Hemorrhagic fever with renal syndrome is an acute zoonotic viral natural focal disease, accompanied by severe fever and kidney failure. It is caused by RNA viruses, which are distributed mainly in the East, as well as in the western regions of Europe. This virus is the most dangerous, and mortality in the incidence of this pathology is approximately 20%.
Causes and pathogenesis
Hemorrhagic fever viruses enter the body from rodent carriers, which can be domestic and field rats, mice, jerboas. They, as a rule, become infected from each other by airborne droplets and carry the infection in a latent form. There are several ways of infection with this human infectious disease:
- Contact, for example, in direct contact withrodents or their excrement.
- Air-dust - when inhaling air, in which there are tiny particles of dried rodent feces.
- Fecal-oral – through the ingestion of dirty food containing particles of excrement from these rodent species.
Description of the disease
A person is susceptible to the causative agent of this pathology in 100% of cases. The most affected by this disease, accompanied by renal syndrome, men from 20 to 60 years old.
For hemorrhagic fever of this type is characterized by seasonality and the presence of specific endemic areas. The peak incidence is observed from the beginning of summer to the end of autumn. In Russia, the highest incidence of this viral infectious pathology with renal syndrome was recorded in such regions as Tatarstan, Udmurtia, Bashkortostan, Samara and Ulyanovsk regions.
Frequent cases of the disease are also recorded in the Volga region and in the broad-leaved zones of the Urals. To a slightly lesser extent, cases of pathology were recorded in Eastern Siberia.
A single hemorrhagic fever with accompanying renal syndrome gives lasting immunity for life.
The virus that causes this disease in the human body settles on the mucous membranes of the respiratory and digestive systems, where it begins to actively multiply and penetrate into the blood. During this period, the patient has a pronounced intoxication syndrome, which is caused by penetration into the bloodstream of this type of infection. Subsequently, this virus is localized on the internalwalls of vessels and violates their integrity. The patient develops acute hemorrhagic syndrome. Viruses are excreted from the body through the urinary system, so the following clinical picture develops:
- Renal vascular lesions.
- Inflammatory process and swelling of kidney tissues.
- Development of acute renal failure.
This period of the pathological process is the most dangerous and is usually characterized by a fatal outcome. In more favorable cases, the reverse process begins to form in the form of resorption of hemorrhages, restoration of the excretory function of the kidneys. The duration of this recovery period for hemorrhagic fever can usually be from one to three years.
Varieties of the pathological process
To date, there is no single classification of hemorrhagic fever with renal syndrome. However, depending on the territories in which an outbreak of this disease is registered, the following forms are distinguished:
- Yaroslavskaya.
- Transcarpathian.
- Ural.
- Tula.
- Far Eastern.
- Korean form.
Crimea-Congo
Crimean-Congo hemorrhagic fever is an acute natural focal infectious disease. The causative agent of this pathology is an RNA neurovirus. Pathogenic microorganisms are localized in the cytoplasm. The pathogenesis has not yet been fully studied.
Virus in Congo-Crimean hemorrhagic fever affects the human body very selectively. That is, it accumulates in the cells of various organs, leads to increased blood filling, which provokes hemorrhages of varying degrees, the appearance of blood clots and impaired blood circulation. The subsequent massive attack damages the hypothalamus of the brain and the adrenal cortex.
Crimean hemorrhagic fever is difficult to recognize in the early stages. This is fraught with the onset of death. That is why infectious disease specialists around the world pay maximum attention to identifying the disease.
Clinical classification of Crimean hemorrhagic fever has not been developed, so the stages are conditionally divided into:
- initial stage;
- hemorrhagic period;
- convalescence (when a person recovers on his own, but dysfunction of some systems is detected).
Besides, there are no symptoms during the incubation period of the disease.
Omsk hemorrhagic fever is a natural focal transmissible viral infection characterized by hemorrhagic reactions with a predominant lesion of the respiratory system and central nervous system. It proceeds with high fever, severe pain in the head, myalgia, bleeding, bronchitis, pneumonia, cerebral and meningeal phenomena.
Depending on the type of RNA virus that caused the development of the disease, they are distinguished:
- Western type of hemorrhagic fever, which is provoked by the Puumala virus and is accompanied by a severe course,oligoanuria and hemorrhagic syndrome in 10% of cases. Mortality is approximately 1-2%.
- The eastern type of the disease is usually caused by the Hantaan virus. In 40-45% of cases, a very severe course of the disease is observed, accompanied by acute renal failure and hemorrhagic symptoms. Mortality is about 8% of cases.
- Hemorrhagic fever caused by the Seoul virus serotype. The course of the disease is relatively mild in almost half of the cases and is accompanied by the development of hepatitis and disorders of the respiratory system.
Methods of infection
There are six ways to become infected with hemorrhagic fever, but they are united by human contact with a virus that enters the environment from the saliva and feces of rodents:
- Forest type - during picking mushrooms or berries in contact with infected dried feces of sick rodents.
- Household type - when using household items.
- Production type - when working in the forest zone, on oil pipelines in the taiga regions, on drilling rigs, etc.
- Country type - when cultivating land in gardens and cottages.
- Camp type - in camps, on vacation in tents, etc. (mostly children get infected this way).
- Agricultural - people get infected in the fields, the peak of activity is autumn/winter.
Symptoms and stages of the disease
Symptomatic specificity of hemorrhagic fever with renal syndrome varies depending on the stageshe is situated. There are only four such stages, and each of them is characterized by alternating cycles. In other words, after a certain time after the fourth stage, the first may come again, and so on.
Acyclicity can only be characterized by a disease caused by the Seoul serotype. The incubation periods for this infectious pathology with renal syndrome last about 2 weeks. Symptoms of hemorrhagic fever in this period do not appear significantly.
The feverish, or initial, period of the disease lasts no more than 7 days, and most often about three days. The disease begins acutely and is characterized by an increase in the patient's body temperature to 39-40 degrees. The patient feels severe headache, muscle and spinal pain, general malaise, thirst and dryness of the mouth, flies before the eyes and blurred vision. During this period, there may be minor hemorrhages on the mucous membrane of the palate and sclera.
The oliguric phase of fever lasts about a week. At the same time, the temperature drops, but the condition begins to gradually worsen. Nosebleeds, bruises on the body, sclera appear. In the chest area, as well as in the armpits and on the legs, a pronounced red rash forms, which is caused by numerous ruptures of capillaries. There is also an increase in patients' complaints of acute pain in the back and abdomen. The daily volume of urine decreases. In some cases, there is an increase in the size of the liver.
Polyuric period of hemorrhagic fever symptomsstarts on the 10th day. The volume of urine increases dramatically and can reach 6 liters in 24 hours. Its low density is also found, which is the main sign of acute kidney failure.
The convalescent period of viral hemorrhagic fever is the longest, and it begins on about the 20th day, and lasts six months. This stage is characterized by an improvement in the patient's condition and normalization of kidney function. Recovery with a mild course of the disease is observed in some cases after a month, and with moderate severity - after 6 months. In patients who have undergone severe stages of hemorrhagic fever, asthenic syndrome may remain for life.
Acute kidney failure
Symptomatic of various manifestations of hemorrhagic fever affects the urinary system and seriously disrupts its activity.
The three main syndromes of this disease have different degrees of their manifestation, depending on how severe the disease is. They are considered:
- intoxication;
- renal;
- hemorrhagic.
This infectious disease with mild renal syndrome manifests itself as the following disorders:
- The temperature rises to 38 degrees (three days).
- Headache.
- Temporary agnosia.
- Reduced diuresis.
- Puncture hemorrhages.
- Urine laboratory tests show elevated protein and urea levels.
- Agnosia.
The average degree of hemorrhagic fever is characterized by:
- Increase in body temperature to 39 degrees (five days).
- Quite severe cephalalgia.
- Hemorrhages on the skin and mucous membranes, which are usually multiple in nature.
- Periodic bouts of vomiting with blood in it.
- Increased heart rate, which is the initial stage of infectious toxic shock.
- Oliguria that lasts 3-5 days.
- Urine lab tests show elevated levels of proteins, creatinine and urea.
Severe hemorrhagic fever accompanied by:
- Rise in temperature to 40-41 degrees (eight days).
- Multiple bouts of vomiting blood.
- Systemic hemorrhages of the skin and mucous membranes.
Signs of infectious intoxication of the body in hemorrhagic fever with renal syndrome are:
- digestive disorders;
- signs of weakness;
- insomnia;
- proteinuria;
- hematuria;
- oliguria;
- increase in urea and creatinine levels.
The disease affects people of all ages, even babies. The course of the pathology is characterized by an acute onset, which may not be preceded by a variety of symptoms.
Diagnosis of hemorrhagic fever
To determine the exact diagnosis, it is extremely important to take into account the patient's history, as well as the presence ofcertain clinical manifestations of the disease and data from serological and laboratory studies. If necessary, ultrasound, FGDS, computed tomography or X-ray examination may be necessary.
When symptoms of this disease occur with accompanying renal failure, the patient is specified the likelihood of contact with field mice and other rodents that are carriers of this disease. The clinical picture of hemorrhagic fever is characterized by fever, redness of the skin of the neck, face and head. In addition, hemorrhagic syndrome and signs of kidney failure may occur after a decrease in body temperature.
Diagnosis of this pathological process is carried out through the following laboratory and serological studies:
- General urine and blood tests.
- Indirect immunofluorescence reactions.
- Radioimmunoassay.
- Reactions of passive hemagglutination.
In the blood of a person with hemorrhagic fever, there is a pronounced decrease in the number of leukocytes (at the initial stage), which is accompanied by a sharp increase in temperature. In the subsequent stages of infectious pathology, there is an increase in ESR, thrombocytopenia and neutrophilic leukocytosis, as well as the appearance of plasma in the patient's blood. The production of antibodies to the virus can be diagnosed on the 7th day, and their maximum is observed approximately on the 14th day.
Hemorrhagic fever with accompanying renal syndrome is similar in course to other diseases,characterized by fever, such as typhoid fever, encephalitis, tick-borne rickettsiosis, leptospirosis and common influenza. This means that when detecting pathology, differential diagnostic methods are very important.
Hemorrhagic fever treatment
Therapy is carried out exclusively in the inpatient department of the infectious diseases hospital. The patient is required bed rest, especially in the acute period of the disease, characterized by hyperthermia. In addition, a diet containing a large amount of carbohydrates is shown with the exception of fish and meat. Treatment, which is aimed at eliminating the main cause of the pathological process, can have a positive effect already on the first five days of the disease.
As a rule, drug treatment is prescribed with medications that can inhibit RNA synthesis. In addition, the patient is treated with human immunoglobulin, alpha-interferons are prescribed rectally and orally, which stimulate the production of natural interferons.
Interferon
This infectious disease is characterized by diverse pathogenic changes in internal organs. This means that the main therapeutic measures are aimed at eliminating these pathogenic changes, which are usually caused by a syndrome of severe intoxication in the body and kidney failure and hemorrhagic syndrome. Patients in such cases are assigned:
- Glucose and some polyion solutions.
- Calcium and vitamin C preparations.
- "Papaverine".
- Eufillin.
- Heparin.
- Diuretics etc.
Papaverine
In addition to the above therapeutic agents, patients with hemorrhagic fever syndrome are prescribed treatment that is aimed at lowering the body's sensitivity to a certain type of virus that caused this disease. Symptomatic therapy includes the elimination of attacks of vomiting, pain syndrome, as well as the restoration of the activity of the heart and blood vessels.
In severe cases of the disease, patients are shown hemodialysis and some other ways to normalize hemodynamics and blood clotting disorders.
During the recovery period after the disease, patients need general strengthening treatment, good nutrition and maintaining immunity. They may also be prescribed physiotherapy, exercise therapy and massage. What is the prevention of hemorrhagic fever?
Disease prognosis and prevention
If the patient is given adequate therapy in a timely manner, even at the stage of the onset of a febrile syndrome, then recovery usually occurs very quickly. However, in most cases after hemorrhagic fever with accompanying renal syndrome, residual effects are noted for some time. These manifestations include:
- Asthenic symptoms that manifest as weakness, fatigue, etc.
- Painful disorders of the kidneys, characterized by swelling of the face, drynessin the mouth, low back pain, polyuria.
- Disturbances in the functions of the endocrine and nervous systems in the form of pleurisy, pituitary cachexia, etc.
- Development of cardiomyopathy after an infectious disease in the form of shortness of breath, heart pain, tachycardia, etc.
- In rare cases, chronic pyelonephritis develops.
Chronic kidney disease
People who have been ill with hemorrhagic fever need constant monitoring by a nephrologist, infectious disease specialist and ophthalmologist, which avoids many serious consequences from some body systems.
Severe course of such a pathological process is dangerous because there is a risk of complications, which in almost 10% of cases lead to death.
Prevention of this type of infectious disease with the development of acute renal syndrome consists in observing hygiene measures, which is especially true for those who live in endemic areas. You should also carefully consider hygiene procedures after visiting forests, staying in fields and household plots, you must thoroughly wash your hands and disinfect clothes. Food should be stored in special sealed containers.
To avoid infection with viruses that cause hemorrhagic fever accompanied by kidney failure, you should only drink boiled water.
When working in dusty environments such as fields, barns, etc.,wear a special protective mask or respirator on your face to prevent airborne infection.
Rodents should not be picked up or stroked, and in natural focal areas, deratization and thorough cleaning of the living quarters should be carried out in a timely manner.
We looked at the symptoms and treatment of hemorrhagic fever. We hope the information was useful to you. Don't get sick!
