic fever due to Chapare virus (Bolivian hemorrhagic fever can be caused by Machupo or Chapare viruses) Wikipedia+2MalaCards+2

Doctors sometimes also describe “types” or “forms” of illness based on how severe it is. These are not official separate diseases but simple ways to describe how the infection looks:

• Mild febrile form – mostly fever, headache, body pain, and tiredness, with little or no obvious bleeding. WVOEPS+1

• Classic hemorrhagic form – fever plus vomiting, diarrhea, stomach pain, bleeding from gums or nose, and small red spots or bruises on the skin. PMC+2MalaCards+2

• Severe shock and neurologic form – strong bleeding, very low blood pressure, confusion, seizures, and sometimes coma. This form has the highest risk of death. PMC+2PubMed+2

Causes

In simple words, the real “cause” of this disease is infection with the Chapare virus. But people get infected because of many different risk situations. Below are 20 important causes or conditions that can lead to infection or a worse outcome.

1. Contact with rodent urine
   The main suspected source of Chapare virus is certain wild rodents. When their urine contains virus and touches human skin, eyes, mouth, or small cuts, the virus can enter the body. This can happen when people sleep, sit, or work in places where rodents live. Restored CDC+3CDC+3GOV.UK+3

2. Contact with rodent droppings (feces)
   Tiny dried pieces of rodent droppings can carry the virus. When people clean houses, barns, or grain storage and breathe in dust, the virus can get into the lungs. This breathing in of “infected dust” is a common way arenaviruses spread. Pan American Health Organization+2Restored CDC+2

3. Contact with rodent saliva
   Rodent saliva can be on food, grain, or objects if rodents chew on them. It can also enter the body if a rodent bites a person. The virus in saliva can then infect the person’s blood and tissues. Pan American Health Organization+1

4. Rodent bites or scratches
   A direct bite or scratch from an infected rodent pushes saliva and possibly blood deep into the skin. This gives the virus a clear path past the outer protective layer of the body and into the bloodstream. Restored CDC+1

5. Breathing air contaminated by rodents
   In closed spaces like grain warehouses, barns, and poorly ventilated homes with many rodents, tiny virus particles from dried urine or droppings can float in the air. Breathing this air for a long time increases the risk of infection. Pan American Health Organization+2Restored CDC+2

6. Eating food or drinking water contaminated by rodents
   Food kept in open containers or on the floor can be contaminated by rodent urine, droppings, or saliva. Drinking or eating these contaminated items lets the virus go directly into the stomach and intestines and then into the blood. Restored CDC+1

7. Living in or visiting endemic rural areas of Bolivia
   All known outbreaks have happened in Bolivia. People who live in or travel to affected regions, especially rural areas with rodent problems, have a higher chance of meeting infected rodents or their waste products. PMC+3CDC+3Wikipedia+3

8. Poor housing and storage conditions
   Houses made of materials that are easy for rodents to enter, and food stored without protection, make it easier for rodents to infest living spaces. This increases daily contact with rodent excreta and raises the risk of infection. GOV.UK+2ScienceDirect+2

9. Agricultural work in rodent-infested fields
   Farmers and field workers often work in areas where rodents live and feed on crops. Handling crops, soil, and storage sacks that rodents have contaminated can bring the virus to human hands, face, and lungs. GOV.UK+2ResearchGate+2

10. Cleaning barns, storage rooms, or grain silos
    Sweeping or cleaning old storage places stirs up dust that may contain dried rodent urine and droppings. Without masks or wet cleaning methods, people working in these spaces can breathe in virus particles. Pan American Health Organization+1

11. Direct contact with the blood of a sick person
    Chapare virus can also spread from person to person. Touching the blood of a patient, especially without gloves, can let the virus enter through tiny skin breaks or mucous membranes. This is a big risk for family members and healthcare workers. CDC+3Wikipedia+3PMC+3

12. Contact with other body fluids (vomit, urine, stool, saliva)
    The virus has been found in many body fluids, including urine, saliva, and secretions from the lungs and gut. Caring for a patient, cleaning vomit or diarrhea, or sharing items contaminated with these fluids can spread infection if protection is not used. Wikipedia+2PMC+2

13. Sexual contact with an infected survivor (semen)
    In some patients, Chapare virus RNA has been found in semen weeks to months after illness. Sexual contact without protection can be a risk if the virus is still present in bodily fluids. Wikipedia+2GOV.UK+2

14. Needle-stick injuries in healthcare workers
    Doctors, nurses, and lab staff who handle blood from infected patients can be exposed if a needle accidentally pierces the skin or if sharp tools are not disposed of safely. This can directly inject virus into their bloodstream. PubMed+2CDC+2

15. Handling samples in the laboratory without proper biosafety
    Lab workers who process blood and other fluids need high-level safety measures. If there are mistakes, spills, or poor protective equipment, Chapare virus can infect them through inhalation or skin contact. PLOS+2CDC+2

16. Lack of personal protective equipment (PPE) in hospitals
    In hospitals, especially in low-resource settings, gloves, masks, gowns, and eye protection may not always be available or used correctly. This increases the chance of person-to-person spread during patient care. CDC+2CDC+2

17. Delays in diagnosis and isolation
    Early symptoms look like many other infections, such as dengue or malaria. If the illness is not recognized quickly, patients may stay in general wards, and many people may be exposed before proper isolation and precautions are put in place. World Health Organization+2PMC+2

18. Weak immune system
    People with weak immune systems, such as those with chronic illnesses or malnutrition, may have more severe disease and may shed virus for a longer time. This may not “cause” infection but can worsen outcomes and extend contagious periods. Infectious Diseases Journal+2OSTI+2

19. Co-infection with other diseases
    Having malaria, dengue, or other infections at the same time can confuse the picture and delay correct care. Co-infection can also stress the body more and increase the chance of shock and organ failure. Infectious Diseases Journal+2ScienceDirect+2

20. Limited access to high-level care
    In remote areas, there may be no intensive care unit, limited blood products, and few trained staff. When a patient with Chapare hemorrhagic fever cannot get rapid supportive care, the chance of death increases. OSTI+3World Health Organization+3PMC+3

Symptoms

Symptoms usually begin with general “flu-like” signs and then progress to bleeding and brain problems in severe cases. Because this is a rare disease, our knowledge comes from a small number of patients, but some patterns are clear. Wikipedia+3GOV.UK+3PMC+3

1. Fever
   Almost all reported patients have had a high fever. The fever often starts suddenly and may be persistent, meaning it does not go away easily. Fever is the body’s way of trying to fight the virus. GOV.UK+2PMC+2

2. Severe headache
   Strong headache is a very common complaint. Patients often describe a deep, constant pain in the head, sometimes with pain behind the eyes. This happens because the virus and the immune reaction affect blood vessels and tissues in the head. MalaCards+2WVOEPS+2

3. Muscle pain (myalgia)
   Many patients have painful muscles in the arms, legs, and back. The pain can make it hard to move or walk. This is typical for many viral hemorrhagic fevers and reflects inflammation and tissue injury caused by the virus. GOV.UK+2MalaCards+2

4. Joint pain (arthralgia)
   Joint stiffness and pain, especially in knees, ankles, and wrists, are also frequent. The joints may feel swollen or tender. This symptom often lasts for a long time, even after the acute illness improves. GOV.UK+2PMC+2

5. Back pain
   Some patients report very strong lower back pain. This can be due to muscle involvement or strain from vomiting, as well as irritation of tissues along the spine. Wikipedia+2PMC+2

6. Nausea and vomiting
   Feeling sick to the stomach and vomiting are very common. Vomit may later become bloody in severe cases. Constant vomiting can lead to dehydration, which makes blood pressure fall and organs suffer. OSTI+3GOV.UK+3PMC+3

7. Diarrhea
   Loose or watery stools are seen in many patients. Diarrhea, together with vomiting, causes large loss of fluids and salts from the body. This contributes to shock and kidney problems if not corrected quickly. PMC+2MalaCards+2

8. Stomach (abdominal) pain
   Pain in the stomach area is common and may be crampy or constant. It can be related to inflammation of the gut, liver involvement, or bleeding inside the abdomen. PMC+2MalaCards+2

9. Bleeding from the gums (gingival bleeding)
   Many reported patients have bleeding from the gums, especially when brushing teeth or even without brushing. This happens because the virus damages small blood vessels and affects clotting factors, making it easier to bleed. OSTI+3GOV.UK+3PMC+3

10. Nosebleeds (epistaxis)
    Blood may come from the nose as small drips or heavier flow. Nosebleeds are another sign that blood vessels and clotting are not working normally. They are a key sign of hemorrhagic fever. OSTI+2WVOEPS+2

11. Skin rash, red spots, and bruises (petechiae and ecchymoses)
    Patients can show small red or purple spots or larger bruises on the skin. These marks come from leaking blood under the skin. They may appear on the arms, legs, or trunk and are a visible sign of bleeding problems. Infectious Diseases Journal+3PMC+3MalaCards+3

12. Red eyes and eye pain
    The white part of the eyes may become red due to dilated and leaky vessels. Some patients feel pain behind the eyes or difficulty focusing. This is common in many viral hemorrhagic fevers and shows that even the eyes are affected. MalaCards+1

13. Dizziness and signs of low blood pressure
    As bleeding and fluid loss get worse, blood pressure can fall. Patients may feel dizzy, weak, or faint, especially when standing. Cold, sweaty skin and fast heart rate are also warning signs of shock. OSTI+2Infectious Diseases Journal+2

14. Confusion, irritability, and behavior changes
    The brain can be affected by low blood flow, inflammation, and toxins. Patients may become restless, confused, or unusually irritable. Family and staff may notice that the patient “is not behaving normally” or is difficult to calm. PMC+2Orpha+2

15. Seizures and coma in very severe cases
    In the most severe form, patients may develop seizures and loss of consciousness (coma). These signs usually appear late and are associated with a very poor prognosis, reflecting severe brain involvement and multi-organ failure. PMC+3Orpha+3PubMed+3

Diagnostic tests

Physical examination

Doctors first use careful physical examination to suspect hemorrhagic fever caused by Chapare virus. These tests do not confirm the virus but help decide who needs isolation and further lab testing. CDC+2WVOEPS+2

1. Vital signs assessment
   The doctor checks temperature, heart rate, breathing rate, and blood pressure. High fever, fast heart rate, and fast breathing are common. Low blood pressure may show early shock. Tracking these numbers over time helps judge if the patient is getting better or worse and if urgent fluids or intensive care are needed. OSTI+2Infectious Diseases Journal+2

2. Skin and mucous membrane examination
   The doctor looks at the skin, gums, inside the mouth, eyes, and nose. They search for rash, small red spots (petechiae), larger bruises, gum bleeding, nosebleeds, and redness of the eyes. The pattern of bleeding signs together with fever suggests a viral hemorrhagic fever rather than a simple flu-like illness. MalaCards+2WVOEPS+2

3. Abdominal examination for organ enlargement
   The doctor gently presses on the stomach area to feel if the liver or spleen is enlarged or tender. Organ enlargement can occur in many severe infections, including Chapare virus infection, and may point to heavy involvement of these organs in the disease process. OSTI+2ScienceDirect+2

Manual bedside tests

These are simple tests done with very basic tools at the bedside. They give quick information about circulation, brain function, and fluid status, which are important in hemorrhagic fevers. CDC+2WVOEPS+2

4. Capillary refill time
   The doctor presses on a fingernail or skin until it turns pale and then releases it, counting how many seconds it takes to turn pink again. If it takes longer than about two seconds, this suggests poor blood flow to the skin, which can be a sign of shock. In severe Chapare hemorrhagic fever, capillary refill time is often prolonged. OSTI+2Infectious Diseases Journal+2

5. Orthostatic blood pressure test
   Blood pressure and pulse are measured when the patient is lying down and then again when standing. A big drop in blood pressure or a big rise in heart rate on standing suggests volume loss from vomiting, diarrhea, or bleeding. This simple test helps doctors see how much the patient’s circulation is affected by fluid loss. OSTI+2Infectious Diseases Journal+2

6. Glasgow Coma Scale (GCS) scoring
   The Glasgow Coma Scale is a simple score based on eye opening, verbal response, and motor response. It helps measure how awake and responsive a patient is. In Chapare hemorrhagic fever, a falling GCS score can signal brain involvement, worsening shock, or the need for urgent intensive care. Orpha+2OSTI+2

Laboratory and pathological tests

Laboratory tests are essential for evaluating organ function and blood clotting, and for confirming Chapare virus infection. Many of these tests are also used for other viral hemorrhagic fevers. PLOS+3OSTI+3Infectious Diseases Journal+3

7. Complete blood count (CBC)
   CBC measures red blood cells, white blood cells, and platelets. Patients with Chapare hemorrhagic fever often have low white blood cells (leukopenia), low platelets (thrombocytopenia), and sometimes anemia. These changes increase bleeding risk and reflect serious bone marrow and vascular involvement. OSTI+2Infectious Diseases Journal+2

8. Coagulation profile (PT, aPTT, INR)
   These tests show how well blood can clot. In hemorrhagic fevers, the clotting time is often prolonged because clotting factors are used up or the liver is damaged. Prolonged PT or aPTT and an abnormal INR suggest a high risk of bleeding and help guide decisions about plasma or blood product transfusion. OSTI+2Infectious Diseases Journal+2

9. Liver function tests (LFTs)
   These tests include enzymes such as AST and ALT, and measurements of bilirubin. Many patients with Chapare virus infection have elevated liver enzymes, which means liver cells are injured. Severe liver involvement worsens bleeding and can be a marker of poor outcome. OSTI+2PMC+2

10. Kidney function tests (creatinine, urea)
    The kidneys may be damaged by low blood pressure, dehydration, and direct viral effects. High levels of creatinine and urea in the blood show that the kidneys are not working well. This alerts doctors to give careful fluids and sometimes dialysis in very severe cases. OSTI+2Infectious Diseases Journal+2

11. Serum electrolytes and blood glucose
    Sodium, potassium, chloride, and bicarbonate levels show if the body’s salt and acid–base balance are normal. Vomiting and diarrhea can cause dangerous imbalances. Blood sugar may be low or high in critically ill patients. Correcting these values is key to good supportive care. OSTI+2PMC+2

12. Arterial blood gas and lactate
    An arterial blood gas measures oxygen, carbon dioxide, and blood pH, while lactate shows how much the tissues are suffering from low oxygen. High lactate and abnormal pH are signs of shock and severe disease. In viral hemorrhagic fevers, these tests help decide when intensive care and advanced support are needed. OSTI+2Infectious Diseases Journal+2

13. RT-PCR for Chapare virus
    Reverse-transcription polymerase chain reaction (RT-PCR) is the main test to confirm infection. It detects Chapare virus RNA in blood or other body fluids. This test is very sensitive during the acute phase, but it requires specialized laboratories and strict biosafety. CNPHI+3PLOS+3New England Journal of Medicine+3

14. Serologic tests for Chapare and related arenaviruses (IgM, IgG)
    Antibody tests can detect IgM and IgG antibodies to Chapare virus or related New World arenaviruses. IgM usually appears first and suggests recent infection, while IgG appears later and can show past exposure or recovery. These tests help understand who has been infected, especially when RT-PCR is no longer positive. PubMed+3GOV.UK+3CNPHI+3

15. Tests for other infections (dengue, hantavirus, Machupo, malaria, leptospirosis)
    Because early symptoms of Chapare hemorrhagic fever look like many other tropical infections, doctors often test for dengue, hantavirus, Machupo virus, malaria, leptospirosis, and others. Negative results for these diseases, together with exposure history and bleeding, may raise suspicion for Chapare virus, especially in Bolivia. PMC+3Infectious Diseases Journal+3ScienceDirect+3

Electrodiagnostic tests

Electrodiagnostic tests study the electrical activity of the heart and brain. They are not specific for Chapare virus but help manage severe complications such as shock and seizures. OSTI+2CDC+2

16. Electrocardiogram (ECG)
    An ECG records the heart’s electrical activity. In patients with hemorrhagic fever, ECG can show fast heart rate, rhythm problems, or signs of poor blood flow to the heart muscle. These changes may appear when the patient is in shock or has serious electrolyte problems. Monitoring ECG helps guide fluids and medications safely. OSTI+2Infectious Diseases Journal+2

17. Electroencephalogram (EEG)
    An EEG records abnormal electrical activity in the brain. In very severe cases of Chapare hemorrhagic fever, patients may have seizures or unexplained confusion. EEG can confirm seizure activity and help decide on anti-seizure medicines, and it reflects how seriously the brain is affected. Orpha+2OSTI+2

Imaging tests

Imaging tests use X-rays and other methods to look inside the body. They do not show the virus itself but reveal complications such as lung damage, bleeding, or organ swelling. OSTI+2Infectious Diseases Journal+2

18. Chest X-ray
    A chest X-ray can show lung changes such as fluid in the lungs (pulmonary edema), pneumonia-like shadows, or bleeding. These findings often appear in advanced disease and help doctors decide about oxygen therapy, ventilation, and antibiotics for secondary infections. OSTI+2PMC+2

19. Abdominal ultrasound
    Ultrasound uses sound waves to view organs like the liver, spleen, and kidneys. In Chapare hemorrhagic fever, ultrasound may show enlarged liver or spleen, fluid in the abdomen, or signs of kidney injury. This information helps judge how many organs are involved and supports decisions about intensive care. OSTI+2ScienceDirect+2

20. Brain CT or MRI
    Computed tomography (CT) or magnetic resonance imaging (MRI) is used in very severe cases when patients have seizures, coma, or strong confusion. These scans can show brain swelling, small hemorrhages, or strokes linked to the disease. In a rare, high-fatality illness like Chapare hemorrhagic fever, such imaging is important to understand brain damage and guide further care. Orpha+2OSTI+2

Non-pharmacological treatments

1. Strict isolation and barrier nursing
   Doctors place the patient in a single room with a private toilet and limit movement to stop the virus spreading. Staff wear gowns, gloves, masks and eye protection whenever they enter the room. These steps help protect nurses, doctors and visitors from blood, vomit, diarrhea and other body fluids that may contain Chapare virus. Good barrier nursing is one of the most important “treatments” for the community.World Health Organization+2MalaCards+2

2. Standard, contact, droplet and airborne precautions when needed
   Healthcare workers follow layered infection-control rules. For routine care they use standard, contact and droplet precautions with eye protection. For procedures that can spray blood or secretions into the air (like intubation or suctioning), they use an N95 or similar respirator and negative-pressure rooms if available. This reduces the risk of person-to-person spread inside hospitals.World Health Organization+2CDC+2

3. Careful hand hygiene programs
   Hand washing with soap and water or alcohol-based hand rubs before and after touching the patient, their room or specimens is a simple but powerful tool. It lowers the chance that Chapare virus on gloves or skin is carried to another patient or to the worker’s own eyes, mouth or nose. Hospitals teach and monitor proper hand hygiene as part of VHF care bundles.CDC+1

4. Environmental cleaning and disinfection
   Surfaces in the isolation room, including bed rails, doorknobs and bathroom fixtures, are cleaned multiple times per day. Disinfectants such as 0.5% sodium hypochlorite (bleach solution) are used after visible cleaning. Spills of blood or body fluids are cleaned immediately using PPE. Proper cleaning breaks the chain of infection from contaminated surfaces to hands and then to other people.World Health Organization+1

5. Safe handling of linens and waste
   Bed linens, gowns and other fabrics from the patient are placed in leak-proof bags and washed separately from other laundry. Waste such as used gloves, dressings and tubing is treated as infectious and managed under biohazard waste rules. These steps prevent the virus from spreading through laundry rooms, waste areas or transport routes inside the hospital.World Health Organization+1

6. Fluid balance and oral rehydration where possible
   In milder cases, patients are encouraged to drink oral rehydration solution and clear fluids frequently. This replaces water and electrolytes lost from fever, vomiting and diarrhea. Close monitoring of urine output, body weight and vital signs helps the team decide when to move to intravenous fluids. Maintaining hydration protects kidneys and other organs.CDC+1

7. Intravenous fluid resuscitation and hemodynamic monitoring
   In more severe Chapare hemorrhagic fever, patients often need IV fluids to treat low blood pressure and shock. Doctors choose balanced crystalloids and adjust the rate based on blood pressure, pulse, urine output and laboratory tests. Over- or under-hydration is dangerous, so continuous monitoring is critical. This therapy supports circulation while the body fights the virus.CDC+2PMC+2

8. Oxygen therapy and respiratory support
   Many patients develop shortness of breath or lung involvement. Nasal cannula or face mask oxygen can maintain safe oxygen levels. If breathing becomes very difficult, non-invasive ventilation or intubation with mechanical ventilation may be needed in an ICU. These interventions buy time for the lungs and heart while treating shock and other problems.CDC+1

9. Blood component support (without drug additives)
   Transfusions of packed red blood cells, platelets or fresh frozen plasma are often needed when there is severe anemia, thrombocytopenia or coagulopathy with active bleeding. These blood products are considered supportive therapies. They improve oxygen-carrying capacity and clotting, helping to control hemorrhage and stabilize the patient.PMC+2CDC+2

10. Renal replacement therapy (hemodialysis)
    Some patients with VHF, including South American arenavirus infections, develop acute kidney injury. For these patients, hospital-based hemodialysis can remove waste products, balance fluids and correct severe electrolyte problems. Special VHF dialysis guidelines help staff protect themselves while safely performing the procedure.Restored CDC+1

11. Careful neurological monitoring and seizure control (non-drug aspects)
    Chapare hemorrhagic fever can cause confusion, agitation and seizures. Nurses perform frequent neurological checks, protect the patient from falls and injury, pad bed rails and ensure a quiet environment. Rapid recognition of seizures allows timely medication by doctors and may prevent lasting brain damage.Wikipedia+1

12. Temperature management and physical cooling
    High fever is treated with lightweight clothing, cool compresses and fan-assisted cooling, alongside medical antipyretics. Physical measures lower body temperature slightly, which may reduce discomfort and metabolic demands. Cooling must be gentle to avoid shivering, which increases oxygen use.CDC+1

13. Nutritional support and easy-to-digest food
    Even in intensive care, doctors try to provide early nutrition, often using soft foods or tube feeding if the patient cannot eat. Adequate protein, calories, vitamins and minerals support immune function, wound healing and recovery of muscles. Nutritious, low-fat, low-fiber foods are easier to tolerate when there is nausea or diarrhea.CDC+1

14. Psychological support for patient and family
    Being isolated with a life-threatening infection is frightening. Simple explanations in clear language, regular updates, video calls with family and access to psychological support can reduce fear and depression. Maintaining hope and trust helps patients cooperate with treatment and follow infection-control advice after discharge.CDC+1

15. Safe specimen collection and laboratory handling
    Blood and other samples are drawn using PPE and leak-proof tubes. In many settings, tests for Chapare virus (such as RT-PCR and ELISA) are done in high-level biosafety labs. Correct labeling, triple packaging and biohazard shipping rules protect lab workers and transport staff from accidental exposure.New England Journal of Medicine+2ResearchGate+2

16. Contact tracing and monitoring of exposed persons
    Public health teams identify healthcare workers, family members and other contacts who had unprotected exposure to the patient’s body fluids. These people are followed for about 21 days to check for fever or other early symptoms. Early detection allows rapid isolation and may prevent a larger outbreak.World Health Organization+2CDC+2

17. Community education and risk communication
    Health authorities explain in simple words how Chapare virus spreads and what people can do: avoid rodent droppings, store food safely, use gloves when cleaning, and report severe fevers quickly. Clear, honest messages reduce panic, prevent rumors and encourage early care-seeking, which improves outcomes.CDC+2Drishti IAS+2

18. Rodent and environmental control around homes
    Because Chapare virus is likely carried by wild rodents, reducing rodent contact is key. Families are advised to keep food in rodent-proof containers, seal holes in walls, remove rubbish and avoid sleeping on floors where rodents may run. These measures lower the risk of new infections, especially in affected regions of Bolivia.CDC+2PMC+2

19. Safe burial and body-handling practices
    The bodies of people who die from Chapare hemorrhagic fever can still contain high levels of virus. Trained burial teams use full PPE, avoid washing or touching the body with bare hands, and follow national VHF burial protocols. This protects grieving families and the wider community from infection during funerals.World Health Organization+2CDC+2

20. Post-discharge follow-up and counseling
    Survivors can have long-lasting fatigue and neurological or psychological symptoms. Viral RNA has been found in semen for months after illness, so safe-sex counseling and follow-up testing may be advised. Outpatient visits help detect late complications and give further education on protecting partners and family members.Wikipedia+1

Drug treatments used in Chapare hemorrhagic fever care

There is no drug proven to cure Chapare virus itself. Medicines are used to manage symptoms and complications, based on general VHF and critical-care practice. All doses are examples from FDA-approved labels for other conditions and must only be used by doctors in hospital settings.CDC+2PMC+2

1. Ribavirin (investigational for arenavirus hemorrhagic fevers)
   Ribavirin is a broad-spectrum antiviral that has shown activity against several arenaviruses in animals and in people with Lassa fever. It is not specifically approved by the FDA for Chapare or other VHF, but some experts discuss its emergency, off-label use in severe arenavirus infections. Dosing regimens come from hepatitis C or Lassa fever protocols and require very close monitoring for hemolytic anemia and other toxicities.FDA Access Data+3PubMed+3PLOS+3

2. Acetaminophen (paracetamol)
   Acetaminophen is often preferred for fever and pain because it does not affect platelets or clotting as much as many anti-inflammatory drugs. Hospital teams use carefully calculated doses to lower fever and relieve headache and muscle pain while avoiding liver toxicity. It is safer than aspirin or ibuprofen in hemorrhagic fevers, which can worsen bleeding.CDC+1

3. Ondansetron
   Ondansetron is a 5-HT3 receptor blocker widely used to control nausea and vomiting. In Chapare hemorrhagic fever, IV or oral ondansetron can help patients keep down fluids and medications, reducing the risk of dehydration and electrolyte imbalance. FDA labels describe adult IV regimens such as 0.15 mg/kg up to 16 mg per dose in chemotherapy settings; similar dosing principles guide supportive use under medical supervision.FDA Access Data+3FDA Access Data+3FDA Access Data+3

4. Proton pump inhibitors (e.g., pantoprazole)
   Pantoprazole and other PPIs reduce stomach acid and help prevent stress-related mucosal bleeding in critically ill patients. In Chapare hemorrhagic fever, they may lower the risk of upper gastrointestinal bleeding on top of viral coagulopathy. Intravenous pantoprazole 40 mg once daily for short durations is described in FDA labels for hospitalized patients with severe reflux or bleeding risks.FDA Access Data+3FDA Access Data+3FDA Access Data+3

5. Broad-spectrum IV antibiotics (e.g., ceftriaxone)
   Because VHF patients are very sick, doctors often start broad-spectrum antibiotics such as ceftriaxone while ruling out bacterial sepsis or treating secondary infections. These drugs do not treat the virus but can prevent or control overlapping bacterial pneumonia or bloodstream infections, which otherwise increase the risk of death. Doses follow standard sepsis guidelines.CDC+2PMC+2

6. Piperacillin–tazobactam or similar combination antibiotics
   In intensive care, combination antibiotics like piperacillin–tazobactam may be used when there is strong suspicion of severe bacterial infection or hospital-acquired pneumonia. They provide very broad coverage while doctors await culture results. Once the pathogen is known or ruled out, therapy is narrowed or stopped to reduce side effects and resistance.CDC+2PMC+2

7. Vancomycin (for resistant Gram-positive bacteria)
   Vancomycin is considered when there is a risk of resistant Gram-positive infections, for example catheter-related bloodstream infection. It does not treat Chapare virus but is sometimes necessary to cover dangerous bacteria in critically ill patients. Dosing is based on kidney function and blood-level monitoring to balance effectiveness and toxicity.CDC+1

8. Norepinephrine (vasopressor for shock)
   In viral hemorrhagic fevers with septic-like shock, norepinephrine is often the first-line vasopressor to raise dangerously low blood pressure. It is given as a continuous IV infusion via central line in an ICU. FDA labels describe its use for severe acute hypotension, with careful titration to effect and monitoring for tissue ischemia and arrhythmias.CDC+3FDA Access Data+3FDA Access Data+3

9. Other vasopressors (e.g., vasopressin, dopamine)
   When norepinephrine is not enough, doctors may add vasopressin or dopamine in specialist settings. These drugs tighten blood vessels or support heart output, helping maintain vital organ perfusion. Their use in Chapare hemorrhagic fever follows general septic shock protocols rather than disease-specific data and always needs intensive monitoring.CDC+2PMC+2

10. Tranexamic acid (cautious use for bleeding)
    Tranexamic acid reduces the breakdown of clots and can sometimes help control severe bleeding. In hemorrhagic fevers, its use is controversial and must be carefully balanced against the risk of abnormal clotting in small vessels. If used, it is usually for short periods in life-threatening hemorrhage when other measures fail.PMC+1

11. Vitamin K (for coagulopathy related to deficiency)
    Some patients have abnormal clotting partly due to low vitamin K (from poor intake, diarrhea or antibiotic use). In such cases, injectable vitamin K can help the liver produce clotting factors and may reduce bleeding. It is not a direct treatment for Chapare virus but supports the body’s own clotting system.PMC+1

12. Insulin for stress hyperglycemia
    Severe infection and shock can cause high blood sugar, even in people who do not have diabetes. Carefully controlled IV insulin infusions, with frequent glucose checks, may be used in ICUs to keep blood sugar in a safe range. This improves overall outcomes and reduces complications like infections and poor wound healing.CDC+1

13. Electrolyte replacement (e.g., potassium, magnesium)
    Vomiting, diarrhea, kidney injury and high urine output can disturb potassium, magnesium and other electrolytes. IV or oral replacement solutions help maintain normal heart rhythm and muscle function. Doctors follow strict hospital protocols because too much or too little of these electrolytes can be dangerous.CDC+1

14. Loop diuretics (e.g., furosemide) in fluid overload
    After aggressive fluid resuscitation, some patients develop lung congestion or swelling. Furosemide, a loop diuretic, can help remove excess fluid via the kidneys, improving breathing. It must be used very carefully to avoid worsening kidney injury or dropping blood pressure too much.CDC+1

15. Opioid analgesics (e.g., morphine) for severe pain
    When pain is very strong, such as with abdominal pain or severe myalgia, low-dose opioid pain medicines can be used under close monitoring. They ease suffering and help patients tolerate other procedures. Doctors must watch for respiratory depression, especially in patients with lung involvement.CDC+1

16. Sedatives (e.g., midazolam) during mechanical ventilation
    If the patient is intubated and ventilated, sedatives like midazolam may be needed to reduce anxiety, prevent accidental tube removal and improve synchrony with the ventilator. They are titrated slowly and stopped as soon as possible to avoid long-term confusion or weakness.CDC+1

17. Prophylactic antifungals (e.g., fluconazole) in selected cases
    Very ill patients receiving broad-spectrum antibiotics and ventilation can develop fungal infections. In high-risk cases, doctors might start antifungals such as fluconazole or echinocandins according to sepsis guidelines. The goal is to prevent or treat secondary fungal sepsis, not the Chapare virus itself.CDC+1

18. Intravenous immunoglobulin (IVIG) in immune complications
    For some arenavirus hemorrhagic fevers, convalescent plasma or immunoglobulin from survivors has been explored experimentally. IVIG can also modulate immune responses in some autoimmune-like complications. For Chapare hemorrhagic fever, this remains investigational and would only be used in research or highly specialized centers.PMC+1

19. Stress-dose corticosteroids (e.g., hydrocortisone) in refractory shock
    In septic-like shock that does not respond to fluids and vasopressors, some protocols use low-dose hydrocortisone to support adrenal function. This may help maintain blood pressure. However, steroids also weaken the immune system, so they are used carefully and are not specific therapy for Chapare virus.CDC+1

20. Experimental antivirals in future studies
    New broad-spectrum antivirals and monoclonal antibodies are being studied for various hemorrhagic fevers. For Chapare, there are no approved agents yet, but future clinical trials may test drugs that target arenavirus replication or viral proteins. Until then, these treatments remain research only and are not standard of care.PMC+2ScienceOpen+2

Dietary molecular supplements (supportive only)

These supplements do not cure Chapare hemorrhagic fever. They may support general immune and recovery functions under professional guidance, usually in recovery or low-resource settings, not as a replacement for hospital care.

1. Vitamin C (ascorbic acid)
   Vitamin C is a water-soluble vitamin that supports white blood cells and antioxidant defenses. In critical illness, higher needs are seen, and some ICUs use IV or oral vitamin C as supportive therapy. Typical oral supplement doses in adults range from 200–1000 mg per day, but high-dose regimens must only be used under medical supervision due to kidney stone risk in some people.CDC+1

2. Vitamin D
   Vitamin D helps regulate immune responses and may modulate inflammation. Many people are deficient, so correcting low levels can support overall health during recovery. Oral doses around 600–2000 IU daily are common in deficiency prevention, but large “mega-doses” should only be prescribed after blood tests and medical advice.CDC+1

3. Zinc
   Zinc is a trace element important for antiviral defense, wound healing and gut barrier function. Infections and diarrhea can reduce zinc levels. Oral supplements of 10–20 mg elemental zinc per day are commonly used in deficiency states or short-term during diarrheal illnesses, but high doses over time can cause copper deficiency and should be avoided.ResearchGate+1

4. Selenium
   Selenium is an antioxidant trace mineral that supports enzymes which protect cells from oxidative damage. Low selenium has been linked in some studies to worse outcomes in severe infections. Carefully dosed oral selenium (for example 50–100 micrograms per day) may be used in deficiency, but overdose is toxic, so supplementation must be cautious and guided by professionals.ResearchGate+1

5. B-complex vitamins
   Illness, poor intake and diarrhea can deplete B vitamins, which are essential for energy metabolism and nerve function. Balanced B-complex supplements provide B1, B2, B6, B12, niacin and others in physiological doses. They support appetite, energy and nervous system recovery but are not specific antivirals.ResearchGate+1

6. Omega-3 fatty acids (fish-oil based)
   Omega-3 fatty acids like EPA and DHA may help modulate inflammation and support heart and brain health. In recovery from severe infection, moderate doses (for example 500–1000 mg combined EPA/DHA daily) can be used if there is no active major bleeding and after talking with a doctor, because these oils can slightly affect clotting.PMC+1

7. Probiotics
   Probiotics are live “good” bacteria that support gut health. After severe diarrhea or broad-spectrum antibiotics, they may help restore a healthy gut microbiome and reduce some gastrointestinal symptoms. Only clinically tested strains and doses should be used, and severely immunocompromised patients need special care due to rare bloodstream infection risk.ResearchGate+1

8. Glutamine
   Glutamine is an amino acid used as fuel by gut cells and immune cells. Some ICU protocols use glutamine supplements to support gut barrier function and reduce muscle wasting, but evidence is mixed and high doses are not suitable for everyone. If used, it must be part of a supervised nutrition plan.PMC+1

9. Arginine
   Arginine is another amino acid that supports nitric oxide production, wound healing and immune activity. It is sometimes included in specialized enteral formulas for critically ill patients. However, in sepsis-like states, arginine may affect blood pressure, so its use requires expert assessment rather than self-supplementation.PMC+1

10. Multinutrient recovery formulas
    Commercial recovery drinks or powders combining protein, vitamins, minerals and sometimes omega-3s can help patients who are too weak to cook or eat full meals. They provide balanced nutrition in small volumes and support weight and strength gain during convalescence, under dietitian or doctor guidance.CDC+1

Immunity-support, regenerative and stem-cell-related drugs

None of these drugs is approved specifically for Chapare hemorrhagic fever. Some are used in other conditions to support blood cell production or modulate immunity. Others are experimental and only used in clinical trials.

1. Granulocyte colony-stimulating factor (G-CSF, e.g., filgrastim)
   G-CSF drugs stimulate bone marrow to make more neutrophils. They are approved for chemotherapy-induced neutropenia and some bone-marrow failures, not for Chapare virus itself. In theory, they might help if severe viral infection causes prolonged low white blood cells, but any use would be highly individualized and specialist-led.PMC+1

2. Erythropoiesis-stimulating agents (e.g., erythropoietin)
   Erythropoietin analogues help the bone marrow produce more red blood cells in chronic anemia, especially in kidney disease. They are not used in the acute bleeding phase of hemorrhagic fever but might be considered later in long-term anemia when bleeding has stopped and iron is adequate.PMC+1

3. Thrombopoietin receptor agonists (e.g., romiplostim, eltrombopag)
   These drugs stimulate platelet production and are approved for chronic immune thrombocytopenia and some other conditions. In viral hemorrhagic fevers, their role is uncertain, because the problem is not only low platelet count but also damaged blood vessels and coagulation pathways. At present they are not standard care for Chapare and would be considered only in research settings.PMC+1

4. Interferon-based therapies (experimental)
   Interferon-alpha and related drugs boost antiviral responses and are used for some chronic viral infections. For arenaviruses, interferons have theoretical benefit but also significant side effects, including flu-like symptoms and depression. No interferon regimen is proven for Chapare; any use would need careful ethical and scientific review in a clinical trial.PMC+1

5. Intravenous immunoglobulin (IVIG) and convalescent plasma
   IVIG and plasma from survivors have been explored in other hemorrhagic fevers to provide ready-made antibodies. For Chapare, evidence is extremely limited, and such therapies remain experimental. They might be considered if a robust donor pool, safe collection and controlled trials are available, but they are not routine treatment.PMC+1

6. Mesenchymal stem cell–based therapies (research only)
   Mesenchymal stem cells from bone marrow or umbilical cord are being studied for severe lung injury and sepsis in experimental trials. They may help by dampening harmful inflammation and supporting tissue repair. These therapies are complex, expensive, and strictly experimental; they are not used in standard management of Chapare hemorrhagic fever.PMC+1

Surgical and invasive procedures

Surgery is rarely used directly for Chapare hemorrhagic fever because patients bleed easily and infection risk is high. Procedures are only done when absolutely necessary for life-saving reasons, with full PPE and strict infection-control.

1. Central venous catheter insertion
   A central line is placed into a large vein in the neck, chest or groin to give vasopressors, fluids and blood products safely. It allows accurate measurement of central venous pressure and blood sampling. In Chapare, insertion is done with full barrier precautions to protect staff from blood exposure.CDC+2CDC+2

2. Endotracheal intubation and tracheostomy
   If a patient cannot breathe adequately, doctors may insert a breathing tube (intubation) and connect the patient to a ventilator. In some prolonged cases, a tracheostomy (a tube through the neck) is performed. These procedures are high-risk for aerosolization, so airborne precautions and experienced teams are essential.CDC+2World Health Organization+2

3. Emergency surgical control of internal bleeding
   Very rarely, life-threatening internal bleeding (for example from a ruptured organ) may require emergency surgery. Surgeons try to control the bleeding source and remove large blood collections. Because the risk to staff is high and the patient is extremely fragile, this is a last resort.CDC+2PMC+2

4. Neurosurgical procedures for life-threatening brain bleeding
   If Chapare causes massive bleeding inside the skull with severe pressure on the brain, neurosurgeons may consider urgent decompression. The goal is to save life and prevent brain herniation, but the operation is very risky and only done in centers with strong VHF protocols.Wikipedia+1

5. Permanent dialysis access procedures
   In survivors who develop chronic kidney failure, procedures to create arteriovenous fistulas or tunneled dialysis catheters may be needed. By this stage, viral load is typically gone or very low, but infection-control measures are still followed until confirmatory tests are negative.Restored CDC+1

Prevention of Chapare hemorrhagic fever

1. Reduce contact with wild rodents and their droppings.CDC+2Drishti IAS+2

2. Store food and animal feed in rodent-proof containers.CDC+1

3. Keep homes clean, seal holes and remove clutter where rodents can nest.CDC+1

4. Wear gloves and masks when cleaning areas with rodent droppings or urine, and disinfect surfaces afterwards.CDC+1

5. Avoid direct contact with blood, vomit or other body fluids of sick people with suspected Chapare hemorrhagic fever.CDC+1

6. Use proper PPE and isolation procedures in hospitals for suspected VHF patients.CDC+1

7. Follow safe injection and specimen-handling practices in healthcare and laboratories.CDC+1

8. Practice safer sex or abstain if recovering from Chapare infection until advised that the virus is no longer detectable in semen.Wikipedia+1

9. Educate communities in affected regions of Bolivia about early symptoms and the need for rapid medical care.World Health Organization+1

10. Strengthen surveillance and outbreak response teams to detect and contain new cases quickly.Lybrate+2World Health Organization+2

When to see doctors

Anyone living in or travelling from areas where Chapare virus is known or suspected should seek urgent medical care if they develop high fever, severe headache, muscle or back pain, nausea, vomiting or diarrhea within about three weeks of possible rodent or body-fluid exposure.CDC+1

Immediate emergency care is needed if there is bleeding from gums, nose or gut, extensive bruising, very low blood pressure, confusion, seizures, difficulty breathing or signs of shock. In such cases, go straight to a hospital emergency department and inform staff about possible Chapare exposure so they can quickly apply VHF precautions and arrange testing.CDC+2New England Journal of Medicine+2

What to eat and what to avoid

What to eat
During and after Chapare hemorrhagic fever, when a doctor allows oral intake, it is helpful to focus on soft, easy-to-digest foods: soups, broths, plain rice, boiled potatoes, bananas, cooked vegetables and small portions of lean protein like eggs, fish or chicken. These foods provide energy, protein, vitamins and fluids without stressing the stomach. Frequent small meals and oral rehydration solutions can support hydration and gradual recovery.CDC+1

What to avoid
Patients should avoid alcohol, very spicy or oily food, raw meat, unpasteurized milk, street food of uncertain hygiene and herbal products that can affect the liver or blood clotting (such as some traditional remedies). Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or aspirin should not be used without explicit medical advice because they can increase bleeding risk.CDC+2MD Searchlight+2

Frequently asked questions (FAQs)

1. Is Chapare hemorrhagic fever always fatal?
   No. Chapare hemorrhagic fever has a high fatality rate, but some patients survive with intensive supportive care. Survivors may have a long recovery with lingering fatigue or neurological symptoms, so follow-up is important.CDC+2Wikipedia+2

2. Can Chapare virus spread from person to person?
   Yes. Evidence from Bolivia shows that Chapare virus can spread between people through close contact with blood and other body fluids, including in hospitals. That is why strict PPE and isolation are required for suspected or confirmed cases.New England Journal of Medicine+2Wikipedia+2

3. Is there a vaccine against Chapare virus?
   No vaccine is currently available for Chapare hemorrhagic fever. Research on arenavirus vaccines is ongoing, but nothing is ready yet for routine use. Prevention relies on rodent control, infection-control practices and rapid outbreak response.ScienceOpen+1

4. Is there any specific antiviral medicine for Chapare?
   At present there is no antiviral medicine proven and approved specifically for Chapare virus. Some experts discuss possible off-label ribavirin use based on data from other arenaviruses, but this remains unproven and must only be considered in specialized settings.ResearchGate+3ScienceOpen+3PubMed+3

5. Where has Chapare hemorrhagic fever been reported?
   All known outbreaks have occurred in Bolivia, including the Chapare Province and areas near La Paz. There is no evidence of widespread or sustained transmission outside these regions, but surveillance continues.CDC+2New England Journal of Medicine+2

6. How is Chapare hemorrhagic fever diagnosed?
   Diagnosis uses specific laboratory tests such as RT-PCR to detect viral RNA, ELISA for antibodies or antigen, and sometimes advanced methods like immunohistochemistry or virus isolation. These tests are usually done in reference or high-biosafety laboratories.New England Journal of Medicine+2ResearchGate+2

7. Can Chapare virus remain in the body after recovery?
   Yes. Viral RNA has been found in bodily fluids for weeks to months after symptom onset, including semen. That is why survivors are advised to use condoms or abstain from sex until follow-up testing confirms clearance, according to health authority advice.Wikipedia+1

8. Is Chapare hemorrhagic fever the same as Bolivian hemorrhagic fever?
   Chapare hemorrhagic fever is one cause of hemorrhagic fever in Bolivia, caused by Chapare virus. Bolivian hemorrhagic fever classically refers to infection with Machupo virus. Both are arenaviruses and produce similar clinical pictures, but they are caused by different viruses.Wikipedia+1

9. How is Chapare different from Ebola?
   Both Chapare and Ebola cause viral hemorrhagic fever with high death rates and bleeding. Chapare belongs to the arenavirus family, while Ebola belongs to the filovirus family. Chapare outbreaks have been much smaller and limited to Bolivia, and many details about its transmission and natural host are still being studied.CDC+2Wikipedia+2

10. Can children get Chapare hemorrhagic fever?
    In principle, anyone exposed to infected rodents or body fluids can be infected, including children. However, documented cases are few, and most reports involve adults, including healthcare workers. Pediatric management follows general VHF principles with age-appropriate dosing and specialist care.New England Journal of Medicine+2National Organization for Rare Disorders+2

11. Is it safe to travel to Bolivia?
    For most travelers, Chapare virus risk is extremely low. The disease is rare, and outbreaks have been small and localized. Travelers should still follow rodent-avoidance measures, practice good hygiene and follow local public health advice.Lybrate+2CDC+2

12. Can simple masks prevent Chapare infection?
    Surgical masks help protect against splashes into the mouth and nose and can reduce spread of droplets, especially when combined with gowns, gloves and eye protection. For procedures that generate aerosols, N95 or similar respirators are recommended. Masks alone are not enough without full infection-control measures.CDC+2World Health Organization+2

13. Can traditional or herbal medicines cure Chapare hemorrhagic fever?
    No traditional or herbal remedy is proven to cure Chapare hemorrhagic fever. Some herbal products can harm the liver or affect blood clotting. They should not replace hospital treatment and should only be used, if at all, under medical guidance in the recovery phase.PMC+1

14. Why is supportive care so important?
    Supportive care—fluids, oxygen, blood products, control of shock and careful monitoring—keeps vital organs working while the immune system fights the virus. For most viral hemorrhagic fevers, including Chapare, supportive care is currently the main reason some patients survive despite the lack of specific antiviral drugs.CDC+2PMC+2

15. What should people in affected areas do right now?
    People in affected regions should reduce rodent contact, store food safely, keep homes clean, report clusters of severe fever with bleeding quickly and follow health authority advice during outbreaks. Healthcare workers should be trained in VHF PPE and isolation, and laboratories should be prepared for safe testing.Lybrate+2World Health Organization+2

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: December 21, 2025.

Previous

Chapare Hemorrhagic Fever

Next

Char Syndrome

Related Articles

Added to wishlistRemoved from wishlist 0

Chikungunya Virus Infectious Disease

Added to wishlistRemoved from wishlist 0

Chikungunya Virus Disease or Disorder

Added to wishlistRemoved from wishlist 0

Chapare Hemorrhagic Fever

Added to wishlistRemoved from wishlist 0

Soft Chancre Chancroid