A patient presents to the hospital. He has been feeling ill since his return from safari in Africa a few days ago. He exhibits symptoms of fever, mild hypotension, flushing, conjunctival injection, and now a bad rash has appeared that is bleeding in spots. What type of viral infection do you suspect?

• A. Dengue
• B. Viral Hemorrhagic Fever
• C. Typhoid
• D. Malaria

Answer: (B)

When a traveler returns from Africa with fever, signs of vascular involvement, and a bleeding rash, think about a viral hemorrhagic fever. These infections cause fever and damage to the lining of blood vessels along with disruptions in clotting, which leads to bleeding under the skin (petechiae, ecchymoses) and can progress to low blood pressure from plasma leakage and shock. The conjunctival injection and the hemorrhagic rash fit this pattern, especially in the Africa travel context where viruses such as Ebola, Marburg, Lassa, or related hemorrhagic fevers are a concern.

While other illnesses can cause fever and rash, the combination of a bleeding rash with hypotension points more strongly toward a hemorrhagic fever rather than malaria or typhoid, which usually present with different sets of symptoms (malaria with paroxysms and anemia, typhoid with stepwise fever and abdominal signs). Dengue can cause bleeding, but the scene described—hemorrhagic rash after a safari with systemic signs and shock potential—aligns best with a hemorrhagic fever. If suspected, this requires urgent isolation and public health notification due to high transmissibility and the need for specialized care.